How should a Catholic evaluate health care policy?

Catholic News Agency

Another effort to repeal and replace the Affordable Care Act seems on the verge of failure, after three Republican senators stated that they would not support a pending Senate bill. As next steps for health care reform are considered, how should Catholics approach health care policy, according to Church teaching?

“The Church really, clearly teaches that health care is a right, that one has a right to be able to obtain such health care as is reasonably possible for one to obtain,” Dr. Kevin Miller, a professor of moral theology at the Franciscan University of Steubenville, told CNA.

On Monday, the Catholic Medical Association released a letter of public support for the latest GOP health care proposal, the Graham-Cassidy bill. In recent months, House and Senate Republicans have proposed several health care bills to repeal and replace the Affordable Care Act, but none have been able to pass both houses of Congress. The Catholic Medical Association wrote the offices of U.S. Senators asking them to support the latest proposal.

However, by Monday evening, with Republican senators announcing their opposition to the Graham-Cassidy bill, it seemed unlikely to pass the Senate, unless the bill was amended or senators changed their vote.

The Catholic Medical Association explained its support for the bill through the lens of several core Catholic principles of health care, saying that the bill would put those principles into practice.

The benefits of the bill, they said, included protections against taxpayer funding of abortions in health care plans via subsidies and tax credits, as well as blocking Medicaid reimbursements of abortion providers like Planned Parenthood.

The bill would have also set up conscience protections for employers, and individuals in health care, against mandates that they “purchase policies that include morally offensive ‘preventive services’,” the Catholic Medical Association’s letter argued.

Also, by repealing certain regulations and limiting federal Medicaid funding for states, the bill transferred more power and decision-making in health care to lower levels in the Catholic principle of subsidiarity and “preferential option for the poor,” the group said.

According to the letter, “the ACA created literally dozens of boards and commissions and imposed thousands of pages of new regulations, many of them injurious to the work of Catholic health care providers and additions to the cost of care.”

The changes to Medicaid gave the opportunity for “public and private entities closest to the people to experiment with options that maximize the ability of patients to choose providers who share their convictions regarding Hippocratic medicine.”

Under the old Medicaid system, the letter said, states that chose to expand their Medicaid pools and receive more federal funding also were restrained by the government in the care they could provide to vulnerable populations.

However, leading U.S. bishops recently sent a letter on behalf of the United States Conference of Catholic Bishops to all senators, asking them to change the Graham-Cassidy bill “while retaining its positive features,” because it would result in harm to the poor and chronically ill.

The changes to Medicaid could cut coverage for people relying on the program, the bishops said, or it could burden some states with additional costs and responsibilities that they may not be equipped to handle. If a state is facing a budget deficit and federal Medicaid funds are cut, state programs for low-income populations could also be cut, the bishops said.

The pro-life provisions are laudable and must be kept if the bill is amended, the bishops added.

Miller explained that the bill raises important questions for American Catholics: when a Catholic is considering health care policy, what are the principles of health care that the Church teaches, and how should a Catholic understand statements by the U.S. Conference of Catholic Bishops, as well as other Catholic groups?

When the U.S. bishops’ conference releases a statement on a “prudential application of the Church’s teaching,” there is “more leeway” to respect a statement without feeling obliged to assent to it, Miller said.

However, while bishops’ conferences themselves do not “share in the Church’s magisterium,” he said, typically they “draw from what is already the established teaching of the Church” on topics like human rights.

When Catholic groups of laity issue a statement on policy, he said, “less deference is required, because by definition you’re not dealing with the magisterium at that point.”

On the question of health care, “the Church really, clearly teaches that health care is a right,” Miller said, and Pope St. John XXIII clearly stated this in his encyclicals Mater et Magistra (1961) and Pacem in Terris (1963).

Paragraph 2288 of the Catechism of the Catholic Church also lists providing health care as among the obligations of a society to its citizens:

“Concern for the health of its citizens requires that society help in the attainment of living-conditions that allow them to grow and reach maturity: food and clothing, housing, health care, basic education, employment, and social assistance.”

If one cannot work to obtain these essential things, Miller said, “you have a right to have these provided for you in some other way.” And, he said, “I think the same thing would easily apply to health care.”

This doesn’t necessarily mean one has a “right” to the “most advanced, most expensive forms of treatment,” Miller said, but it would probably mean one has a right to care “typically available to those who have kind of normal health insurance.”

The Church does not state how, specifically, health care must be made available to everyone, Miller said, and so the question to be decided is “what’s going to work?”

Also significant, the Church does not say that the state cannot be involved in the financing of health care, Miller said. “The Popes have sufficiently made it clear,” he said, “that at least sometimes, the state has a necessary role to play in these kinds of matters.”

