Catholic Social Teaching and Healthcare Reform

In Matthew 25, Jesus paints an image of His return in glory. On the Day of Judgment, Christ will separate His sheep from the goats. The sheep are those that cared for "the least" of Jesus' brothers: the hungry, the thirsty, the naked, the stranger, those sick, and those in prison. The goats didn't remember "the least" among them and as Christ foretold, "in all truth," they have "received their reward," in this life and will not in the next. Jesus’ teaching is unavoidable.

This message is especially relevant to the injustice of the American healthcare system. To call American healthcare—as a system—immoral makes no judgment on healthcare professionals or hospitals, but rather on the design itself. Many have advocated for universal healthcare in our country and have been rejected for proposing so-called "socialized medicine." I am personally a proponent of a universal healthcare system. We have the medical care, the financial resources, but we seem to lack the moral will to acknowledge that we are our brother's keeper.

Does the United States have the best healthcare in the world? It depends. In reality, there are at least five different co-existing healthcare systems in our country. They can be described as follows: first, at the top of the system are the wealthy and well-insured, particularly those with indemnity, fee-for-service health insurance. In this case, the United States has the highest quality, most technically advanced medicine in the world; second from the top is the private, employer-based insurance for the middle class, usually with some features of "managed care" and some restrictions on what the insurance company will cover; the third layer consists of insurance for lower-income workers in the form of tightly managed health maintenance organizations (HMO), substantial out-of-pocket payments and moderate restrictions on the doctors that can be seen and treatments covered; the fourth layer is Medicaid, Medicare, and the State Children's Health Insurance Program (SCHIP), which are grossly underfunded systems of federal and state insurance for the lowest of middleclass families, the poor, for children, the disabled, and the elderly. This group faces severe restrictions on doctors that can be seen and on treatments covered; the bottom of the ladder is "charity care" and emergency room care, which is available to those who have no medical insurance.

The American healthcare "system" translates into a socio-economically based distribution of medical care, which is fundamentally more of a medical caste system than a healthcare system. This hardly seems compatible with Jesus' teaching in Matthew 25. The results aren’t either. In virtually every form of basic statistics measuring days of illness, death rates, and life expectancies, the United States ranks behind almost every other industrialized nation. The U.S. ranked last in 2007 of every industrialized nation in terms of the citizens dying from preventable disease; France ranked first. In France 64 people died from preventable disease, in the U.S. approximately 101,000 died from preventable disease. The difference couldn't be starker, particularly given the fact we spend more on healthcare than any other industrialized nation in the world and for us it is only partial, not universal coverage as in other countries.

The "every-man-for-himself," radical individualist strategy of American healthcare not only is disastrously irresponsible, it seriously violates basic Christian teaching. Make no mistake, this is not an endorsement to eradicate personal responsibility and moral virtue (communism, in other words), but an observation that a private sector dominated healthcare system is bad business without some sort of minimal regulation. The Catholic principle of subsidiarity is an organizing principle that calls us to allow the smallest, most local institution to handle matters if it can be done more efficiently than or just as efficiently as would be done at the national level (or state level in America). But, if the task cannot be done efficiently at this level, then the national (or state) government has an obligation to have some sort of role to ensure the common good.

Any healthcare system—in my view—that is based on private insurance with no government intervention is fatally flawed. The incentive of private insurance is upside down. After premiums are paid, the less care they provide, the higher their profits—this is undoubtedly their goal. Hence, all the horrid stories one hears about insurance companies searching for the smallest technicality to not cover something. Thus, public health and human welfare is not the incentive, but rather profit. Profit over health and dignity is not a Christian value. Fundamentally, health and wellness should not be treated like any other consumer-based industry.

The problem with healthcare costs is hard to deal with in the current system. With thousands of different private health insurance plans, it's virtually impossible to negotiate consistently lower costs with healthcare providers and drug companies. A universal healthcare system, on the other hand, has the potential to rein in costs. More importantly, private insurance is a colossal waste of money. Administrative costs for Medicare, for example, which is government-financed (not government-run) are 2-3% of the total cost. Approximately 30% of private insurance premiums go to overhead, profits, and executive salaries. Overall the administrative costs of private insurance exceed $400 billion dollars in a year. That is arguably sufficient to cover all the uninsured without raising taxes.

Many conservative-leaning thinkers are concerned about the loss of freedom and the efficiency of a national healthcare plan. Ironically, the freedom that many people fear will be loss at the implementation of a universal healthcare system is already gone. Many choices in healthcare are at the discretion of the private sector insurance companies. They choose what doctors you can see, whether you are qualified to be covered (if you have a history of illness, good luck—you cost too much), what they will and will not cover and how long you can receive treatment, and this is all if they don't find some small technicality on which they can drop coverage all together to preserve their profits. It seems that we fail to realize how much is already controlled by large corporations—at least government officials can be voted out of office.

