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We need real reform

August 22, 2009

On the day before his installation as Archbishop of New Orleans, at which the native New Orleanian was greeted with thunderous applause, Gregory Aymond, re-iterated the USCCB’s position on health care reform:

The Catholic bishops in the United States recognize a pressing need for health care reform. Too many American citizens lack basic health care coverage and the cost of health care is becoming prohibitive for many more.

The Lord Jesus, who came to save us from our sins, manifested a great concern for the sick in his public ministry. He also urged us to reach out to the poor and sick in our midst. The Church rightly considers that government has a responsibility to ensure access to basic health care for all.

The bishops do not propose a specific plan or policy. But we set out the following principles to shape public policy:

Strident or shrill rhetoric does not help us to engage in civil and respectful deliberation about a serious social issue with significant moral implications. God grant us the wisdom to discern what is right and the courage to do it.

* We need to develop a plan which ensures access to basic health care for all.
* We need to make sure that the poor and the vulnerable, including legal immigrants, are part of this plan.
* We need to control health care costs so that it is affordable to all.
* We need to make sure that abortion, euthanasia or other immoral activities are not mandated or financed with tax payer dollars. This includes conscience protection for all providers, whether institutions or individual persons, and for all recipients.

The bishops, without proposing either a public or private sector option, urge that any plan which is developed embrace these principles. Catholics are urged to contact their United States Senators and Representative to ask them to use these principles to evaluate all proposals that are developed.

I find nothing with which to disgree in Archbishop Aymond’s statement. The health care reform on which we, as Catholics, must insist should look, in part, like what he has described. If we, as Catholics want not merely to stake out the moral high ground, but to actually work toward real health care reform, much more needs to said and done.

First, if we are serious about having a health care system which does not fund abortions, we must not merely cry foul whenever abortion is mentioned, but offer real ideas for compromise. The bishops have offered the abstract goals and ideals. Catholic politicians must be willing and able to help put those ideas into concrete form to establish a real reform. If being anti-abortion is a part of the Republican platform, then Republican senators and congressmen, especially those that are Catholic, must be willing to sacrifice one or more of the other Republican demands as a trade-off in order to help assure that abortions are not funded by our tax dollars.

Second, one of the prime reasons we are in dire need of health care reform is that health care has become primarily about making money. An entrepreneurial culture has invaded the health care industries. Therefore, patients have become a means to an end, rather than being treated as ends in themselves. Atul Gawande of the New Yorker made this point excellently in a well researched article entitled, the “Cost Conundrum.” He found that the areas with the most expensive health care statistics, those that get the most care, do not reflect better health. That is, even though a person in these areas receives more health care, even though he pays more for health care, his health care is not better but is found to be deficient when compared with others who have paid less. Gawande found that in some cases, less is more. When? When the climate of the health care institution is one of patient-centered care, the Mayo Clinic for example. However, this is rare, because every incentive in the system pushes toward health care as a business. (We see this reflected throughout society. As a former high school teacher, I can attest that a majority of students who claim to want to become doctors site money as the primary reason.) Gawande writes:

[A] choice must be made. Whom do we want in charge of managing the full complexity of medical care? We can turn to insurers (whether public or private), which have proved repeatedly that they can’t do it. Or we can turn to the local medical communities, which have proved that they can. But we have to choose someone—because, in much of the country, no one is in charge. And the result is the most wasteful and the least sustainable health-care system in the world.

Thus, we need real reform. We need reform which will give doctors and institutions the incentives to work toward patient-centered care rather than profit-driven (I hesitate to call it) care. We need reform which sees the person as possessing inestimable dignity and as being worthy of quality affordable health care.

If these two things are not addressed – political comprimise to ensure that we will not be funding abortions and real reform which is centered on the dignity of the patient – then whatever “reform” we end up with will not be real reform and will only serve to further undermine the dignity of the human person.

  1. G-Veg permalink
    August 23, 2009 7:35 am

    The problem is not one of theory but of practice.

