Since President Obama signed the Patient Protection Act into law in March 2010, the acrimonious debate on this far-reaching legislation has persisted. For many, the concerns over the Obama administration’s health care reform effort are based on both moral and fiscal grounds. Now, with House Republicans scheduling a vote to repeal “Obamacare” in the days ahead, the debate is once again ratcheting up.
Perceived threats to the sanctity of life have been at the heart of moral objections to the new law. Despite a March 2010 executive order elaborating the Patient Protection Act’s “Consistency with Longstanding Restrictions on the Use of Federal Funds for Abortion,” many pro-life advocates fear a judicial order could reverse long-standing Hyde amendment restrictions on the use of federal tax dollars for abortion. Impending Medicare insolvency and the Patient Protection Act’s establishment of an “independent payment advisory board” to address treatment effectiveness and cost suggest bureaucratic restrictions on the horizon for medical care of the elderly and disabled.
The objections made on fiscal grounds are serious. Prior to the 2008 presidential election, Barack Obama voiced concern for 47 million Americans without health insurance. More recently, supporters of this legislation focused on 32 million Americans, with 15 million immigrants and others left out of the equation, yet still requiring care in United States emergency rooms. The Patient Protection Act increases eligibility for Medicaid recipients, yet state budgets are severely strained with their current underfunded medical obligations. Moreover, doctors struggle to provide health-care access to Medicaid patients when reimbursed below the overhead costs of delivering care.
Who Should Pay?
The perception among consumers of third-party responsibility for health, including payment for health-care resource consumption, is the major factor for unsustainable escalation of medical spending in the United States. Yet the Patient Protection Act augments third-party authority and threatens doctor-patient relationship autonomy, by increasing responsibility of government and employers for health care. Patients and physicians will face increasing involvement of third parties in decision making in exam rooms and at the bedside.
Let’s be clear about one thing: Health-care reform is absolutely necessary in the United States. The demographic tsunami of aging baby boomers, ever increasingly expensive advances in medical technology, anticipated Medicare trust fund insolvency, and millions of persons in the United States with limited medical access provide witness to this necessity. However, the Patient Protection and Affordable Care Act, and the Health Care and Education Reconciliation Act, of 2010, threaten human dignity and do not adequately address these problems. The Patient Protection Act neither sufficiently protects patients nor sustains long-term affordability.
Catholic social teaching can be very helpful in assessing health care reform and applying universal principles for all those of good will concerned about the common good. Respecting the following Catholic social teaching principles can help this country achieve sorely needed consensus on critically necessary health-care reform.
Human Dignity: The first principle of social teaching -- respect for the dignity of the human person -- is absolutely fundamental for health-care reform. Otherwise, health-care reform is meaningless; why bother? This principle must apply on both ends of the stethoscope in respect for both provider and patient. Health-care providers must have freedom to follow their conscience in prescribing and providing treatment. Furthermore, the dignity of the greater community must be respected; premium payers and taxpayers must not be complicit in procedures or treatments which violate human dignity.
Common Good: The Catechism of the Catholic Church defines the common good as “the sum total of social conditions which allow people, either as groups or as individuals, to reach their fulfillment more fully and more easily.” This principle prompts consideration of how scarce health care resources ought to be allocated in society. On this teaching, moral theologian Fr. Thomas Williams makes a helpful observation in his book Who Is My Neighbor? He distinguishes between moral and civil rights. These differ with respect to their demands upon the government. We might agree upon a moral duty to make health care accessible to all citizens and work toward that goal, while challenging the presumption that our government should assume greater responsibility for health care (a civil duty). The appropriate balance between market-oriented and government-controlled medical resource allocation belongs in the realm of prudential discussion. According to the Church’s social doctrine, “A truly competitive market is an effective instrument for attaining important objectives of justice.” On the other hand, as Pope John Paul II wrote in his 1991 encyclical letter Centesimus annus, “Regulating the economy solely by centralized planning perverts the basis of social bonds; regulating it solely by the law of the marketplace fails social justice, for ‘there are many human needs which cannot be satisfied by the market.’”
Subsidiarity: Another core principle of Catholic social teaching – subsidiarity -- emphasizes that those with “closeness to those in need” provide care for them. This principle argues for health-care reform solutions which fortify individual and family responsibility for health-related decisions. The doctor-patient relationship should be strengthened and protected rather than threatened by distant bureaucratic panels. Local, or community level, initiatives should receive priority over increasing the role of more distant employers and the government.
Solidarity: A key principle often cited in the health care debate, solidarity, obliges us to maintain a “preferential option for the poor and vulnerable” in confronting socio-economic problems. Solidarity motivates us to fulfill our duty to the poor and vulnerable, in the spirit of loving our neighbor, feeding the poor, and caring for the sick. Health-care reform must address the needs of immigrants within our borders, the chronically ill, the disabled, the economically marginalized, and human beings who are particularly vulnerable at the chronological extremes of life.
Push the Reset Button
Let’s keep the following objectives in mind as we enter a new round of policy proposals in health care debate.
Human dignity must be defended at the most vulnerable stages, from conception to natural death. Medical providers’ freedom of conscience must be protected. Health care ought to be considered as a scarce resource and allocated with competitive market-oriented reforms rather than further increasing third-party responsibility for medical care. The principle of subsidiarity leads to increasing responsibility for health care at the patient, family, doctor-patient, and local levels of society rather than at distant bureaucratic plateaus. Finally, the principle of solidarity requires us to confirm that our policy initiatives have benefited the most poor and vulnerable.
We share a duty in the United States to care for all those within our borders, and improve health-care affordability and quality. Yet “Obamacare” does not fulfill criteria required by fundamental moral principles; millions remain uninsured, and millions more are precariously insured. The Patient Protection and Affordable Care Act, and the Health Care and Education Reconciliation Act of 2010, neither sufficiently protects patient’s dignity nor sustains long-term affordability. Catholic social teaching guides us to a universal -- that is, for all those of good will – conclusion that our work is not done on health-care reform.