There is nothing ambiguous about the principle of subsidiarity as enunciated in Quadragesimo Anno. It recognizes the danger of concentrating power in the central government. It offers a way to avoid the danger of what some call “creeping socialism.”
The corollary, of course, is that a Catholic who is convinced that a single-payer system is a nightmare to avoid at all costs is free to make his case, as well. He is free to quote the Wall Street Journal to press the issue. The Journal’s editors opposed John Kerry’s health care proposals because they maintain they would lead “inevitably toward the kind of low-innovation, low-quality government systems found in Europe and Canada.”
Is it my contention, then, that it is impossible for anyone to violate the teachings of the Church in the debate over how to finance health care? No. For example, if an individual were to push for socialized medicine as part of an agenda to move country closer to a totalitarian socialist system, he would not be thinking with the Church. Pius XI’s admonition in Quadragesimo Anno stands: “No one can be at the same time a sincere Catholic and a true Socialist.”
Likewise, someone who proposes a health care system that benefits himself at the expense of the commonweal. He also would not be thinking with the Church. How could anyone do that? Let’s say there is an individual who has a generous insurance health-care package provided by his employer, who opposes a larger role for the government in health care solely to keep his taxes low — who does not care what that might mean for the health-care needs of the rest of society, for the least of our brethren.
Permit me to be specific. Let’s say there is someone who was vehemently opposed to Medicare, Medicaid, and anything resembling the Canadian single-payer system, during the years when he was working and a member of his employer’s medical plan. What would be the implications if this person changes his tune once he retires and is no longer eligible for his employer’s health-care package? What would it mean if he wants the taxpayers to foot the bill for all his medical bills now that he is eligible for Medicare and Medicaid — now that he is a tax recipient, rather than a taxpayer? Whatever else it means, it is not an application of subsidiarity.
James Fitzpatrick's new novel, The Dead Sea Conspiracy: Teilhard de Chardin and the New American Church, is available from our online store. You can email Mr. Fitzpatrick at fitzpatrijames@sbcglobal.net.
(This article originally appeared in The Wanderer and is reprinted with permission. To subscribe call 651-224-5733.)
The teaching is clear: “Just as it is gravely wrong to take from individuals what they can accomplish by their own initiative and industry and give it to the community, so also it is an injustice and at the same time a grave evil and disturbance of right order to assign to a greater and higher association what lesser and subordinate organizations can do.”
It is a wise and just counsel: We are not to assign to the federal government the task of dealing with a social or economic problem — poverty, unemployment or health care, for example — until we have determined that the problem cannot be handled adequately in the private sector or by lower levels of government.
But the application of the principle is another matter. It is not always self-evident. How precisely can we tell when private charities and associations and state and local governments have proven incapable of dealing with a particular social dislocation? The Church does not draw that line for us. It leaves the question — the nuts and bolts of social policy — to our prudential judgment. In our pursuit of social justice, we are free to argue for more or less government, for a greater application of free-market theory or for a more paternalistic role by the federal government. That is why the American bishops made clear in their pastoral letter Economic Justice for All that the Church “does not embrace any particular theory of how the economy works, nor does it attempt to resolve the disputes between different schools of economic thought.”
The debate over how America should pay for health care offers a good example of how Catholics may disagree in good faith over how to apply the principle of subsidiarity. Clearly, something must be done about how we pay for health care, especially Medicare. But what? The Wall Street Journal recently (10/16/04) spotlighted the problem staring us in the face. The Journal's editors noted that “Medicare alone is projected to gobble up perhaps 35% of all federal spending by 2030 (up from about 13% now).” But they also observed that socialized medicine, or some other form of “single payer” system, such as Canada’s, is not an “easy” answer. High taxes, rationing and long waits for treatment are the price Canadians pay for their “free” health care.
Those are the stakes. If we don’t want Canadian-style high taxes and rationing of health care, what is the alternative? The Journal maintains that our current system, whereby most Americans get their health coverage from their employers, is “unsustainable…. With five of every six health care dollars paid by third parties, patients have little or no incentive to make cost-conscious decisions, and neither do physicians — especially since our out-of-control tort system places them in jeopardy of getting sued if they haven’t prescribed every conceivable test.”
I can remember a pamphlet that was used in social studies classes in the high school where I taught back in the 1980s. Even then, the math was incontrovertible. It is a classic catch-22 situation, one that left every student in my classes fumbling for an answer. Facts are facts: Americans are living longer, in large measure because of expensive medical techniques such as dialysis. More of these expensive medical innovations are on the horizon. How can we find a way to provide these expensive medical treatments for millions of elderly Americans who will live into their nineties?
Employers will go broke if they are required to foot these medical bills for their retirees. And there will not be enough taxpayers to cover the expenses if we assign the health care responsibility to Medicare, especially now that the numbers of younger taxpayers are decreasing in relative terms to the elderly. If we don’t want to ration health care and we want granny to have to best medical treatment available, someone has to pay for it. High-minded rhetoric and good intentions simply are not sufficient to deal with the problem. Socialized medicine does not solve the riddle. Those countries that have socialized medicine cannot provide everyone with the best of every medical treatment available. They have to ration, deny treatment in certain cases, and assign patients to long waiting lists…and tax, tax, tax.
In the recent election campaign, neither George Bush nor John Kerry proposed the kind of thoroughgoing reform of health care that will be necessary somewhere down the road. But they nibbled at the edges. According to the Wall Street Journal, Kerry proposed “an increasing role for government…new taxpayer subsidies to companies that insure their employees…and moving millions more children and some of their parents onto the government rolls.”
In turn, George Bush offered “Health Savings Accounts that marry real insurance (that is, coverage for high and unpredictable costs) with contributions to a savings account that can be ‘rolled over’ from year to year. In other words, individuals, not insurance companies, ‘ration’ most of their own health care, and young people get a chance to save tax-free for the higher medical bills that kick in later in life.”
Which of these proposals is more in line with the encyclicals? Neither. Neither is more “Catholic.” Both proposals fall within the framework of subsidiarity. They are the “nuts and bolts” of social policy that Catholics are free to debate. The same could be said of the call for a single-payer system. If you think it would be a mistake to turn to a system like Canada’s, you may be right. But an individual would not be a violation of anything in the social encyclicals if he concluded that our current mixture of free market and government intervention is not working and that the time has come to turn to the central government for an answer. This individual would be free to argue that some form of rationing of health care by the government, with all its problems and inequities, is preferable to permitting market mechanisms to handle health care.
