The National Catholic Review

Republicans continue their victory dance on the grave of health care reform. I hope they will take a moment to read the letter they received from the USCCB yesterday. It calls upon all members of Congress "to come together and recommit themselves to enacting genuine health care reform that will protect the life, dignity, conscience and health of all." The letter reaffirms the Church’s teaching that "health care is a basic human right." Indeed, among the criticisms of the bills the Bishops cite is the fact that they do not go far enough, that they still leave too many uninsured, especially immigrants. The letter also reiterated the bishops’ support for the language passed by the House regarding abortion funding and called for additional conscience protections.

The letter was signed by Bishop William Murphy, head of the Domestic Policy Committee, Cardinal Daniel DiNardo, Chairman of the Pro-life Committee and Bishop John Wester, who leads the Bishops’ Committee on Migration. The letter is a fine, bracing reminder that the USCCB is not in the business of partisan politics, that the Church’s commitment to universal health care is long standing, and that health care is not merely a political issue but a moral one, involving basic human rights.

So, can we expect InsideCatholic to call for those who voted against health care reform in their respective chambers to be denied communion? Can we expect Archbishop Burke to accuse Senate Minority Leader Mitch McConnell, who said "I hope so," when asked if health care was dead, will the Prefect accuse him of acting at the behest of "the Father of Lies?" Will the "Catholic Key Blog" in Kansas City denounce those bishops who suggested health care was not a right?

I completely respect the right of my fellow Catholics who belong to the Republican Party to disagree with the bishops on any and almost all political issues. I do not think they should be denied communion because of their disagreement. I do not think they should be labeled "bad Catholics" or "cafeteria Catholics" or "faux Catholics" because their stance is so at odds with the nation’s bishops. But, because they are so quick to deny the Catholic credentials of those of us who do not worship at the pagan altar of conservative ideology, I do question them, not because of their ideas, but because of their self-righteousness in condemning others. One can be wrong without being bad. But can one be a Christian and be so relentlessly, vindictively judgmental about others, not about their ideas, but about their souls?

To be clear, it is ideas, and political ideas, that are at issue. No one gets a free pass to say, for example, "I’m a Catholic and I do not believe the Holocaust happened." If anyone were to say, "I’m Catholic and I think abortion is a completely acceptable way of dealing with a pregnancy" you are dangerously close to finding yourself no longer a Catholic in any meaningful sense. And, of course, if you deny the Creed, you are no longer a Catholic by definition. But, deciding how to deal with Holocaust denial and with those who procure abortions raises a set of thorny political and juridical questions on which Catholics can entertain a variety of opinions.

One thing has been missing from all the statements on health care that have been coming from the USCCB. In their pastoral letters on nuclear weapons and the economy, drafted in the 1980s, the bishops made clear that their moral teaching had a diminishing degree of certainty as it moved from principles to specific policies, that we can be certain that the intentional taking of innocent, civilian life is wrong, but that we must admit less certainty when discussing precise war-fighting strategies, even those that unintentionally involve the killing of innocents. Issues of intention, in a world of mixed motives, are not so easy to assess and politics is always a world of mixed motives. In the current case, the USCCB’s judgment about the relative merits of the Senate and House bills regarding abortion rests on their guess as to what market forces will do. That is not the kind of ground upon which bishops should invoke their teaching authority with too much precision.

Still, of all the many actors in the struggle over health care reform, the Catholic Church has been the most consistent and the most credible. They have been so not primarily because our intellectual bearings are any better than anyone else’s, although the Church’s consistency in defending life puts partisans to shame on both sides of the aisle. The main reason the Church’s voice is so clear and so convincing is because of the good work the Church does nationwide caring for the ill, at places like Providence Hospital here in Washington, D.C. or at St. Joseph’s Living Center in Willimantic, Connecticut, to name only the two Catholic hospitals that have come to my family’s aid. It is the work of the Little Sisters of the Poor, giving dignity and comfort to the elderly poor, that gives the Church credibility when we denounce euthanasia. It is the work of the Daughters of Charity and other religious orders that give the Church authority outside its own walls when discussing health care. Many Catholics, mostly Catholic women religious, preach about health care with their hands and have done so for decades. Congress should listen.

Michael Sean Winters



Anonymous | 1/29/2010 - 2:00pm

I still would like clarification on the statement that health care is a right.

If a treatment is effective then is it always a right no matter how expensive?

