A common theme in the media is the discussion of health care, especially during the presidential election year. The rising costs, the provider shortages and insurance changes are not only frequent laments of political candidates, but for many are the daily reality of trying to manage one’s health. Everyone agrees that the trajectory of our current system of health care is unsustainable. However, there are vast differences in propositions from different political candidates and policy makers regarding what the future of healthcare in America should look like. In the face of all these competing voices, what is a Catholic to do?
Fortunately, the Church has a rich treasury of magisterial teaching to help us make decisions in our individual lives and to guide policies for society at large. As related to the role of the state and marketplace in society, it is referred to in general as Catholic Social Teaching. While the foundations of these teachings are found in the Bible and the works of many Church Fathers and Doctors of the Church, it began to coalesce in Pope Leo XIII’s encyclical Rerum Novarum in 1891. These teachings were further developed in Pope Pius XI’s Quadragesimo Anno in 1931 and by Pope St. John Paul II’s Centesimus Annus in 1991. These teachings appeal to four primary principles: human dignity, the common good, solidarity and subsidiarity. In this order, with human dignity as the most fundamental and foundational of these principles, one can begin to describe a Catholic vision for health care.
The ultimate goal of Catholic Social Teaching is to protect and serve our human dignity, which originates in every person’s creation in the image of God. In health care, this is deplorably attacked head-on by abortion, physician-assisted suicide and euthanasia, which prey on the weak, aged and disabled in our society. These are the most heinous abuses of the strong against the weak and those who are perceived useless by the powers that be. However, it is defense of these disenfranchised persons that must be a starting point in any health care discussion against the implicit assault of utilitarianism that suggests these lives have a lesser value.
Additionally, human dignity pertains not only to patients but to health care workers as well. As such, the freedom of conscience for health care workers must be secured at all times since a person’s duty to act according to his conscience is a fundamental expression of his dignity. Unfortunately, the premier secular bioethicist, Ezekiel Emanuel, recently asserted in the New England Journal of Medicine that it is “unjustifiable” for health care workers to object to procedures like abortion that are “not medically controversial.” It is the current opinion of secular medicine as stated by Emanuel that: “Healthcare professionals who are unwilling to accept these limits… [should] leave the profession.” If health care workers are forced to violate their conscience in the line of their work, we will all suffer by pushing out those who would act rightly and enabling those who will not stand up for the vulnerable.
The dictate to serve the common good leaves many areas for improvement in our current health care system with the most obvious being the rising cost of health care. The rising cost of care is secondary to not only advances in the sciences that allow for more intricate and extraordinary measures, but also the lack of transparency of the cost of providing those services. Currently, the cost of medical care is often not driven by operating expenses or market rates, but by hidden and negotiated deals of large insurance companies, drug manufacturers and hospital systems. Frequently, the cost of care varies dramatically even for the same service at hospitals across the street from each other and patients never know until long after the fact when they get the bill! Patients must have transparency of pricing and the freedom to shop for these services to the extent possible to facilitate cost-effective care. Furthermore, in addition to improving the cost of care for patients today, we must also consider our duty to future generations related to the debt incurred from the cost of government-directed health care. It is unjust to our children to continue on an unsustainable trajectory assuming debt that will need to be paid by someone else further down the line.
Solidarity is the principle of standing in unity with our brothers and sisters in Christ, especially the poor and most vulnerable. Our health care system must have, as Christ does, a preferential option for the poor. This means maintaining strong and sustainable social safety nets while allowing for the essential role of charity in healthcare. Currently, many of our safety nets miss some of the most vulnerable among us. At the same time, the presence and expansion of these safety nets has pushed out many previously effective programs and opportunities for charitable care for those in need. Moreover, it often occurs that even if someone has insurance through a safety net program, they cannot access care in a timely manner because these programs do not pay for the overhead of providing that care. As a result, this has forced many providers out of those programs against their will and has led to severely negative outcomes to those with insurance but no access to timely medical care.
The fourth principle is subsidiarity, which guides us to delegate matters to the most proximate and least centralized competent authority rather than a central overarching authority. In health care, this is the doctor-patient relationship. It is important to keep each individual patient at the center of health care decisions to the extent possible. In my practice, I am always impressed by the vastly different choices that patients make even when presented with similar circumstances. Medicine is not one-size-fits-all, and attempts by insurance companies and governmental bodies to coerce and ration care needs to be subordinated to the decisions of patients working in concert with their physician of choice.
Ultimately, health care needs to be ordered toward the good of the individual patient with their eternal destiny in mind. While there are several truths that are non-negotiable in health care policy discussions, there are many aspects that are matters of prudence and ongoing debate. Thank God that we have magisterial teachings to serve as guideposts to aid us in our work toward developing a Catholic vision for the future of health care.
Dr. Andrew J. Mullally, MD, is a family physician who co-hosts the “Doctor, Doctor” radio show on EWTN and practices in Indiana.