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Michael Sean WintersSeptember 03, 2009

Archbishop Joseph Naumann of Kansas City, Kansas and Bishop Robert Finn of Kansas City, Missouri issued a joint pastoral letter on health care reform yesterday. The text has caused quite a bit of controversy already because it deviates so starkly from the statements coming from the Bishops’ Conference. A similar letter from Bishop R Walter Nickless of Sioux City, Iowa caused a similar stir. Our friends at National Catholic Reporter posed the question "Who Speaks for the Bishops?" in an on-line editorial yesterday.

But, that is not the most important question or the truly interesting one. The most important question is – who is right? The Naumann/Finn document suffers from two deficiencies that are fatal: First, it misapplies the doctrine of subsidiarity and, second, it fails to take account of the available policy alternatives at this moment.

Subsidiarity is a Thomistic notion that seeks to answer the question that all public policies must face, namely, what level of society should treat a given issue. Further, subsidiarity suggests that issues be treated at the lowest level possible, that is, at the level closest to the individual. So, families should do what they can, neighborhoods should pick up the slack, the free market should adjudicate the distribution of goods and services, local government should take the lead on most issues and the federal government should only get involved when its unique reach and power, specifically the taxing power, is required. This part of subsidiarity is ably repeated in the Kansas City text. But, the text does not grasp the moral obligation of the higher levels of government. As Pope Leo XIII wrote in his 1892 encyclical Rerum Novarum, "Whenever the general interest or any particular class suffers, or it is threatened with evils which can in no other way be met, the public authority must step in to meet them."

I think it goes without saying that the current entirely private method of delivering health insurance is not working. In addition to those whose pre-existing conditions are not covered, there are some 47 million Americans who are not covered at all. Mind you, it is good business practice not to cover a pre-existing condition, so when you read warning that "The teaching of the Universal Church has never been to suggest a government socialization of medical services," be advised that you are reading a GOP talking point and not an application of Catholic social doctrine to the circumstance the nation faces. In this regard, both bishops were ill-served by their advisors in failing to distance themselves from the inflammatory language about "socialization" that has tapped such a reservoir of anxiety in the nation.

The political reality is that unless one of the proposals currently before Congress passes, there will be no health care reform in the foreseeable future. The 47 million uninsured will see their numbers grow, the cost of Medicare and Medicaid will continue to spiral out of control, people with health insurance will continue to see insurance companies deny them coverage for pre-existing conditions or for any treatments the company can dodge paying for, etc. The stance of the Conference, of Cardinal Justin Rigali and Bishop William Murphy, chairmen, respectively, of the USCCB committees on pro-life activities and domestic policy, has been pitch-perfect and simple to understand: We want health care reform that achieves universal access and abortion coverage is a deal-breaker.

The most interesting question posed by this document is not who speaks for the bishops but whether or not the USCCB should bother to do its work if it is merely going to be undermined by some bishops who disagree with the proposals adopted by their brothers. It is undoubtedly true that every bishop is the supreme teacher of faith and morals in his own diocese but in this media age, where dissent is lionized and disagreement makes a good read, a teaching document from any one bishop that is at odds with the statements of the Conference is sure to muddy the waters and confuse the faithful nationwide. That is to say, that in their efforts to present the principles and insights they thought most important to their flocks, Archbishop Naumann and Bishop Finn have unwittingly undermined their brother bishops in two ways. First, it appears to the average reader of the news that the U.S. bishops are divided about health care, and this at a critical moment in the negotiations with the administration and congressional leadership, negotiations that are delicate and can easily be de-railed when outliers throw a wrench into the works. Second, it appears to the average reader of the news that the long tradition of consensus and collegiality by the American episcopate is threatened by a small group of bishops who appear more intent on achieving ideological victories than in preserving the ecclesiological unity of the various local churches in the United States.

The tradition of consensus and collegiality goes all the way back to the decision to elect the first bishop of the United States, and continued through the provincial and later plenary Councils of Baltimore, then the annual meetings of the archbishops, and finally, in 1922, the founding of what was then the National Catholic Welfare Conference, the forerunner of today’s USCCB. In one of the archbishops’ annual meetings, an issue was put to a vote. Cardinal Gibbons voted last and he cast his ballot in opposition to his own preferred views and that of his close friend Archbishop John Ireland. He did so because he understood that it was more important to maintain the peace and unity of the archbishops than it was to win a particular vote.

That American tradition was not only vindicated in the documents of the Second Vatican Council, but the storied example of collegial action by the U.S. bishops became something of a model for other countries. The value of collegial action is obvious: Many issues are national in scope, and complicated and difficult to penetrate. By establishing a Conference with a professional staff to help the bishops understand the real world consequences of the issues involved, the bishops can speak intelligently in the public square about a host of issues, giving witness to the Church’s teaching which make her, in Pope Paul VI’s words, "an expert in humanity." That expertise is now questioned because people do not know who to believe. The problem with the document coming from the twin cities of Kansas City is not medical. It is ecclesiological.

