Healthcare reform – it’s one of those causes almost everyone favors, but which almost automatically produces sharp arguments when we ask what it means and how it might be realized. You would have had to be living in a cave for the past eight months to be unaware that Americans are deeply divided on this matter, and that the division runs clean through the middle of many communities. That includes Catholic America.
Of course, there are a small number of non-negotiables for Catholics, whatever their politics, when it comes to healthcare reform. These principally concern any provisions that facilitate or encourage the intentional termination of innocent human life, or which diminish existing conscience exemptions.
Without question, these are the primary issues for Catholics who take their Church’s teaching seriously when it comes to healthcare legislation. They dwarf everything else.
No matter how good the rest of the legislation might be in, for example, widening access to affordable healthcare, it is a stable principle of Catholic faith - and natural law - that you cannot do evil in order that good may come from it. St Paul insisted upon this almost 2000 years ago (Romans 3:8), and it is constantly affirmed by Scripture, Tradition, and centuries of magisterial teaching. Try as they may, no amount of rationalization by the usual suspects can get around this point.
For this reason, much of the Catholic contribution to the healthcare debate, especially that of Catholic bishops, has focused on these issues. We’ve yet to see what impact this might have on whatever eventually arrives on the floor of Congress.
But let’s hypothesize. Imagine the healthcare legislation submitted to Congress involved a massive expansion of government involvement in healthcare. Let’s also suppose that the same legislation was stripped of any provisions that violated non-negotiables for Catholics. Would Catholics be obliged to support passage of such legislation?
The answer is no. When it comes to how we achieve the good end of healthcare reform - such as making it more affordable, universal, and ensuring that the most marginalized are protected - there’s a legitimate diversity of views among Catholics.
The reason for this is simple. While Catholic moral teaching has always insisted that evil acts may never be chosen, it also holds that the realization of good ends (such as making healthcare more affordable and accessible) mostly falls into the realm of prudential judgment. Outside those principles that translate into an obligation to support or work towards direct prohibitions of certain acts, the Catholic Church has always recognized that, within some rather broad parameters, faithful Catholics can disagree about matters such as how we achieve the end of more affordable universal healthcare.
But this very basic point seems to have escaped the attention of those Catholics who seem to imagine that an extension of government involvement in healthcare is by definition the Catholic approach to healthcare reform. It’s curious that the same people who are so utterly absolutist about such prudential matters invariably dissent from the truly non-negotiable injunctions of Catholic moral teaching.
This essential incoherence, however, has not stopped them from assailing the increasing number of American Catholic bishops who have questioned, on prudential grounds, those reform proposals that significantly increase the state’s involvement in healthcare. One Catholic magazine described such critiques as somehow out of step with Catholic teaching and even, oddly enough, as “quasi-libertarian” - as if only self-described “libertarians” would question the wisdom of extending government involvement in healthcare.
It might, however, be that these groups have a deeper concern: their realization that the days when American Catholic bishops could be relied upon to accept or advocate extension of the state’s participation in more-or-less any area of social and economic life are long gone.
In part, this trend reflects the collapse over the past forty years of the knee-jerk association of Catholics with the Democratic Party. But it may also indicate that increasing numbers of Catholic bishops are tired of being presumed to adhere to any number of positions on prudential policy issues simply because one or more departments of the United States Conference of Catholic Bishops happen to advocate a particular viewpoint.
Frankly, it’s a welcome development. First, it illustrates that more bishops are not going to be muzzled by a “conference line” (real or imagined) on prudential issues. Moreover, it suggests that, on truly prudential matters, faithful Catholics increasingly recognize they are entitled to reason their way through these subjects on the basis of Catholic principles and knowledge acquired from other sources, instead of being simply assumed to adhere to any number of (invariably left-liberal) positions on such questions.
That’s one part of the old, often-romanticized “Catholic ghetto” that, thankfully, can be consigned to history.