As Speaker Nancy Pelosi promoted passage of last month'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.