Even more so, we already pay for people to get medical care. When people go to the emergency room to receive medical treatment without health insurance, the cost is spread amongst everyone else. This is one reason why insurance premiums skyrocket and we're also taxed, since hospitals can receive government grants to offset some of their losses. Wouldn't we rather have paid for the preventative care than wait until it is much more expensive?

Additionally, it is nothing unusual for a hospital to have to bill more than 700 different payers and insurers--HMOs, PPOs, MCOs, IPAs, and an alphabet soup of other organizations. Each one has its own set of rules for what services are covered, the level of reimbursement and the kinds of documentation and pre-approval required. It is an administrative nightmare. And for this mess, we Americans shell out $2.2 trillion a year (more than any other nation) and all this inefficiency costs patients tens of billions of dollars each year. Billing, collection, and payment administration represents some 20 percent of that $2.2 trillion we spend on healthcare. There is nothing even remotely "conservative" about this—it’s nothing but “big spending” and for what results?

To consider this again in Christian thinking—we have a call from the Lord to give preferential option to the most vulnerable among us. Poverty and ill health travel often together. Poverty puts one's health in jeopardy, ill health with its attendant high medical bills, impairment of working ability, and days lost from work, make it difficult to find and hold a good job. This is a terrible and vicious cycle. The current healthcare system is evidently not accommodating.

Now there is a "safety net" of charity healthcare that ought to be commended. The Veterans Administration healthcare system, the Indian Health Service, state and local departments of public health, public hospital emergency rooms, community health centers and clinics, faith-based clinics for the poor and homeless, and the list goes on. Despite their tireless work and efforts, many lack the funding and the resources to address the problem at hand—they adequately cannot overcome the effects of the lack of good, regular access to mainstream healthcare.

Hispanics, African Americans, people with less education, part-time workers, and foreign-born persons have the highest rates of being uninsured. Guess what? They also are the same people who have more abortions. 1 in 2 African American pregnancies end in abortion. African American children are born into this world more often than not with the odds against them—the black community is experiencing a terrible crisis of missing fathers, thus single parent households. Statistically, children that grow up in such environments are inclined to have a weak parent-child relationship, prone toward committing crime, drugs, alcohol, sexual promiscuity, more likely to repeat a grade, less likely to graduate high school, and are often victims of abuse and neglect. And single mothers, particularly young ones, face a long, uphill battle toward economic self-sufficiency and the current healthcare system does little to help those in this sort of situation.

The elderly have limited economic productivity and healthcare is getting exponentially more expensive; we have a moral obligation to see that their needs are met, particularly for a group that often has very dire medical needs. While there is Medicare, it faces problems in providing long term care of chronic conditions, incorporating new technology, and lacks the financial resources needed.

Much of this may be slightly more "liberal" than one's own political perspective, but Catholic Social Teaching is beyond "left" and "right" politics. If we subjectively identify with one side of the political spectrum more than the other, we must do so as Catholics, which entails crossing party lines. We cannot continue to allow our politicians to cover unborn children in the children’s healthcare program to encourage women not to have abortions only to denounce expanding coverage, or redirect funding from the program. This isn't all "liberal" either. We need to heed the Bishops advice on the both/and approach. There is another side of this debate that conservatives need to win. That debate is in regard to much of the content of American healthcare and this debate involves religious freedom, Catholic and private hospitals, abortifacents, emergency contraception, patients rights', and the full range of so-called "reproductive health services," in vitro fertilization, genetic manipulation, etc.

The Democratic Party is currently the natural home of legislative proposals for healthcare reform. I firmly believe that universal healthcare is going to come sooner or later and if Catholics aren't sitting at the table, our values will be off the table. I see this fundamentally as a "life issue" in its own respect and from a pro-life perspective, the status quo is not acceptable. We may not agree on the details, but on fundamental principles of human dignity, basic civil rights, and the end goal of, in some way or another, providing universal access to quality and affordable healthcare, there should be agreement. No one should be left out. That’s the ideal goal.

Back to the fundamental question: does America have the greatest healthcare system? Not at all and I don't even think it's debatable. And reform is not only necessary, it is required.

