ANALYSIS

Searching for a Catholic health care reform

Why the Church is vital to the debate

By J.D. Long-García | Oct. 1, 2009 | The Catholic Sun

About 20 years ago, a student in the Osborn School District went home with an ear infection. It was a Thursday.

Over the weekend, the infection turned into an abscess and the child, who was uninsured, was dead by that Monday.

“Sometimes we identify something minor that can be treated early on,” said Sr. Margaret McBride, RSM, vice president of mission integration at St. Joseph Hospital and Medical Center.

“If he had gotten antibiotics and been treated on Thursday, he would have been alive,” she said. St. Joseph’s now sends a nurse practitioner to the school regularly and keeps beds available for possible referrals.

These kinds of stories are common in the debate over health care reform. An uninsured person, unable to afford a visit to the doctor’s office, foregoes treatment of a minor symptom only to wind up in critical condition.

“If all people had some type of coverage, it would allow patients to do more preventative care,” said Dr. William Chavira, an OB/GYN who said at least 40 percent of his patients lack full coverage, meaning their prenatal care needs aren’t covered. “Much of what physicians do is crisis management.”

An uninsured person is often part of the “working poor,” or has a job but his employer doesn’t offer insurance. The person works, but the company’s insurance is too costly, so the person doesn’t sign up. Or, nowadays, the person might have lost their job and their insurance with it.

Catholic hospitals bear the brunt of the broken health care system in part because of their commitment to charitable care, Sr. Margaret said. They want to provide care to those who can’t afford it.

Right to health care

The U.S. bishops have been advocating health care reform for a while now. In a 1993 resolution, they wrote, “Every person has the right to adequate health care. This right flows from the sanctity of human life and the dignity that belongs to all persons, who are made in the image of God.”

More recently, Bishop Blase Cupich of Rapid City, SD, issued a statement on health care reform for his diocese.

“Our healing apostolate is rooted in a belief in the dignity of each human person, realizing, as did Jesus, that one’s ability to live a fully human life is greatly affected by health,” he wrote in the Aug. 25 statement. “In a word, we consider health care a basic human right.”

How to ensure the right to health care gets a bit tricky. Some say the government is responsible for it, others, like the Kansas City bishops, say the government need not be involved.

“The right of every individual to access health care does not necessarily suppose an obligation on the part of the government to provide it,” Archbishop Joseph F. Naumann of Kansas City and Bishop Robert W. Finn of Kansas City-St. Joseph wrote in an Aug. 22 statement.

“Yet in our American culture, Catholic teaching about the ‘right’ to health care is sometimes confused with the structures of ‘entitlement,’” they wrote. “The teaching of the universal Church has never been to suggest a government socialization of medical services.”

The bishops instead stress the right to health care accessibility and insisted the “personal responsibility of each individual to care properly for his or her own health.”

Their joint pastoral statement came while Congress debated the public option — a government insurance plan detailed in a proposal before the House of Representatives.

“That’s going to be open to debate,” said Fr. Tad Pacholczyk, director of education at the National Catholic Bioethics Center in Philadelphia.

“What exactly is the nature of the system going to be? Would a public option indeed be able to provide improvement in accessibility and in cost management in an ethical way?” he said in an interview with The Catholic Sun. “If you had reasonable indications that it could, a public option would not be out of the question.”

That said, Fr. Pacholczyk also noted that competition has always been a part of society in the United States.

“I don’t think that health care is by nature exempt from that,” he said. “But again, how do you make competition work for the benefit of the patient in the bed, in the hospital? That’s going to be a critical question.”

In Phoenix, Dr. Chavira said a health care overhaul would be incomplete without liability reform. He pays $72,000 a year for malpractice insurance and he’s never had a suit filed against him.

“That just adds to the cost of medicine,” he said. “It gets transferred onto the patients.”

The threat of a lawsuit, Chavira said, often leads to physicians practicing defensive medicine — ordering potentially unnecessary tests and procedures to protect themselves.

Nikolas Nikas, president and general counsel of the Bioethics Defense Fund, a national public service firm based in Scottsdale, raised another key issue.

“Any public option that covers all ‘health care services,’ if that includes abortion, then that’s a problem,” he said.

Rights to life and conscience

Unquestionably the most debated issue in health care reform — at least in Catholic circles — is abortion coverage. In an address to the nation last month, for example, President Barack Obama promised, “Under our plan, no federal dollars will be used to fund abortions.”

Many contested the president’s statement because it was debated whether abortion would be covered under the much-scrutinized House bill. The non-partisan FactCheck.org said, “…the matter is not so simple or clear as the president would like it to seem.”