Or is this right dependent on the cost. If it is dependend on cost then it is a very strange right.
Marie Rehbein | 1/29/2010 - 12:14pm
Joe Kash, thank you for responding to my questions.  I agree that part of the effort would involve coming to an agreement on what constitutes health care. 
Do you think that every person is interested in being healthy?  I think many of your examples indicate that a large number of people are not particularly interested in attaining optimal health, but that almost everyone is interested in being not sick.  There is a difference, but how do we codify this? 
In my opinion, health care should cover a yearly check up and immunizations, and it should cover doctor's visits for illness and whatever it takes to cure the illness. 
It should be up to the patient to determine how far to take treatments for illness that has a low cure rate.  Even if the treatment is outrageously expensive, this does not lead to more cases of the illness or even more ill people choosing that treatment.  Which of the many outrageously expensive treatments would be pursued depends to a great degree on how successful they are - the more people who are treated according to what is available rather than what they can afford, the better our statistics on what is successful would become.
The idea that some treatments should be limited because of the cost, is an insurance company perspective that is based on a concern for profitability.  When a concern for profit is not in the picture, then the reality is that if more people are getting sick, the costs for everyone go up, and if more people are getting effective, timely treatment for sickness or are not getting sick, then the costs for everyone go down. 
Under the current system, if someone gets sick, their getting better depends on their personal good fortune or lack of it.  It depends not only upon the choices they make that influence health.
cris vicquery | 1/29/2010 - 4:05am

the pope says “ heath care is a fundamental right of the person and the treatment of individuals also is a benefit of the society as a whole” and “The modern concept of health care is the human promotion: from curing the patient to preventive cures” of course he doesn’t go into details , but obviously the current system in the US is very far from the Catholic view.
Anonymous | 1/28/2010 - 6:35pm

I submit to the pope's authority. Can you tell me how he defines "health care"?

Should all metastatic colon cancer patients get Avastin? Should all breast cancer and lung cancer patients get Avastin? How much benefit should be guaranteed?

Should all "preventative services" be included in the definition of "health care"? What about a personal trainer? What about a health club membership? What about the flu shot? What about organic food? What about vitamins? What about a chiropractor? What about acupuncture? What about work out shoes? What about a treadmill for your home? What about weight loss surgery? What about diet programs (weight watchers, jenny craig, etc)? What about diet books?

Also, how do you guarantee this right? Should the governement just nationalize all business so as to ensure all will have access to health clubs, diet programs, personal trainers and organic food?

This might sound absurd, but that is how it sounds to me when someone says health care is a right without trying to give a precise definition of "health care".
Marie Rehbein | 2/1/2010 - 2:08pm
People currently prioritize their spending such that health maintenance takes a back seat to almost everything else, especially if they are short of discretionary funds.  Then, when their self-neglect catches up with them, and they become so sick that it prevents them from working or makes them fear becoming a burden or dying premeaturely, then they put the money they would otherwise prefer to spend in other ways into health care. 
Despite the fact that people might be better served by treating their blood pressure, their chronic cough, or whatever other nuisance ailment they have that indicates the potential for a much more serious affliction, there has been no response from the medical community to make preventive care available at a cost that would entice people to spend their discretionary money on health care.  Therefore, I see no indication that any system would be likely to make medical caregiving into a consumer-driven, competitve industry.
I think the health savings account model could be a variation on what I would favor where a single entity does the accounting and one can "overdraw" one's account.  Current HSA's have people put money into their accounts, which they lose at the end of the year if they don't use it.  The logic behind that limitation eludes me.
The only role that I see for insurers is for them to offer protection from loss of income in the case of a catastrophic illness or injury.
Anonymous | 1/31/2010 - 3:55pm
I think almost any system that gives the financial decision to the consumer (the patient) is better than a government system.
These systems include but are not limited to:
- A voucher health care system
-Health savings acount model
-pure free market with private charity for those in need (get the churches to do what they have neglected - caring for people rather than political advocacy)
All of these systems would benefit by getting rid of the multiple layers of regulations in health care that restrict competition between doctors and nurses and other alternative care givers, between insurance companies, between hospitals, between drug companies, etc.
In my system some people would be able to and would spend hundreds of thousands for a few weeks of benefit but most of us would not.  This would bend the cost curve.
Innovation spurred on by competition would continue to make treatment cheaper and more effective.
Insurance would probably only cover catastrophic health care needs.  Ultimately we need a system where patients freely decide what preventative care is worth the cost. 
Unfortunately our addiction to government utopia and political deal makers, and big business desire to restrict the competition will make this free system never happen.
Marie Rehbein | 1/31/2010 - 11:53am
I agree with you that the patient - presumably in consultation with the doctor - should make the decision.  However, I do not see where your system is "free" if the patient has to make the decision based on whether he can afford the treatment.  If there is more to your idea, please describe it in more detail.
I, personally, distrust government to do the compassionate thing.  My thought is that the government should only collect and disburse the money the residents of the United States allocate to medical care.  It should provide a detailed accounting each year and see to it that the contributions of the residents adds up to the previous year's expenditures.
I believe that the reason this simple approach is not "understood" is because insurers have put a lot of effort into making it seem complicated and threatening.
Anonymous | 1/31/2010 - 12:00am
You say, "I think it is a right such that if a treatment is effective people should be able to get it if they want it no matter the cost."
Really!?  Well this is certainly NOT what is proposed by those who want single payor, or the public plan or the Senate plan or the House plan.  All of these plans would use "comparative effectiviness" "data" to decide what is worth it.  We live in a world where some treatment offer weeks or months of benefit for houndreds of thousands of dollars per patient.
Why do you think that we hear so much about "controlling" health care costs or "bending the cost curve".
I respect your opinion but it is not realistic.  There needs to be some way to ration health care.  I would propose one of a number of systems the empower the patient to decide the worth of an intervention rather than a government "comparative effectiveness" panel of experts.  The goernment system would be "equal" but my system would be "free".
Marie Rehbein | 1/29/2010 - 4:38pm
I think it is a right such that if a treatment is effective people should be able to get it if they want it no matter the cost.  I think our country is still wealthy enough to spare a percentage of each person's wealth and put it into a collective pot from which all truly medical bills are paid.  This will not cause more people to get the sickness so they can get the cure or anything like that.  There are self-limiting factors at work, such as treatments not being worth the side-effects or someone feeling that his illness is God's way of coming to get him.  I think the only real danger is in people passing themselves off as medical providers and stealing from the collective pot with no one having enough interest to prevent the crime.
Anonymous | 1/28/2010 - 2:10pm
This issue of whether health care is a right definitely needs to be explained.