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13 years 5 months ago
First of all, study your theology and ecclesiology. National bishops' conferences have little real juridical or teaching authority, and what they have is ambiguous.
Martino was absolutely right on this score, by the way.
This health care reform is truly a matter of prudential judgment. It is not a illegitimate question to ask which reform proposals would truly contributed to the common good. There is a good argument to be made that reforms like being able to buy insurance policies across state lines, shying away from coverage mandates, releasing insurance from the employment tie - would actually in the end help more people and bring more affordable health care to more people.
There are arguments to be made that more government intrusion into health care would hurt the poor. There are arguments to be made that much of the difficulties we experience today in terms of health care are in part attributable to greater government intrusion at both the federal and state level.
Arguments can be made, and that really is okay.
13 years 5 months ago
I'm glad you mentioned Leo XIII, Michael. Not only is he too often forgotten, but his teaching can, I think, be directed tied to healthcare reform. As I wrote on Vox Nova ([url=http://vox-nova.com/2009/08/11/the-healthcare-debate-revenge-of-the-laissez-faire-liberals/#more-9016]http://vox-nova.com/2009/08/11/the-healthcare-debate-revenge-of-the-laissez-faire-liberals/#more-9016[/url]), the main jist of the reform is to place a code of conduct for insurance companies, and allows those without insurance to access it through a health exchange, with the help of subsidies. (The public option is simply designed to control costs, something that is often forgotten, and will be extremely limited in scope). In other words, it tries to level the playing field a little, to increase the bargaining power of the ordinary person. Right now, the insurance company has all the power, which is why those outside employer-based insurance find so much trouble getting and staying covered. Even those with employer-based coverage will face limits on what is paid for, sometimes based on rules, sometimes quite arbitrary.
And this is where the great insight of Leo XIII comes in – there is a law of natural justice greater than the law of the market, and the worker could be “the victim of force and injustice” if this is not respected. This is the reason behind the Church’s staunch support of unions, of course — to make an unequal bargaining relationship more equal, to allow the outcome better accord with natural justice. I would contend the same is true in healthcare — just as unions bring workers together to protect them from exploitation, so the proposed reforms give ordinary people greater leverage, making it more likely that natural justice (in this case, the right to healthcare) wins out over the market solution.
13 years 5 months ago
"I think it goes without saying that the current entirely private method of delivering health insurance is not working."
Are you serious??  "entirely private"???
Our current system of Medicare, Medicaid and a absurdly regulated insurance industry that prevents competition is governement intrusion at its finest.  No one can seriously say that we have an "entirely private" health care system.
In addition hospitals and physicians spend wasteful time with "quality improvement" initiatives that do nothing to improve quality.  All mandated by big brother.
13 years 5 months ago
Is there a reason you don't provide a link to the doc from the bishops so readers might judge it for themselves?
It's here, by the way:
13 years 5 months ago
Right on, Michael. I sense now, more than during the presidential election, that Catholics are becoming fed up with these pandering bishops (in this case, pandering to the sensibilities of the Republicans in their diocese) and are standing up to their quite fallible teaching on this matter. None of us should forget that most of these bishops didn't get elevated because of their theological accomplishments. As in business and politics, they climbed the ladder because of their connections. Not all of them, mind you, but most. Theologians (and that doesn't include everyone with a degree in theology) are the ones we should be listening to.
13 years 5 months ago
To Chris. 
I understand your frustrtation.  However, please remember that the bishops are the ordained successors to the apostles and are thus given authority by Christ Himself.  Like us, they are not perfect, but they, and their office deserve our respect.  Theologians should be at their service, not the other way around.
13 years 5 months ago
There is no place in the Church's infallible Magisterium for Republican talking points in any form.  Further, the funding of abortion in any public option is very remote - as remote as the existing taxpayer support which occurs through the tax exemption for businesses on private insurance plans, which do fund abortion in many cases.  The ethics book used in minor seminary and pre-law programs, Fagothy's Right and Reason, states that Catholics may not withhold their taxes or participation in the state in a pluralistic society due to the legality of abortion.  Therefore, the insistence on abortion neutrality as a "deal breaker" is mostly a desire for influence, a need to save face and keep the peace in the Church and is, at worst, tribalism.  Finally, any insistence that the federal option, especially if we succeed in abortion neutrality, is in any way contradictory with the Magisterium comes close to, if not crosses the line of, heresy.  Indeed, not supporting such an option, especially if it is abortion neutral and possibly if it isn't, may be heresy as well.
13 years 5 months ago
Well done, Mr Winters. How can bishops forget or disregard the moral dimensions of a problem ? Maybe they are too preoccupied carrying water for politicians. More to the point, they justify absolutism on moral grounds when one small part of the health care puzzle is considered (health care for fetuses), but disregard the moral dimensions of the broader problem, the one us breathing humans have.
13 years 5 months ago
Today my friend was supposed to have a hysterectomy  - for the past several weeks she has been undergoing tests and preparation. 
Her health insurance company advised her on Monday that as of September its contract with her doctor was under negotiation and there was a question as to whether her surgery would be covered by her insurance. She was advised by her insurance carrier that if she went forward with the surgery she could be liable for the entire cost of the surgery. No concern on the part of the insurance company that she hemorages and could bleed to death from her medical condition. She did not have her surgery today because she was afraid it would bankrupt her - she is not sure when she will be able to find a new doctor who is acceptable to her insurance carrier. 
Talk about a death panel.
We need health insurance reform now.
13 years 5 months ago
The Republcan bishops humiliated themselves by spouting a transparently GOP talking point.  Like comparisons to Hitler, hackneyed references to phantom socialism and/or socialized medicine demean the writer/speaker.  Sad to see the bishops propagating GOP talking points instead of the cause of social justice.
But, the Republican bishops do seem to know on what side their bread is buttered.    
13 years 5 months ago
W-a-l-k-e-r (not Walter) Nickless

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