The Pro-Life Movement On The Left

Most Americans who are pro-life don't experience it from the left side of the political spectrum. Without a doubt, it is terribly difficult to be pro-life on the political left. The current political landscape in America presents a dire problem for "pro-life progressives," even more so if they're Catholic and observe the Church's teachings. Pro-life progressivism is a growing, still voiceless, movement in the Democratic Party. There is a sense of alienation from pro-choice Democrats in regard to "women's issues" (abortion) and "life-saving scientific research" (embryonic stem cell research) as well a sense of being out of place amongst conservative Republicans whom we might agree with on a few issues, but disagree with on a host of others and perhaps fundamentally on political philosophy. This movement (I think) is really reflective of many American youth, who not only oppose abortion and euthanasia, but would like to see "life issues" extend to the 30,000 children who die globally each day from poverty and preventable disease, issues of genocide in places like Darfur, human trafficking, healthcare, foreign policy issues of war and peace, and even to environmental stewardship. Many Catholic Democrats see this as what the late Joseph Cardinal Bernardin coined as the "consistent life ethic."

While I personally hold this view, I think there are two fundamental tendencies of this approach to politics ("the consistent life ethic") that presents a profound challenge, particularly to Catholics. The first is the prevailing tendency to make all political issues morally equal, i.e. fighting abortion is morally equal to providing universal healthcare. This is a tragic intellectual mistake. In the current election season this sort of thinking hasn't gone unnoticed with the wave of pro-life Americans voting for Sen. Barack Obama despite his radical abortion stance because "there are other issues." Indeed, I'm not one to deny that there are other issues that I care deeply about, but not even a monolithic committment to all these other issues in a "pro-life" way can draw attention away from the insurmountable horror of Barack Obama's hyper-liberal abortion agenda.

The second tendency of this group (this is just modern "progressivism" in general) actually causes the first. This tendency is toward moral relativism; the absence of an objective standard of good and evil easily allows for a pro-life individual to see reforming the American healthcare system as "more pressing" than stopping the genocide of 1.2 million unborn children every year. And the tendency toward this kind of thinking is more deep-seated than we like to realize. The American political tradition (and therefore the thinking of American citizens) is deeply rooted in legal positivism, which as a philosophy sees a disconnect between law and morality. This theory fundamentally presupposes moral relativism because allegedly the only way to maintain order in a secular society is not to affirm moral truths, which in itself establishes a false sense of peace, which begins to dissipate into what Princeton law professor Robert P. George calls the "clash of orthodoxies," i.e. secular humanist-moral relativists vs. Judeo-Christian moral conservatives.

It's safe to say then the fundamental problem is our moral thinking. Consider what C.S. Lewis coined as the "abolition of man." If God created us and endowed us with our human nature, then we can be assured that our nature is in harmony with His good purposes. Given that we have a nature, certain things go against it, won't fulfill us, and this is what we Christians call sin. But what if we could alter our nature? We live in a society where we create life in laboratories, can alter genetics, and implant embryos. This invokes to my mind a looming possibility of Huxley's Brave New World. The fundamental question is: is this in accord with our nature? Are humans meant to be created in this way? Whether or not a person believes in God will profoundly shape their conclusion to this question. There is no natural law without God and the fundamental notion that follows the absence of God is that our humanity is not a creation and therefore, there is no reason why we should not create embryos in laboratories for medical research nor for mothers who want a baby as if it were a consumer product.

How is this relevant to "pro-life progressives?" This group sees why abortion is a repugnant evil, which is wonderful. This movement may be key in ending the horror of abortion in America if they are successful in reversing the Democratic Platform and align themselves with pro-life conservatives. However, the mordern notion of "progress" may inevitably be their (and everyone else's) downfall.

In a recent political debate with a friend of mine, who like me, is a pro-life Democrat, except I'm Catholic, the fundamental difference is just as I described. He is voting for Obama and I'm voting for McCain. My friend sees it this way: American healthcare reform, namely universal healthcare is a "pro-life" issue, McCain won't do anything about abortion, and healthcare will help reduce the abortion rate. Perhaps he's right. But what about the fact that Barack Obama said that his worse choice in his senatorial career was his vote to save Terry Schiavo (he doesn't oppose euthanasia) and his expression at the "Compassion Forum" that he thinks people should have the choice to end their lives and their suffering if they choose to (physician-assisted suicide)? Or what of his remarks about funding abortion through his healthcare plan undermining the Hyde Amendment?

It doesn't matter. For my friend, healthcare reform is a pivotal issue that we cannot miss this time around. "Love your neighbor," he cited as his reasoning for voting Obama. But modern, hyper-liberal, pro-sexual revolution thinking doesn't really include God. The notion of the natural law is godless (because we have to include the atheists) because we cannot affirm the existence of God and without God, we cannot recognize our neighbors, whom we're supposed to love, for what they are. To be a person, according to the natural law, is to be a proper subject of absolute regard—a "neighbor"—it is persons whom I must not kill, must not steal from, etc. What is a person? A person is a creature made in the image and likeness of God.