I think that everyone would agree (those who say it is a right and those who say it is not an intrinsic right) that everyone cannot get all healthcare. We just do not have enough money. Should everyone get a 100,000 dollar drug that extends median survival by 2 weeks? Should woman age 40 to 50 be guaranteed mammography if only one woman in 2500 over 10 years benefit?

If you say that health care IS a right then you will only get my attention if you also simultaneously define health care. Otherwise you are only throwing a sound bite that has no true meaning.
Steve White | 1/28/2010 - 11:39am
Mr. Binder: Changing how we pay for healthcare will make it so people don't need emergency care? Really? Perhaps you mean that better preventive care can reduce costs by reducing preventable disease? Fair enough. But the questions remains, what is the best way to provide (rightful) access to health care? I don't have a perfect answer, but like a majority of Americans, I look at what Congress is doing and think, "I appreciate your good intentions, but the bill you've concocted will do more harm than good. That is to say, while doing nothing will be disasrtous, your plan will be even worse. Try again."
Anonymous | 1/27/2010 - 6:45pm
I meant August 2009.
Anonymous | 1/27/2010 - 6:44pm
I am all for health care reform. I agree with Senator Brown from MA that we need to go back to the drawing board with transparent negotiations to reform the system. Obama said that health care needed to be done by August 2008 or there would be a great tragedy. This is obviously not true. We have time for debate, negotiation and transparency.
Beth Cioffoletti | 1/27/2010 - 6:36pm
Thank you for this explanation, Marie.
It all reminds me of the scene from the Grapes of Wrath, where the "machine" has to be fed.  No one is responsible, it's just the way things are.  Profits have to made, period.  It's out of our hands, the monster has already grown too large.
We need a radical, Christ(?), response. 
Beth Cioffoletti | 1/27/2010 - 1:23pm
Aside from any moral issues, why in the world would any American NOT want healthcare reform? 
Of the very few people I talk to who say they oppose Healthcare Reform, ALL of them say the reason that they oppose reform is because they don't want their taxes to go up.  They are all covered under Medicare.  They've got theirs.
Gabriel Marcella | 1/27/2010 - 11:05am
We could have had meaningful reform of our health care system if it had included tort reform, various other improvements, such as the ability to sell health insurance across state lines, and adoption of the Stupak amendment. Instead one party festooned the legislation with all kinds of payoffs (Louisiana Purchase, Cornhusker payoff, the exemption to unions) that insulted the intelligence of the American people at a time of economic downturn, layoffs, and the huge loss of capital in the real estate market. The obscene bonuses paid to Wall Street executives rescued by the hard earned dollars of American citizens shocked the conscience. To add such political confusion and ethical lapses to economic insecurity is a prescription for legislative failure, no matter which party is in power. It's called overreaching. Critics say that tort reform will make a miniscule impact, but at least it helps to gain the moral high ground and demonstrates political will against the entrenched power of trial lawyers in the party in power. This does matter to American citizens. The miscalculations by the White House and Congressional leadership on this entire matter are a great case study on how not to mobilize the nation for major change.
Anonymous | 1/27/2010 - 1:02pm
Re: the "health care is a right" statement 
1. Where in an American legal document is such a right defined?  I even quibble with the notion that Catholic moral teaching states that "health care is a right" in the way it seems to be being used, although assuming this is true for the moment, if health care is a moral right, that statement certainly only frames the debate very broadly rather than solving the issue.  If it is a right, where does it "rank" among all the other rights a person has, including, supposedly, the right to not purchase health care?  If health care is a right, then shouldn't persons be entitled NOT to exercise that right, and hence NOT purchase health care? Moreover, does this "right" dictate the particular provisions of health insurance policies?  If its a right, and the right to choose an abortion is a right, then doesn't that mean that health plans that exclude the right to get an abortion violate the right of a person to health care?  In the end, the statement "health care is a right" does very little to get us down the primrose path to universal coverage or insurance reform.
