WWJD? Health Care Reform and Catholic Social Thought

Christ Among the Doctors, Followers of Hieronymous Bosch (1550-1600)

This Easter, I was struck by a thought while preparing for the day’s celebrations.  I was reflecting on the significance of the day and also thinking of a topic for this week’s post when that 1990s phrase came to mind: WWJD (”What would Jesus do?”).  Although it might be biting off a bit too much to speculate as to how Jesus would vote or how God would reform the American health care system, I have settled for the more modest task of applying Catholic social thought to the debates of the day.

Health Care as a Human Right

In 1963, Pope John XXIII stated in Pacem in Terris that man “has the right to bodily integrity and to the means necessary for the proper development of life,” including the right to “medical care” and “to be looked after in the event of ill health.”  This concept is reflected in a February 2009 publication by the U.S. Conference of Catholic Bishops (USCCB):

All people need and should have access to comprehensive, quality health care that they can afford. Access to health care should not depend on a person’s stage of life, where or whether one works, how much one earns, where one lives, or where one was born. Health care is a social good, and accessible and affordable health care for everyone benefits both individuals and society as a whole.

Although the Bishops call for universal access to affordable care, the means to such an end are left to policy-makers.  For instance, this could be obtained by setting price caps, instituting a single-payor system, or requiring every citizen to maintain a minimal amount of insurance.  With regard to the means, the Bishops call for a system that “respect[s] pluralism, offering a variety of options and ensuring respect for the moral and religious convictions of patients and providers.”

Who Should Be Responsible for Providing Health Care?

In Laborem Exercens, Pope John Paul II explains that it is the role of an employer to provide for “[t]he expenses involved in health care… medical assistance should be easily available for workers, and [] as far as possible it should be cheap or even free of charge.”  However, this is not to say that employers should be the sole providers of health insurance or health care.  Such a structure would neglect the dignity of the unemployed and it would render superfluous the many religious orders that provide health care as a part of their mission.  “Health care ministry is one way the Church continues Jesus’ mission of healing and care for the “least of these” (Mt. 25).”  Catholic health care remains the largest non-profit health care system in the nation, providing care to one in six U.S. patients.

The government also has a duty to protect citizens’ rights to “those things that make life human.”  In Pacem in Terris, Pope John XXIII calls on governments to “give considerable care and thought to the question of social as well as economic progress, and to the development of essential services,” including medical care and the provision of insurance facilities.  Even imprisoned criminals are entitled to receive “timely medical care.”  Furthermore, the U.S. Conference of Catholic Bishops has called on all Catholics “to ensure that everyone has access to those things that enhance life and dignity: decent housing, a job with a living wage, and health care.”

All stakeholders should be financially responsible for universal healthcare, according to ability to pay.  “A fair health care system assures society’s obligation to finance universal access to comprehensive health care in an equitable fashion, based on ability to pay.”  At a bare minimum, the legislatively structured system should reallocate wealth to the extent that all pay their fair share.

The Individual Mandate

The individual mandate, section 1501 of the Affordable Care Act, has been the most contentious (or at least most litigious) aspect of the Affordable Care Act.  As such, it raises the question: WWJD?  At the very least, the USCCB would design the system to create:

1)      effective measures to reduce waste, inefficiency, and unnecessary care;

2)      measures that control rising costs; and

3)      incentives to individuals and providers for effective and economical use of resources.

According to the District Court of the Northern District of Florida, the argument for the individual mandate is that “[w]ithout the individual mandate and penalty in place… people would simply ‘game the system’ by waiting until they get sick or injured and only then purchase health insurance (that insurers must by law now provide), which would result in increased costs for the insurance companies.”  Essentially, the individual mandate forces all individuals to pay their fair share into the insurance pool.  As a result, health insurance costs will decrease.

Although the individual mandate would spread responsibility for universal access to affordable health care, it does not address the three USCCB principles for socially beneficial health reform.  First, it fails to address inefficiency or create incentives for the economical use of resources (except that some may spend less on luxury items or vices to pay their insurance premiums).  Second, although it would reduce premiums, it fails to reduce costs.  Universal insurance coverage does not address the problem of moral hazard.

What the individual mandate does do, is redistribute wealth to the extent needed to cover all individuals and make health care more accessible to all regardless of ability to pay.  Although the individual mandate achieves one Catholic objective (universal, affordable access), it fails to truly “fix” the broken health care system.  More is needed to achieve “true reform” in the Catholic sense.