The problem with losing sight of God is this: we don't lose sight of killing our neighbor as wrong, more than we don't recognize our neighbor when we see them (e.g. the unborn). In contemporary secular ethics, the ruling tendency is to concede that there are such things as persons, but to define them in terms of their functions or capacities—not by what they are, the image of God, but by what they can do. Therefore "personhood" is defined in terms of consciousness, reasoning, self–motivated activity, the capacity to communicate about indefinitely many topics, and conceptual self–awareness. If you can do all those things, you're a person; if you can't, you're not. The functional approach to personhood seems plausible at first, just because—at a certain stage of development, and barring misfortune—most persons do have these functions. But to think that they are their functions blows the core right out of the moral code.

This is often used as a justification for abortion. The slogan of pro-choicers is heard loud and clear: "every child a wanted child." But, by this logic, an unwanted child is not a child…so kill it? Obviously, unborn babies are not capable of reasoning, complex communication, and so on. If they cannot perform these functions, then by definition they aren't persons, and if they aren't persons, they have no inherent right to life. The real question is a philosophical one and it's undoubtedly moral. One might say, "surely a collection of tiny cells don't constitute personhood in such a way that trumps a woman's right to personal autonomy."

That's the mindset. But it cannot end with abortion. If unborn babies may be killed because they lack these functions, then a great many other individuals may also be killed for the same reasons—for example the asleep, unconscious, demented, addicted, infants, toddlers, someone in a coma on life-support (euthanasia), not to mention sundry other cases, such as deaf–mutes who have not been taught sign language. In such language, none of these are persons; in theological language, this is clear denial of the human person coming from God.

The cure for such blindness is not to tinker with the list of functions by which we define persons, but to stop confusing what persons are with what they can typically do. Functional definitions are appropriate for things which have no inherent nature, things whose identity is dependent on our own purposes and interests.

If I am a person then I am by nature a rights–bearer, by nature a proper subject of absolute regard—not because of what I can do, but because of what I am. Of course this presupposes that I have a nature, a "what–I–am," which is distinct from my present condition or stage of development, distinct from my abilities in that condition or stage of development, and distinct from how this condition, stage of development, or set of abilities might happen to be valued by other people. In short, a person is by nature someone whom it is wrong to view merely as a means. If you regard me as a person only because I am able to exercise certain capacities that interest you, then you are saying that I am not a person. And so the functional definition of personhood does not even rise to the dignity of being mistaken, it is just irrational and incoherent. With each different criterion of personhood, a different set of beings is welcomed through the gates of others' regard. This is the same rule of all oppression. Those who supported slavery were free and those who support abortion are born. Personhood is defined at our convenience.

It is clear then that moral principles are more important than policies. Moral principles gives us the capacity to priortize our political agendas accordingly and with a sense of how policies should be shaped, i.e. why abortion is a paramount issue. Much more can be said of this, but given the broad set of political issues, the pro-life movement (this is especially true of Catholics) has constantly faced a fundamental question often heatedly debated that I'm not at liberty to answer authoratatively. I have my convictions about if or when a pro-life Catholic could ever (if possible) vote for a pro-choice candidate, but I believe people of good will may disagree with me and I place no judgment on them. Honest disagreement can only lead to a healthy debate.

But we cannot avoid the question that often divides us: Can someone who is pro-life and Catholic vote for candidates who are not only pro-choice, but who promote policies such as universal healthcare that is accompanied by an unquestionably flawed approach to bioethics, which inevitably creates more problems? That is, can we argue "proportionate reasons" when the principles of one side is based on a terribly flawed view of the human person and society? It is striking to me that many pro-life Americans, even Catholics, go to great lengths to defend or qualify a pro-choice candidate's position, or even worse make them out to be more "pro-life" than the person who opposes abortion (Doug Kmiec).

I understand their argument and in all truthfulness, I don't disagree with them entirely, but I do think it gets so casual that one may vote consistently for pro-choice candidates without discerning the issue of abortion. Moreover, I don't think any of these same people would vote for a racist candidate no matter what that candidate said or how good, say, their economic plans are. No one would vote for Hitler because he supported universal healthcare (he did; Germany was the first nation in the world to have it) despite the fact he supported the genocide of 6 million Jews as well as nearly 6 million others who died along side them. Genocide would disqualify him from receiving our votes, period.

