Health Care Rights, and Wrongs

As Speaker Nancy Pelosi promoted passage of Sunday’s health care reform bill, she invoked Catholic support. However, those who assert the right to health care and seek greater responsibility for government as the means to that end, are simply wrong. This legislation fails to comport with Catholic social principles.

Claiming an entity as a right requires clear thinking about who possesses a claim to something while defining who must fulfill this obligation. We can clearly agree on responsibility to care for our neighbor and yet not promote federal dominion over doctors and nurses.

Some mistakenly quote Pope John XXIII‘s 1963 Encyclical Letter Pacem In Terris (Peace on Earth) discussing “the right to live… the right to bodily integrity and to the means necessary for the proper development of life, particularly food, clothing, shelter, medical care, rest, and, finally, the necessary social services (11).” In this context, the Holy Father speaks of health care as a natural right, with corresponding responsibilities, not as a direct obligation of the state. Nowhere in Pacem In Terris is government assigned accountability for food, clothing, shelter or health care.

Archbishop Charles J. Chaput recently reiterated the Church’s understanding of health care as a right. “At a minimum, it certainly is the duty of a just society. If we see ourselves as a civilized people, then we have an obligation to serve the basic medical needs of all people, including the poor, the elderly and the disabled to the best of our ability.” Yet, there are options for society to meet this duty apart from the federal government.

In a May 2008 address to the Pontifical Academy of Social Sciences, Pope Benedict XVI guided us in correct understanding and action:

“The four fundamental principles of Catholic social teaching: dignity of the human person, the common good, subsidiarity and solidarity…offer a framework for viewing and addressing the imperatives facing mankind at the dawn of the 21st century…The heart of the matter is how solidarity and subsidiarity can work together in the pursuit of the common good in a way that not only respects human dignity, but allows it to flourish.”

Respecting these four principles can help this country achieve consensus without increasing reliance upon Washington.

The first principle, Respect for Dignity of the Human Person, is prerequisite. Health care reform is meaningless without it. Life must be safeguarded from conception to natural death. Tax dollars must not subsidize abortion or euthanasia. This principle must apply on both ends of the stethoscope, respecting both patient and provider. Health-care professionals must be able to follow their conscience in prescribing and providing treatment.

We share a duty in the United States to nearly 50 million uninsured, and millions more who are precariously insured, to reform health care. Human dignity also predicates responsibility to care for oneself and one’s family. Many medical problems arise from personal decisions affecting health, and medical resources are over-consumed when perceived as free. Therefore, reform must not abrogate personal responsibility for decisions which affect health, nor financial participation in consumption of medical goods and services.

Pope John XXIII was clear on this as well. “Every basic human right draws its authoritative force from the natural law, which confers it and attaches to it its respective duty. Hence, to claim one’s rights and ignore one’s duties, or only half fulfill them, is like building a house with one hand and tearing it down with the other. (30)”

The second principle, the Common Good, requires us to promote “those conditions of social life” that allow people “access to their own fulfillment.” Impending Medicare insolvency and the inability of strained state budgets to cover more Medicaid patients requires re-evaluation, and not expansion, of government responsibility. Moving forward with incremental improvements that are achievable with consensus is more prudential than comprehensive, and unaffordable, legislation without bipartisan agreement and popular approval.

Policy changes could approach more universal coverage without tremendous additional cost. Tax and insurance market reforms could increase premium affordability and policy portability. National coverage mandates, instead, will hinder insurance affordability. Defensive medical practices, particularly in emergency rooms and critical care circumstances, result in unnecessary expense and compromise compassionate care.

The third principle, Subsidiarity, emphasizes providing care by those closest to persons in need. A community of a higher order in society should not assume tasks belonging to a community of lower order and deprive it of its authority. As Pope Benedict XVI wrote in his 2005 encyclical Deus Caritas Est, “We do not need a State which regulates and controls everything, but a State which, in accordance with the principles of subsidiarity, generously acknowledges and supports initiatives arising from the different social forces and combines spontaneity with closeness to those in need.”

