From the halls of Congress at the national level to town hall meetings in local communities, the debate about health care reform has been in the collective consciousness for months. The discussion has ranged from polite civility in living room gatherings to raucous shout downs and banner-waving public demonstrations. From health care consumers to insurance company CEOs, it seems as if all interest groups have vigorously pushed to have their voices heard. Some of these groups have an authentic stake in the debate while others come forward to simply voice an uninformed opinion and share the media limelight. There is, however, one voice that both the print and electronic media have tended to ignore or underreport. It is the voice of religious organizations and, in particular, that of the Catholic Church.
Some observers might question why the views of the Catholic Church and other religious organizations should be participants in the national dialogue about reforming the health care system. There are three reasons. First, a large portion of all health care services in the country are provided under the auspices of religious organizations. Columbia is unique in that all hospitals are under secular control, whereas in other larger communities hospitals under religious organizations are present. Second, it is a mistake to think that health care reform involves only economic, medical, political and social dimensions. Moral and ethical components are a critical element that can be supplied by religious doctrine and teachings. Finally, some would argue because of the constitutional provision of separation of church and state, the voices of religious traditions have no right to participate in public policy debates. There is no foundation for this argument because, while the First Amendment clearly prohibits the establishment of state-sponsored religion, it is equally clear that it protects the free exercise of religion. The national debate about health care reform will be enriched by a diversity of viewpoints including religious insights and teachings.
The role of the Catholic Church in the national debate is legitimate because of the extent of health services it provides. There are, for example, 624 hospitals under the auspices of the Catholic Church and its various religious orders. These facilities comprise approximately 15 percent of all the hospital beds in the country and about 16 percent of all admissions, according to a report by the Catholic Health Association of the United States. They employ about 500,000 full-time and 200,000 part-time professional and support personnel. In addition, there are more than 1,200 long-term-care, hospice and home-health agencies, according to the Catholic Health Association. Clearly the Catholic Church is a significant and indispensable resource of the national health system. When hospitals and related health care facilities under other religions are taken into account, it is reasonable to estimate that nearly 20 percent of all health care services are under religious auspices.
Because of this involvement, those making policy decisions about reform have a responsibility to take into account the health care priorities and principles not only of the Catholic Church but other religions as well. Of all the religious traditions, the Catholic Church has the most organized set of principles and themes relevant to health care. They are based on two fundamental concepts: social justice and the common good. The essence of the first concept is the existence of structures, laws and institutions that fairly ensure that the social benefits, assets and resources are available to the largest number of people. The common good is the sum total of the fundamental rights and basic conditions all persons need to live in dignity, safety, freedom and health. These include conditions such as adequate nutrition, hydration, decent shelter, access to educational opportunities, meaningful employment with a living wage, access to basic health care and other social and economic supports to live in human dignity. The concepts of social justice and common good are the foundation of an array of Catholic social principles that both inform and enlighten the discussion about health care reform. The five principles of human dignity, preference for the poor, solidarity, subsidiarity and structural reconfiguration are major ones that can guide the specific reform elements of a reform plan.
Human Dignity: A touchstone belief of Catholicism is that all persons are created in the image of God and possess inherent dignity and inalienable rights. Therefore, basic health care is a right and not a privilege and must be available from the time of conception until natural death. It stands in opposition to abortion and supports the provision of universal health care and the public insurance option.
Preference for the Poor: The economically marginalized and those who are without health care insurance are a reform priority. This preference includes a range of health care resources for children and legal immigrants and advocacy efforts on their behalf because they are politically and socially powerless.
Solidarity: “Loving thy neighbor as thyself” leads to a reciprocal relationship and responsibility with other members of the human family. There is an obligation to create a health care system that ensures fairness, equal access and affordability for all, regardless of ability to pay.
Subsidiarity: Health care decisions must be made at the level where it is provided and with appropriate participation of those it impacts. The system must be pluralistic, and government and institutions at higher levels should mediate and intervene only when efforts at lower levels are inadequate.
Structural Reconfiguration: Health care benefits are not commodities to be bought and sold for profit and the current system based on marketplace principles needs to be transformed. This requires introducing a human-centered approach, reducing the emphasis on corporate and institutional profit. At all levels in a restructured system, the conscience rights of health care workers must be respected.
Roland Meinert is a cradle Catholic, retired academic and member of the St. Thomas More Parish and Newman Center.
This is a revised version of a column that first ran in the Catholic Missourian.