Yet when a candidate supports the systematic, public funded genocide of 1.2 million unborn children in America as well as subsidizing abortions overseas (e.g. not giving foreign aid unless they provided abortion facilities as was done under the Clinton administration) and below the border in Mexico, contributing to the over 45 million abortions that occur within 365 days worldwide, there are suddenly "other issues." Sometimes it is argued that overturning Roe v. Wade will not do anything, so we should leave abortion legal. Should we have left slavery legal and only sought to reduce the number of slaves? Such argument is incoherent. It's even argued that social programs will lead to less abortions. I think this is true to an extent, but on some level we (all) should agree that citing evidence from Europe is not convincing because Europeans are contracepting themselves to death and don't have nearly as many children to be carried by the safety net of social programs, hence, less abortions.

I won't objectively say a pro-life American, Catholic or otherwise, cannot (ever) vote for pro-choice candidates. Should they? That's another question and I think good Catholics may come down on both sides. Pro-life progressives, particularly Catholics ones, need to stop accomodating pro-choice candidates. Why should the Democratic Party feel any need to change its position on abortion, if they realize they will receive our uncritical support anyway, even while we disagree?

The Catholic Church and Capital Punishment

I read this article in a philosophy course on Ethics. It illmuminates the moral nature of the death penalty and presents a coherent evolution of the Church's stance on the issue without undermining of Sacred Tradition. It is a valuable read; all too often are there situations where one person says, "I can't support him, he's pro-choice," and the counter-reply is, "Well, the other guy is in favor of capital punishment."

Though, I am direly opposed to capital punishment myself, the argument of "proportionalism" in regard to voting for a pro-choice candidate doesn't work in this situation. (And this is coming from a Democrat). The two issues, abortion and capital punishment, are not morally equal. Abortion was legalized in 1973 and since then approximately 50 million unborn children have died in 35 years. Capital punishment was reinstated in 1976 in only 37 states and approximately 1,100 criminals have been put to death. The massive margin between those two numbers demonstrate in one respect [frequency and scope] how abortion immediately trumps the death penalty. Moreover, the Church has consistently taught that the State does not have the right to kill, but it has the obligation to protect (i.e. self-defense) the citizens from harm and if there are no other means of maintaining the common good, the death penalty is morally permissible. Abortion, on the other hand, is the deliberate and intentional killing of unborn human life making it sustinctly murder whereas this is not the case of capital punishment, though it proves unnecessary today [the gravity of abortion is greater, i.e. murder vs. "needless bloodshed" as capital punishment isn't necessarily murder.]

Cardinal Avery Dulles, Catholicism and Capital Punishment

Democrats for Life of America

Democrats are often concerned about respect, dignity, and compassion. Unfortunately, many liberal Democrats do not extend these concerns to the unborn.

I believe in the separation of Church and State as much as any other American. I think the separation protects churches from political polarization and the State from serving the interests of one particular church in violation of our right to religious freedom. But, the separation due to the freedom of religion does not entail a freedom from religion. Religion is vital to rational dialogue in the public square.

I believe in personal liberties. But the right to life extends beyond personal choice. I do not look down or even condemn a person who has had an abortion. I respect pluralism (not relativism) and welcome different opinions, that is, the Catholic principle of unity-in-diversity in the American political arena in order to create a “culture of life” that enables us to live out the rights to life, liberty, and the pursuit of happiness to the greatest extent that they can be.

Please consider joining the Democrats for Life of America. As Catholics—Democrat, Republican, third party, or independent—we are called to promote the “Gospel of Life” on all sides of the American political discourse. We must do all we can to see to it that liberal Democrats because of their concern for dignity, compassion, and respect for humanity, extend their concern to the most vulnerable among us—the unborn.

Joining this particular group within the Democratic Party does not require any commitment to vote for any pro-choice candidates or any Democratic candidate at all. It does not mean that you support in your beliefs or financially the DNC, but you will add to the voice of pro-lifers in the party itself. This is a non-profit group and they survive only on the effort of pro-life citizens.

Democrats for Life of America

Who We Are
Democrats for Life of America, Inc. is a national organization for pro-life members of the Democratic party.

Our Mission
Democrats for Life of America exists to foster respect for life, from the beginning of life to natural death. This includes, but is not limited to, opposition to abortion, capital punishment, and euthanasia. Democrats for Life of America is one of over 200 member organizations of Consistent Life: an international network for peace, justice and life.

What We Do
We mobilize Democrats at local, state, and national levels to:

• elect pro-life Democrats to office
• support pro-life Democrats while in an elected position
• promote a pro-life plank in the Democratic Party platform
• achieve pro-life legislation with the help of national and state pro-life Democrats
• participate actively in Democratic party functions and offices

Join the Democrats for Life of America: http://www.democratsforlife.org/