This principle argues for strengthening and protecting the doctor-patient relationship. Individuals and families with health savings accounts would be better able to prioritize health care resource allocation through the marketplace, rather than distant bureaucrats assigning mandated benefits. Educating patients about costs, outcomes, and quality of medical goods and services will improve resource allocation, rather than rationing by appointed advisory panels. The fourth principle, Solidarity, obliges us to maintain a preferential option for poor and vulnerable. Our results will be judged by how we have fulfilled our duty, in the spirit of loving our neighbor, feeding the poor, and caring for the sick. (Mt 25:40).

Neighbors who become sick or injured within our borders cannot be left out of the health care reform equation. Doctors and hospitals are required by law and conscience to care for those who come to emergency rooms. The debate over immigration reform has no place at a patient’s bedside. Those with chronic disease are particularly vulnerable and vigilance must be maintained to ensure their safety net. Yet again, this does not mean state expansion. Government can play a role by facilitating the activity of charitable organizations in health care, but the primary obligation falls on all of us to be generous with our time, talents, and treasure. There will always be a place for charity in care for the sick and dying.

We ought to agree on the right to health care as a moral duty, but not as a federal responsibility. Supporters of this deeply flawed bill should contemplate these universal principles.

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  • Joe DeVet

    Amen to all this, and I think what’s missing in much of the rhetoric of religious leaders who assert a “right” to health care is a proper understanding of the economics of the case. In being naive or simply ignorant of the fact that, whatever else it might be, health care is an economic entity. In forgetting this, our religious leaders run the risk of creating an injustice to those who invest in health care and those who provide it. If these are not properly compensated for their contributions, an injustice is done to them.

    The Church leaders also open themselves to justified charges of hypocrisy. Downtown where I live, the Church abandoned a Catholic hospital named after my patron, St. Joseph. It had to be sold off because it was not economically viable. Having abandoned the “duty” to provide the clients of this hospital their “rights” to health care, it is particularly unseemly for the Church to turn around and lecture the new owners about what they must provide to people, without adequate compensation for their efforts.

    This pattern has repeated itself many times across the country. How dare we, as Catholics who could not figure out how to provide under-compensated health care, require as a moral imperative or a legal coercion that others do what we failed to do?

    In fairness, our local diocese also has a clinic by the same name in Spanish, which provides low-cost medical care to the poorest of the poor. They do so mainly through charitable contributions from us faithful at large, plus charitable pro-bono services by medical personnel. In other words, instead of a huge and faceless bureaucratic mandate from a distant power 1500 miles away in Washington, DC, there is real charity at work.

    Unfortunately, the USCCB bishops, having squandered their moral authority with their own flocks, now expend their energy in political lobbying for what I call “surrogate charity.” This is how it works: property is forcefully extracted from the unwilling, skimmed by the unworthy, and the leftovers given to the ungrateful. No one’s soul is saved.

    But it’s beguilingly easy. So easy to be charitable with other people’s money!

  • lkeebler

    If only this health care bill was as much about health care as we want it to be. If it were, it would have been done in a completely different format. But now, instead of health care, we have a huge bureaucracy of insanity.

  • GaryT

    Excellent article! It seems to me that the one thing we all agree upon is the strengthening and protection of the doctor – patient relationship. The problem is that there are many middlemen squeezing in between that disrupt this relationship: government, insurance companies, lawyers, employers, unions. The solution lies in getting these entities out of the equation as much as possible:
    – return insurance to only being used for catastrophic costs, like the way every other insurance works. This would keep the insurance companies out of most everyday health care.
    – move from employer provided insurance to allowing individuals to select the insurance they want. (Maybe employers can provide $ to fund this)
    – Rely on real charity to help fill the gaps
    – Rely on local government health care systems only as absolutely needed
    – Central government as a last resort, not the first (and only) resort.

    Joe, I’d like to talk to you sometime (we are in the same city)

  • Joe DeVet

    Gary T: Glad to talk. Give me a call. I’m in the phone book.

    You present a good list of appropriate health care initiatives. To these I would add two more:

    * Rein in the out-of-control tort awards that drive up costs.

    * Bring a halt to the practice of the AMA and other forces which tend to
    limit the number of doctors available to the system.