    The GOP has mad numerous proposals for scaled down plans that address many of the concerns you cite. None of them can get on the floor because the Dems have such a resounding majority as to be able to silence the opposition.

    What then is the proper response of a Catholic to the bills that are actually on the floor?

    What we would LIKE to see doesn’t matter once the legislative process has reached this point. ALL that matters is whether we can support the bills on the floor.

    Please explain how any of the three bills on the floor fulfill the mission cited above. If you don’t parse them – and you shouldn’t since the Pelosi crowd is committed to achieving at least what is in the bills – is any Catholic bound to support ANY of the bills as written?

    If the answer is no, then I expect you will be removing your support for Obamacare to… right?

  2. August 24, 2009 4:15 am

    Yes, practice is always the issue, and things never are ideal in practice, especially in democratic forms of practice. One of the problems I’ve seen, not with John but in modern political debates, is that people go for an “all or nothing” idealism which always means “nothing.” We must learn to know when and where and how we can bend (in prudence). It’s not an easy question, to be sure. But I think that is what Cardinal Dulles understood, even when it came to abortion:

    “The civil law should not authorize, let alone encourage, such moral evils. It should protect human life and dignity to the maximum degree possible. But in assessing how to proceed, there may be differences of opinion. If it is impossible to obtain passage of a law banning all abortions, or if such a law would be unenforceable, it might be best to work for a law that restricts access to abortion as much as possible, while continuing to work for full justice.”


    “To vote for an appropriations bill that includes some provisions for funding abortions would not be so gravely sinful as to warrant excommunication under Canon 1398. The vote might arguably be licit if the funding for abortion were only incidental and could not be removed from a bill that was otherwise very desirable.

    The legal problem about abortion in the United States does not come primarily from legislators but from the judiciary, which interprets the Constitution as giving a civil entitlement to abortion practically on demand. This interpretation of the Constitution, we believe, is erroneous and should be corrected.”

  3. G-Veg permalink
    August 24, 2009 6:04 am

    This is a common sense answer to the complex question of how abortion should affect public policy debate. It affirms my earlier question: Which of the three bills on the floor, if any, fulfill the purposes that our Bishops wish to steer the healthcare debate? Taken as a whole, which of them places the providing of healthcare to those who cannot afford it at the center of the legislation while making only such concessions to abortion as are demanded by current law?

    I would suggest that none do.

    I do not oppose federal assistance to the states to provide healthcare to the poor. I oppose a regime that is set up for purely political gains and that further encroaches on individual liberty.

    There were good ways to help but Congress has avoided them. For example, Congress could have put together a collateral healthcare funding structure to unemployment insurance. So too, Congress could have made healthcare funding available to the states that adopt aggressive child health programs.

    But, instead, the Democratic Party has decided to go for an hands-down “win” by setting up another overarching and bureaucratic program that will give them a long-term control over a vote-gathering program. This is a trojan horse, designed to deliver a decade’s long mechanism for molding society through healthcare.

    One last… It is a quibble but, I don’t know when Cardinal Dulles made the above statement but I am not sure that the legal problem of abortion is primarily a judicial problem. The Supreme Court has moved into an entrenched position that will be difficult for either side to maneuver out of. At present, the fight appears to be primarily a legislative one and, increasingly one focused on the state legislatures. I suspect this is the reason for urgency in the FOCA agenda – that they don’t want to fight at every state level and would rather subvert through a national healthcare agenda.

  4. August 24, 2009 8:41 pm

    Thanks for taking the time to comment.

    GV, To my knowledge (Catholic) Republicans have not made a clear effort to put abortion on the forefront by sacrificing on other issues, like the public option, for example. (My knowledge on this is very incomplete, so I may be mistaken. If I am, where can I find such proposals?)

    Also, for clarity sake, I have not stated by support for “Obamacare” or any of the other bills. I have stated support for what the bishops have suggested and have added that really doesn’t get to the heart. Real reform = patient and family centered care.

    The moral difference between the status quo and the proposals on the table are not clear to me.What is preferable between a public plan which provides universal health care (yeah!) but funds abortions with tax dollars (boo!) and our current system where insurance corporations offer health care and provide abortions, while many are left without care?

