Kansas City-style Health Care Reform
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.