First Principles

Sometimes, when our minds get lost in the ins and outs of a complicated debate, it’s good to stop and ask a basic question: Why?

Why did we get into this argument in the first place?

That’s what we need to do now, with a health-care reform bill coalescing in Congress. What is wrong with the health-care delivery system in America, and what are the basic principles that will help us fix it?

As in many areas of life, Catholic wisdom has answers, and the bishops of the United States have offered guidance. When a person is sick or in danger of death, should he have to put forward a burdensome sum of money before a doctor will look at him? Should a person without the means to pay for an expensive treatment that will perhaps save his life be denied that treatment?

No, says our faith, which teaches the principle of solidarity: looking out for the common good and the welfare of our fellow man.

From the day Jesus related the parable of the Good Samaritan, the Church has taught that although each person is responsible for his own affairs, there are times when we need to lend a hand.

One of the more recent articulators of this principle was Cardinal Daniel DiNardo of Galveston-Houston, Texas. This summer, he wrote a short but powerful letter on his diocesan website in which he stated that the first principle to consider in the reform of the health-care system is the dignity and respect owed to the human person. 

“For that reason, we support universal health coverage which protects the life and dignity of each person, a coverage that is thus truly universal, especially for the poor and the vulnerable,” Cardinal DiNardo wrote.

To be truly “universal,” he wrote, health-care coverage “must also be assured for all from conception to natural death. For this same reason, we oppose any efforts to expand abortion funding, mandate abortion coverage or endanger the conscience rights of health-care providers and religious institutions.” He pointed out that there are “long-standing current policies on these issues that must be preserved — policies at the federal level that have received wide support.”

An example is the Hyde Amendment, which prohibits federal funding of abortions.

Certainly, the Church’s voice has been heard in the debate. Many advocates and even some members of Congress have referred to Church teaching in their support of this or that aspect of health-care reform.

But Cardinal DiNardo warned against using the Church’s position on health care to advance partisan goals.

“Because there are so many interests and points of view in this debate, it is imperative for the Church to clearly state the principles,” he wrote. “We cannot be used to support sides that have only their own agenda. Instead, we must make clear and repeat the major principles that need to be safeguarded while the debate and the various sides of the debate engage in the difficult legislative work of providing what is genuine universal coverage.”

We can tell when an interest uses the Church to support only its own agenda by measuring its values against those of basic Catholic teaching. Thus, while some Democrats point to the Church’s support for ensuring that everyone has access to health care, regardless of ability to pay, it’s disingenuous for them to then work to ensure that every health insurance option must cover abortions, including any that is funded by our taxes.

For example, John Kerry, D-Mass., sits on the Senate Finance Committee, which produced one version of health-care legislation. Kerry’s website announces that “health reform is … a matter of fundamental moral values.” Why, then, did he vote against amendments from Orrin Hatch, R-Utah, that would have made the bill conform to current federal law prohibiting direct abortion funding and offer protection for medical workers who don’t want to participate in or refer for abortions? Kerry is one of 13 Democrats on the finance committee, all of whom voted against the amendments, leading to their defeat.

We might also point out that those who embrace the Catholic principle of solidarity to promote universal coverage must also accept the Catholic principle of subsidiarity, which says that problems should first be addressed by those closest to them. In health care, this principle would require personal responsibility in ensuring good health — and when needed, good health care — for oneself and one’s family. Creating a system in which the nanny state provides for the needs of every individual — or at least purports to — removes that sense of personal responsibility. Instead of calling for mandatory health insurance, in which the government or some insurer will pay medical bills, why not continue allowing (and promoting) medical savings accounts, in which individuals save money — tax free — for their medical expenses? MSAs encourage people to spend responsibly, simply because the money is coming directly out of their own accounts.

But subsidiarity applies to organizations, as well. Genuine health-care reform would enable organizations such as Catholic hospitals and charitable institutions, for example, to fulfill their proper role rather than co-opting them, introducing burdens that make them unsustainable or forcing them to choose between shutting down and abandoning their own principles — principles that ought to be guaranteed by freedom of religion.

Pope Benedict XVI, in Deus Caritas Est (God Is Love), states: “We do not need a state which regulates and controls everything, but a state which, in accordance with the principle of subsidiarity, generously acknowledges and supports initiatives arising from the different social forces that combine spontaneity with closeness to those in need” (28).

As always, the Pope’s words cut through all the chatter.

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