Health Care Reform

Let me start with a caveat. I have much to learn about health care in the U.S. and how to reform it. So take my comments as those of one with some definite limits on his knowledge of the subject. That being said, here are my thoughts on the matter.

The United States Conference of Catholic Bishops (USCCB) has done quite a bit in forming a Catholic position on the matter. Their information can be found at:

http://www.usccb.org/healthcare/

The bishops are urging us to contact our Congressional Representatives and Senators:

Call your members of Congress (use the Capitol Switchboard at 202-224-3121 to contact your Representative or Senators) and tell them health care reform should:


Include health care coverage for all people from conception until natural death, and continue the federal ban on funding for abortions;

Include access for all with a special concern for the poor;

Pursue the common good and preserve pluralism, including freedom of conscience; and

Restrain costs and apply costs equitably among payers.

Here is what my wife and I sent to our Congressional Representative and Senators:

While we do want to see more extensive health care coverage for Americans, such significant legislation should not be rushed and it should not promote certain agendas that expand abortion and restrict religious liberty. We support the U.S. Conference of Catholic Bishops' position on health reform, which includes health care coverage for all people from conception until natural death, and continues the federal ban on funding for abortions; preserves freedom of conscience clauses; and restrains costs and apply costs equitably among payers. Our concerns include not duplicating the experiences of the United Kingdom, Canada, or the Veteran Affairs department in terms of rationed health care, and not duplicating the experiences of Medicare in terms of inadequate cost containment. In addition, we do not want to see more situations such as Belmont Abbey College which is being compelled by the EEOC [Equal Employment Opportunity Commission] to offer contraception as part of their medical insurance package to employees, even though this is explicitly against the college's religious affiliation with the Catholic Church. Please support responsible health care reform. Thank you.

It seems to me that the bishops have it right. My thoughts on their points, and a couple of my own, are below:

1. How to reform health care is a prudential judgment. Unlike the issues of abortion, embryonic stem cell research, or euthanasia, which are intrinsically evil under all circumstances, health care reform can take one or more of many forms and be consistent with Catholic social teaching. I would argue that expanding coverage is a good thing and should be a primary goal. However, that goal should not be achieved at any cost (either monetarily or morally).
2. The maintenance of conscience clauses is a non-negotiable for health care reform. We cannot allow even a beneficial expansion of health care coverage at the expense of religious liberty. We must continue to protect health care workers from being forced to participate in activities that are antithetical to their moral and religious convictions. In addition, we must also make sure that religious institutions are not forced to offer medical insurance packages that are contrary to their religious missions. The recent situation where Belmont Abbey College is being pursued by the Equal Employment Opportunity Commission (EEOC) to force the college to include abortion, sterilization, and contraception coverage, is deeply disturbing.
3. The explicit statement that federal funding of abortion will not be allowed is a non-negotiable for health care reform. We cannot allow for abortion to become part of a federal health care package. If explicit provisions are not in the legislation, abortion will become part of the coverage. If abortion becomes a basic right of health care, there will be tremendous pressure on Catholic hospitals and doctors to become complicit in abortions. It will expand promotion of abortion and use tax-payer dollars from those who know abortion to be intrinsically evil.
4. Faith and Morals Catholics need to think more about the poor and the uninsured and under-insured, and Peace and Justice Catholics need to think more about intrinsically evil health care issues such as abortion. As one who primarily tends to be more focused on the former set of issues, I need to remember that the Catholic Church is universal in her scope and vision, and that Catholic teaching requires Catholics to promote both faith and orals and peace and justice. We don't get to choose one over the other.
5. All health care is rationed; the question is what is the least rationed model? As long as there are limited resources, health care will always be rationed. It simply has to be. Under our current health care system, there is significant rationing. If you work and don't qualify for Medicaid but your employer doesn't offer health insurance, then your health care is rationed by what you can afford. If you have an employer with health insurance, it is undoubtedly managed health care, which means there are judgments about what is covered and what is not. But we must be careful not to jump from one form of rationed health care into a more severely rationed form. State run, single payer systems seem to be pretty good for maintenance and preventative health care, and pretty poor for severe, chronic, or catastrophic health problems.
6. Health care reform must reduce or control costs or it will not help the people its advocates claim to be helping. Medicare and Medicaid are not self-sufficient. Social Security is not self-sufficient. Federal programs have not shown in recent decades an ability to contain costs. We need to see that this process will be different if we are expected to support it. In addition, the demographics of the current U.S. birth rate significantly affects our ability to support such programs when the number of workers is disproportionate to those who are requiring the most health care.
7. Rushing health care reform will result in bad health care reform. When legislation is pushed through, many, many undesirable things are tucked into the legislation that are not examined by most legislators, let alone most of the public. We need to deliberate and discuss and compromise (but not compromise foundational values). The town hall meetings seem to be mostly for show rather than real exchanges of information, but there have been some exceptions. In addition, the debate cannot go on forever. We need to be committed to real reform, and we need to hold our representatives and senators accountable to such real reform.