“Here’s the issue: the word ‘abortion’ doesn’t appear anywhere in the bill,” said Susan A. Fani of the Catholic League, a Catholic civil rights organization based in New York.

“That’s what the pro-abortion folks have been saying,” she told the Sun. “Well, it’s a legal medical procedure, in addition to being the taking of an unborn life, so it doesn’t have to be specifically mentioned to be included under the health care bills being proposed.”

Nikas of the Bioethics Defense Fund echoed her sentiments.

“The abortion industry knows that people don’t like the word ‘abortion,’ but they like the term ‘right,’” he explained. “So if they call it ‘a reproductive right’ or ‘a right to reproductive choice’ or any of these euphemisms, you can be sure what they’re pushing is abortion.”

In a letter to the House of Representatives, Philadelphia Cardinal Justin Rigali, chairman of the U.S. bishops’ Committee on Pro-Life Activities, demanded that the abortion issue be addressed.

“Much-needed reform must not become a vehicle for promoting an ‘abortion rights’ agenda or reversing longstanding policies against federal funding and mandated coverage of abortion,” he wrote.

“In this sense we urge you to make this legislation ‘abortion neutral,’ by preserving longstanding federal policies that prevent government promotion of abortion and respect conscience rights,” the cardinal wrote.

While some representatives have introduced abortion-restricting amendments to the House bill, none have passed. The so-called pro-life amendment proposed by Lois Capps, D-Calif., did pass, but many — including the Catholic League and the National Right to Life committee — said it fails to adequately address the issue.

Fr. Pacholczyk of the National Catholic Bioethics Center said the “non-negotiables” in the health care reform also include in vitro fertilization, embryo destruction and contraception. Reform should also provide conscience right protection for health care providers, he said.

“The physician should be able to refuse those kinds of procedures that he or she is convinced are immoral or are not medically indicated for this patient,” he said. “He should be able to exercise his medical judgment to the best of his ability.”

Fr. John Ehrich, STL, pastor of St. Thomas the Apostle Parish and a moral theology expert, also said medical professionals should retain their right to “act according to their conscience.”

“This conscience protection should also be extended to Catholic health care institutions and providers,” he said. “We have an important tradition in our society of not forcing people to act against what they believe to be true and good. It would be disturbing to have our government dictate what medical professionals must do.”

Fr. Ehrich also noted that a patient, in consultation with his physician, should make health care decisions. Such decisions should not be made by a government entity.

“Nor should there be coercive policies that reward physicians who simply cut corners and save the government money,” he said. “Equally important is for all citizens to be treated with dignity. This includes people with severe disabilities, as well as our senior citizens. All life is precious and has inherent value.”

That point isn’t lost on Dr. Clint Leonard, a Phoenix-based OB/GYN, who has many uninsured clients, including undocumented immigrants.

“People need care regardless of what their status is,” he said.

The staff at St. Joe’s agreed.

“For Catholic health care, covering all people is important, including undocumented immigrants,” Sr. Margaret said. “But we know that might not get any traction.”

The right kind of reform

Despite such obstacles, Leonard said that the need for health care reform persists.

“Overall, it’s really important that the cost be contained,” he said. “But I think it’s more important to put health care in the hands of the people so they have a certain incentive to take care of themselves.”

Leonard, a pro-life doctor who doesn’t prescribe contraception, was generally skeptical about government involvement.

“The more the government intervenes, the more they’re going to dictate what we do,” he said.

“Politically, they have identified how many people are uninsured,” Leonard said. “But they miss how much good is already taking place. Any reform has to maintain the quality.”

While some hope the government will play a smaller role, others are doubtful. Sr. Margaret at St. Joe’s noted that more than 50 percent of their clients since July have been on government programs like Medicare and Medicaid. While some hospitals won’t accept Medicaid patients, St. Joe’s does.

“We underestimate how much government involvement we have in our health care system,” Sr. Margaret said. “If the government stopped giving us money for health care, we wouldn’t be able to function.”

Sacrifices will have to be made — by hospitals, pharmaceutical and insurance companies — or reform is not going to take place, Sr. Margaret said.

The Church teaches that each state’s primary duty is to secure the common good of its citizens, Fr. Ehrich said. That includes ensuring access to health care.

But wouldn’t any reform be an improvement? Fr. Ehrich doesn’t think so.

“Although health care costs in our country are exorbitant and not everyone has access to basic health care, we still have the best quality of care in the world,” Fr. Ehrich said. “The question is really, how do we allow more people access to that care without mortgaging our future or forcing people to either pay for immoral treatment or force medical professionals to assist in immoral actions?”