2. As for whether Catholic moral teaching states "health care is a right", this causes me concern because the way most liberals are using this comes out of a "rights-based" political philosophy wholly separate from the Catholic moral tradition.  Mary Ann Glendon of Harvard has an excellent book critiquing the "rights-based" moral/political philosophy of contemporary Liberalism.  Certainly because of the fundamental human dignity each person possesses, they ought to have access to adequate and appropriate health care, and no one should be denied some level of treatment simply because of cost. 
3.  While I am sympathetic to moral arguments about health care, my very simple and only point is that politically the plans proposed are unacceptable to most Americans, whom polls show like the health coverage they have currently and are nervous about a plan that would wholly re-make 1/th of the US economy.  Certainly something must be done, but the political reality is that the current plans are DOA - with DEMOCRATS by and large and certainly with Independents (whom we love when they're with us and loathe when they're not), not just Republicans.  Politics is the art of the possible, and right now the Liberal idea that Mr. Winters has staked out as the Waterloo of morally acceptable health care is simply NOT POSSIBLE.  This is what bothers me about religiously-based arguments for political policies whether from the Left or the Right - they usually end up ignoring political reality.
P.S. If you really want to kill the bill, add a provision allowing illegal immigrants to be covered.
Marie Rehbein | 1/27/2010 - 3:29pm
It used to be called health care reform, but then it changed to health insurance reform.  The insurance industry has influenced its representatives in government to put its priorities ahead of the priorities of the nation's citizens, which incidentally includes voters.  The bill supposedly makes it less likely that someone will be ineligible for insurance, but it does little else. 
Nothing in the bill makes affordable either the costs of the actual health care or the cost of the insurance premiums that are paid in lieu of direct payments to health care providers.  The nation's citizens, which includes voters, not just insurance executives and employees, would like to be able to afford to pay a doctor directly for a check up, but most cannot.  They would like to be able to have insurance so that if they were to develop some costly ailment it would not have a devastating effect on their family's wealth.  They do not necessarily want to do business with insurance companies.  They certainly do not want to be compelled by their own elected government to do business with them
Brian Thompson | 1/27/2010 - 10:34am
Jeff, your points are valid to a degree, this has been an epic failure on behalf of the Democratic party, and the efforts at present are likely dead (though I don't want to talk in absolutes until that bloated deformed chimera of a bill is actually safely buried in an unmarked grave). However, Health care is a right. Now, the vehicle by which we provide for that right is debatable. I for one am partial to not doing so via massive government involvement, or at least massive direct involvement.
My preference is to, as a nation, encourage and support those who already supply heath care in a charitable or pro-bono fashion, as they are exponentially more compassionate and efficient than any government agency could hope to ever be. As a culture, we need more generosity of spirit, charitable giving to such groups (not just assuming that care for the poor is the government's role) and docility to the Holy Spirit so that those men and women whom He is calling to serve his people in consecrated life (especially in direct service to the poor, like nursing orders or orders who train some physicians) they will be willing to dedicate themselves to that call generously.
Legally, I do think tort reform is good (no it won't lower costs overall by much but it will drive less doctors out of business, and more supply + static-ish demand might lead to a buyer's market). I support robust conscience protections, an outright and comprehensive ban on government money being involved in abortion. I also think a restriction on some practices by companies is also in order (no denial for pre-existing conditions, no lifetime caps, etc). Tax breaks for health spending are also a good idea. However, I do not support government take over or government being put in the role of directly managing the industry. and I sure as heck do not want a single-payer or government monopoly on the industry.
We do indeed need responsible reform of our healthcare system, but there needs to be sober debate and discussion so that any bill will reflect wise compromise, not a bloated monster dripping with sops and pandering and bribes to buy votes. And, of course, such a plan cannot be evil, or else it is toxic from the root and will be shot down once again.
James Lindsay | 1/27/2010 - 10:18am
Many of the people want more than is in the bill. Additionally, just because the people don't want more health care for migrants, does not mean that they are morally right in doing so. Indeed, denying such health care or calling for its denial is likely mortally sinful.
cris vicquery | 1/28/2010 - 2:37pm
Jeff Landry