    I am not convinced that prudence doesn’t, at the least, make it viable for us to support one of these public plans so the scandal of millions of un and under-insured ceases while we continue to work to diminish the number of abortions.

    I am also not yet convinced that prudence does allow this.

  5. G-Veg permalink
    August 25, 2009 5:13 am

    Joshua B,

    I appreciate the clarification.

    In the interest of full disclosure, my move to the GOP is recent. I was an Independent from age 18 to 25; changing only when I realized that the “real” elections were the Primaries and that, in PA, I was locked out. I became a Democrat because the GOP dominated PA Assembly seemed terribly off-kilter. I wanted to counter-balance and, the legend of Bob Casey, Sr. – perhaps the last courageous conservative Democrat in PA politics – fresh in my mind, I felt certain that the time was ripe for a strong conservative movement within the Democratic party. I became increasingly disenchanted with the Democratic party until last year. It was Senator Casey and Speaker Pelosi that drove me out. Senator Casey lacks the courage and seems to have a greater political ambition than his father. He is a “politician” in the sense that he is content to receive support from whatever quarter it comes. “Pro-life” seems to have no great meaning to him and I find that to be difficult to reconcile with his strong showing of support among the Catholic community. She seems to regard her Catholic identity is merely another tool to garner votes and as a shield to the seemingly correct label of a “liberal,” by which I mean a secular-humanist.

    All this by way of saying that my thoughts are not clear on where either party is going or whether either party stands for anything I can support.

    More particularly, between Speaker Pelosi’s tactics and public or private statements and the President’s periodic statements that those who disagree with him should “shut up,” there is little collegiality in Congress and the GOP has had a difficult time even getting a message out. It is only on the GOP Member’s sites – such as that of Congressman Gerlach’s – that one can see alternatives to the present plans.

    That the GOP advocates for a healthcare program in line with that of our Bishops is a difficult position to hold since GOP control of Congress, though never as overwhelming as the present Democratic control is, did not yield any meaningful healthcare bills. Further, GOP opposition to an expansion of CHHIP funding on cost grounds suggests that only a Democratic controlled government would have even made the attempt.

    I do not believe that the GOP would be venturing into healthcare reform if the Democratic party had not first crashed the gates. But, now that we are in that territory, the GOP has not been silent, it has only been subject to censure – by Speaker Pelosi directly and by a media that, up until very recently, was so enamored of the President as to corrupt the public discourse by refusing to fairly cover any opposition to what amounts to a socialist takeover. There have been proposals but they have not had a vehicle for getting notice. The result is a decidedly extreme argument.

    I would suggest that, by stifling debate and deliberation, the Democrats have turned this into an all-or-nothing situation. Either one takes ObamaCare – in one of the three forms presented- or one does not. It is clear that Speaker Pelosi will not make any further changes to the bills so it is merely theoretical to talk about what we would WANT in a good bill. We will get what is on the table or we will get nothing at all.

    So, the question is not as the Bishops have phrased it. It is not what we want to see, what is just, or fair, or even smart. It doesn’t matter what the GOP suggests or what “Blue Dog Democrats” want. What matters is whether the present bills become law.

    I have read summaries of all three. All three will expand abortion services and restrict the rights of insurers and providers to opt-out of the abortion referral business. All three will make the 85% of Americans who HAVE healthcare coverage pay more and push them towards a “public option.” All three create some form of a public option with heavy government control. All three are overarchingly expensive and the suggested revenue sources sufficiently uncertain as to amount to little less than fiscal negligence.

    Democrat or Republican or Libertarian or Constitutionalist, there is much to hate in these bills. They are a secular humanist’s dream and a conservative’s nightmare.

    Are we bound to swallow any medicine that the doctor proscribes? Shouldn’t we read the accompanying literature and decide for ourselves whether the side effects are worth it or not? And, if so, what is it about the present bills that is sufficiently valuable that those concerns should be set aside?

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