He pointed to Pope St. John Paul II’s encyclical Centessimus Annus (1991) in which the Pope said that the state had, “under certain kinds of circumstances,” a role in providing “Social Security-type assistance for its citizens,” and this “would include in the area of health care.”

Governments in many countries are heavily involved in health care financing, and the Church has not spoken out against those policies, he said.

Although the Church does not endorse a certain system of health care, it teaches that such a just system should involve various sectors of society, and should make a “typical standard of health care available.”

If one cannot obtain this care, “then, morally-speaking, we have a problem,” he said.

Regarding the principle of subsidiarity of Catholic social teaching, it is “widely misunderstood,” especially in the health care debate, Miller said.

The Catechism explains that according to the principle of subsidiarity “a community of a higher order should not interfere in the internal life in the community of a lower order…but rather should support it in case of need.”  Thought sometimes understood to mean that the federal government should simply stay out of the affairs of state and local governments, that is not necessarily true, Miller said.

Rather, “it’s a question of larger communities playing the role of helping smaller communities be ever more fully themselves,” he said, “providing them with assistance of various kinds” without “taking over.”

Again, he said, there are examples of countries where the government is involved “somewhat heavily” in the area of health care, and it is indeed “an option” under the Catholic principles of health care, provided the state does not mandate the provision of any care or procedures that would be immoral, like euthanasia or abortion.

COMING UP: Navigating major cultural challenges

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We’re navigating through a true rock and a hard place right now: moral relativism and the oversaturation of technology. In fact, they are related. Moral relativism leaves us without a compass to discern the proper use of technology. And technological oversaturation leads to a decreased ability to think clearly about what matters most and how to achieve it.

Fortunately, we have some Odysseus-like heroes to guide our navigation. Edward Sri’s book Who Am I to Judge?: Responding to Relativism with Logic and Love (Augustine Institute, 2017) provides a practical guide for thinking through the moral life and how to communicate to others the truth in love. Christopher Blum and Joshua Hochschild take on the second challenge with their book A Mind at Peace: Reclaiming an Ordered Soul in the Age of Distraction (Sophia, 2017).

Sri’s book describes conversations that have become quite common. When discussing moral issues, we hear too often, “this is true for me,” “I feel this is right,” or “who am I to judge?” We are losing our ability both to think about and discuss moral problems in a coherent fashion. Morality has become an expression of individual and subjective feeling, rather than clear reasoning based on the truth. In fact, many, or even most, young people would say there is no clear truth when it comes to morality—the very definition of relativism.

Beyond this inability to reason clearly, Christians also face pressure to remain silent in the face of immoral action, shamed into a corner with the label of bigotry. In response to our moral crisis, Sri encourages us to learn more about our own great tradition of morality focused on virtue and happiness. He also provides excellent guidance on how to engage others in a loving conversation to help them consider that our actions relate not only to our own fulfillment, but to our relationships with others.

Sri points out that it’s hard to “win” an argument with relativists, because “relativistic tendencies are rooted in various assumptions they have absorbed from the culture an in habits of thinking and living they have formed over a lifetime” (13). Rather than “winning,” Sri advises us to accompany others through moral and spiritual growth with seven keys, described in the second half of the book. These keys help us to see others through the heart of Christ, with mercy, and to reframe discussions about morality, turning more toward love and addressing underlying wounds. Ultimately, he asks us, “will you be Jesus?” to those struggling with relativism. (155).

Blum and Hochschild’s book complements Sri’s by focusing on the virtues we need to address our cultural challenges. They point to another common concern we all face: a “crisis of attention” as our minds wander, preoccupied with social media (2). More positively, they encourage us to “be consoled” as “there are remedies” to help us “regain an ordered and peaceful mind, which thinks more clearly and attends more steadily” (ibid.). The path they point out can be found in a virtuous and ordered life guided by wisdom.

To achieve peace, we need virtues and other good habits, which create order within us. “With order, our attention is focused, directed, clear, trustworthy, and fruitful” (10). The book encourages us to rediscover fundamental realities of life, such as being attune to our senses and to aspire to higher and noble things. The authors, with the help of the saints, provide a guidebook to forming important dispositions to overcome the addiction and distraction that come with the omnipresence of media and technology.

The book’s chapters address topics such as self-awareness, steadfastness, resilience, watchfulness, creativity, purposefulness, and decisiveness.  These dispositions will create order in how we use our tools and within our inner faculties. They will help us to be more intentional in our action so that we do not succumb to passivity and distraction.  Overall, the book leads us to consider how we can rediscover simple and profound realities, such as a good conversation, periods of silence, and a rightly ordered imagination.

Both books help us to navigate our culture, equipping us to respond more intentionally to the interior and exterior challenges we face.