Benedict XVI himself made the "health care is a right" statement.

Among other speech :

Marie Rehbein | 1/28/2010 - 12:42pm
Given that people have strong opinions about health care, why is there not more debate about the principles involved in this reform effort.  Should Congress first articulate the idea of people having a right to be healthy?  Do readers here believe that is a right?  If so, then do people have a right to health care that is not a form of extortion - in other words, is it a right that health care be affordable?  If so, does affordable mean that it costs the same amount for everyone based on the particular treatment or procedure, or does affordable mean that it costs each person the same percentage out of their wealth to access whatever care is necessary to be healthy?
Anonymous | 1/29/2010 - 8:47am
As I have said before, the devil is in the details.
Is this "right" of health care tied to cost?  Does an effective therapy lose its status as a right if it is too expensive?  If so then can health care be a right?  Or is there some "basic" health care.
One can argue that in the United States there is universal "basic" health care in that everyone can go the the ER.
Preventative services are even more problematic.  Obesity is clearly one of the biggest problems that our country is and will face.  How far will this "right" of preventative services go?  Who decides how far this so called intrinsic right of preventative health care extends?
The problem with progressives or liberals or whaterver you want to call them is that they, like Obama, are so convinced that their way is the only way that they cannot possibly think that there might be a better way.  When it comes to health care there are more questions than answers.  I can say that I fully agree with the Holy Father's quotes, yet I think my conclusions will likely be very different to yours and MSW and America Magazine.  But I am not so conceited that I will say that my way is the only way.
William Kurtz | 1/28/2010 - 4:17pm
One question for those who say to scrap Obama's proposal, and "try again." Why should we believe the Republicans would support anything beyond an insurance industry wish list? They had the White House for eight years, Congressional majorities for most of that time, and did nothing. If they did nothing when they could write the bill they wanted, they certainly won't support somebody else's input.
cris vicquery | 1/28/2010 - 2:51pm
Joe Kash

"Should woman age 40 to 50 be guaranteed mammography if only one woman in 2500 over 10 years benefit?"

I, as all elderly women in Italy, have a free mammography every two years, and I live in Italy not in US the richest country of the world.

And as I posted above the pope often made the "health care is a right" statement.
James Lindsay | 1/28/2010 - 11:15am
Health care, especially in an emergency, is part of the right to life.

Everyone in an emergency situation gets care as a matter of right - how we share the payment of it and make it so people don't need emergent care is why reform is needed. This reform is also part of that right.
Steve White | 1/28/2010 - 10:05am
To say that health care reform is needed on practical and moral grounds in no way requires an endoresment the legislation currently being considered by Congress. To insist otherwise either ignorant, or dishonest. The fact that the status quo is unacceptable and unsustainable (on which almost every American agrees) does mean that the bill is question will be an improvement. Americans in increasing numbers are judging that the plan before Congress will in fact make things worse, not better. Does Mr. Winter really think that the bishops are telling us we have an obligation to change our health care even if that means making it worse?
Last point. Basic health care (though not all kinds of health care) is a right. Health insurance is not a natural human right. And yes, there is a difference.
Anonymous | 1/27/2010 - 10:04am
Its simple.
The. People. Don't. Want. It.  By at least 51% people are against the health care bill.  As if you couldn't tell after Mass.
And neither do most moderate Dems facing re-election.
So with respect to the bishops, who unfortunately last time I checked did not face regular election cycles, they can say all they want, but the bills in their present state are dead for now.  I'm sorry you lost your argument, but thats how democracy works.  And blaming Republicans (who need I remind you were in the minority in both houses of Congress & weren't allowed to introduce an alternative in the House), or any of the other straw men you've listed, won't change that.
Its amazing that you've talked on this blog so much about what Republicans did to kill health care, but you haven't once taken to task the people who were actually IN CHARGE of handling the bill, who are Democrats.

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