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The satisfaction of universal needs, including adequate healthcare, is a constant endeavor.  In the words of Pope John XXIII: “What has so far been achieved is insufficient compared with what needs to be done; all men must realize that. Every day provides a more important, a more fitting enterprise to which they must turn their hands–industry, trade unions, professional organizations, insurance, cultural institutions, the law, politics, medical and recreational facilities, and other such activities. The age in which we live needs all these things.”

Catholic Doctrine and the Public Option

I claim no expertise in Catholic doctrine, nor for that matter theology; but I have studied them some in relation to law and social justice and as a matter of personal edification. Recently, I have heard of protestations within the Faith against the spectre of the Public Option and “socialized medicine” as such. Again, as I claim no expertise, I’ll just present and lend some analysis to what lies before me; I speak only for myself.

I consulted my copy of the Catechism of the Catholic Church, Second Edition (revised in accordance with the official Latin text promulgated by Pope John Paul II), Libreria Editrace Vaticana. According to the Apostolic Constitution Fidei Depositum, On the Publication of the Catechism of the Catholic Church, “The Doctrinal Value of the Text,” this Catechism is “a statement of the Church’s faith and of catholic doctrine, attested to by Sacred Scripture, the Apostolic Tradition, and the Church’s Magisterium.” The Catechism is also said to be “a sure and authentic reference text for teaching catholic doctrine and particularly for preparing local catechisms.” According to the Apostolic Letter, Laetamur Magnopere in which this Catechism of the Catholic Church is Approved and Promulgated by John Paul II, it was “prepared by an Interdicasterial Commission” presided over by then Cardinal Joseph Ratzinger.”

The Catechism

Part Three, Life in Christ, Article 3, Social Justice, Section II, “Equality and Differences Among Men.”

• 1936 On coming into the world, man is not equipped with everything he needs for developing his bodily and spiritual life. He needs others. Differences appear tied to age, physical abilities, intellectual or moral aptitudes, the benefits derived from social commerce, and the distribution of wealth.[1] The “talents” are not distributed equally.[2]

• 1937 These differences belong to God’s plan, who wills that each receive what he needs from others, and that those endowed with particular “talents” share the benefits with those who need them. These differences encourage and often oblige persons to practice generosity, kindness, and sharing of goods; they foster the mutual enrichment of cultures….

One might think that access to medical care for a sick man, regardless of “the difference” in “the distribution of wealth,” would be essential to “developing his bodily… life.” In addition, it seems plain within the text that despite (or perhaps because of) these “differences,” each should “receive what he needs from others.” There is no provision for pre-existing conditions; no provision which mandates that only the best capitalists’ health needs be met.

As for the prospect of a government constituted by the people and for the people providing en masse for these needs, it may be of some help to look to Part Three, Life in Christ, Article 3, Social Justice, Section I, “Respect for the Human Person.” This section precedes the section quoted above by about a page.

• 1930 Respect for the human person entails respect for the rights that flow from his dignity as a creature. These rights are prior to society and must be recognized by it. They are the basis of the moral legitimacy of every authority: by flouting them, or refusing to recognize them in its positive legislation, a society undermines its own moral legitimacy.[3] If it does not respect them, authority can rely only on force or violence to obtain obedience from its subjects….

If this acknowledgment of certain inherent rights precedent to social structure sounds familiar, it should: as part of the promise which is the Declaration of Independence we are told that all men “are endowed by their Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness” and that it is “to secure these rights, governments are instituted among men, deriving their just powers from the consent of the governed.”

Importantly, according to catholic social justice doctrine, the basis for the moral authority of power (i.e. governance), and thus its legitimacy, is contingent upon its being in accord with the dignity of human beings. Therefore, the failure to reach such an accord in a society’s legislation calls to question the legitimacy of that society’s rule; the legitimacy of such rule being “undermined” in direct proportion to such failures.

As for an example of that which is required by the dignity of human beings/ legitimacy of rule, it may prove to be of some help to look again to “Equality and Differences Among Men.”

• 1938 There exist also sinful inequalities that affect millions of men and women. These are in open contradiction of the Gospel:

• Their equal dignity as persons demands that we strive for fairer and more humane conditions. Excessive economic and social disparity between individuals and peoples of the one human race is a source of scandal and militates against social justice, equity, human dignity, as well as social and international peace.[4]

I would suggest that supplying affordable access to health care to all within this country is the essence of striving for “fairer and more humane conditions.” And that respect for the dignity of mankind, upon which rests “the basis of the moral legitimacy of every authority,” not only allows for such proposals as a Public Health Care Option, but, it would seem, demands it.

[2] 42. Cf. Mt 25:14-30; Lk 19: 11-27.

[3] 36. Cf. John XXIII, PT 65.

[4] 44. GS 29 Sect. 3.