Whose Health Care Is It?
‘Right’ to Care and Subsidiarity Seen as Sticking Points in Debate
BY Steve Weatherbe
September 20-26, 2009 Issue | Posted 9/11/09 at 5:05 PM
WASHINGTON — There is as much debate about health-care reform among Catholics as there is in the nation at large.
And, as Congress returned from its August recess to face the monumental task of crafting a health-insurance reform bill and gain consensus, individual bishops entered the debate, joining the national bishops’ conference, which has been speaking out for some time.
Some are asserting that there is a right to health care, and others are criticizing proposals for heavy-handedness and violation of the “subsidiarity principle.”
Archbishop Joseph Naumann of Kansas City, Kan., and Bishop Robert Finn of Kansas City-St. Joseph, Mo., warned in a Sept. 1 statement, for example, that centralized health-insurance proposals would contradict the Church’s “subsidiarity” teaching that governments should not interfere in or supplant private and local efforts to meet social needs and, thus, “never doing for others what they can do for themselves.”
The bishops speak not of a right to health care itself, but “the right of every individual to access health care” and argue that this “does not necessarily suppose an obligation on the part of the government to provide it.”
Bishop R. Walter Nickless of Sioux City, Iowa, meanwhile, explained in a column on the website of the Diocese of Sioux City that the “natural right” of health care is the “divine bounty of food, water, and air without which all of us quickly die.”
“This bounty comes from God
directly,” Bishop Nickless wrote. “None of us can morally withhold it from
others. The remainder of health care is a political, not a natural, right,
because it comes from our human efforts, creativity, and compassion.”
“As a political right, health care should be apportioned according to need, not ability to pay or to benefit from the care,” the bishop continued. “We reject the rationing of care. Those who are sickest should get the most care, regardless of age, status, or wealth. But how to do this is not self-evident. The decisions that we must collectively make about how to administer health care therefore fall under ‘prudential judgment.’”
The Church does not teach that the government should directly provide health care, he said.
The U.S. Conference of Catholic Bishops and the Catholic Health Association, which represents more than 1,000 hospitals and long-term care facilities nationwide, assert a “right to health care” as their underlying premise.
In a statement of principles, “Our Vision for U.S. Health Care,” the Catholic Health Association makes clear its view that “health care is a fundamental human right.” The same document calls the lack of any health care for 47 million Americans, the number used most often but disputed by some as grossly exaggerated, “an intolerable injustice.”
Rationing of Care?
The Catholic Medical Association, representing Catholic physicians, sees it differently. It downplays health care as a right and emphasizes freedom of conscience in terms of doctors and patients and the public’s right to choose health insurance.
The association said the right to health care was in the first place a “divine demand” on the doctor to provide care and should not be used to extinguish the ability of doctors to exercise charity and freedom of conscience.
The association finds much to criticize in the proposed measures, including its disregard of the sacredness of life and freedom of conscience.
In a July 29 statement, the organization’s executive director, John Brehany, noted that the proposals would increase health costs by “hundreds of billions of dollars” and impose a “heavy-handed” regulatory regime that would be “antithetical to the rights of patients and physicians and to good clinical care.”
A government agency has already been created, Brehany noted, called the Coordinating Council on Comparative Effectiveness. Its duties look like rationing, and rationing “based not only on clinical, but also ‘economic’ criteria.”
Authorized by the American Recovery and Reinvestment Act (the “stimulus bill”), the Council on Comparative Effectiveness will help coordinate research and guide investments in comparative-effectiveness research funded by the Recovery Act, according to a March 19 press release from the Department of Health and Human Services. Comparative-effectiveness research provides information on the relative strengths and weaknesses of various medical interventions, the press release stated.
What’s more, the proposals would almost certainly “make it impossible for any current health insurance plan to survive,” Brehany said. “There is no way private companies can fairly compete with the federal government” and its below-cost public option. This would violate the subsidiarity principle, he said.
Furthermore, it would expand coverage of the poor by adding them to the rolls of Medicaid. But Medicaid’s “costs have run out of control,” noted Brehany, “and 40% of physicians are compelled to refuse Medicaid patients” because the fee schedule doesn’t meet office overhead costs.
Duke University politics professor John David Lewis, who runs the website ClassicalIdeals.com, agrees that rationing is on the horizon if the current proposals pass. He claims that the proposed bills give bureaucrats arbitrary authority and that rationing is an integral part of the leading House of Representatives measure, H.R. 3200. It gives the executive branch the right to determine how many patients with any particular medical problem may be admitted at specific hospitals over specific time periods, Lewis says.
“This is government rationing, pure, simple and straight up,” Lewis said. And, he added, the bill exempts from court review government decisions on who gets treatment and who does not.
The Catholic Medical Association urged Congress to “hit the reset button” on health-care reform and reconsider basic premises. In particular, the association urged that private health care not only be encouraged but freed from its current attachment to employers. The loss of insurance when employment is terminated is particularly harmful during the current economic downturn. Health insurance should be portable.
As for expanding coverage to the working poor, the association called for “targeted measures” rather than wholesale reformation.
Bureaucrats will also determine what both private and public insurers must cover. Since companies will be given the option of providing private insurance or paying an 8% payroll tax to the government, and since private coverage costs smaller companies closer to 12% to 13%, Lewis claims, many will be forced to abandon their private insurers to stay competitive.
“With private insurance starved, many people enrolled in the government ‘option’ will have no place else to go,” he concludes.
The proposals will severely limit the ability of individuals to insure themselves just for catastrophic medical events, while paying for routine medical care out of pocket.
Moreover, people who opt out of coverage will be taxed 2.5% of their income anyway, and those who do nothing will automatically be enrolled, says Lewis.
Lewis sees it as especially sinister that the Internal Revenue Service will become a major enforcer of the plan; the health-care authority will use individual tax filings to determine how much of a subsidy a person merits. Company profits will be accessed to determine how much each firm will contribute to health care so that “successful business owners will bear the highest cost of this plan.”
Whatever the sides taken by various Catholic concerns, Bishop Nickless writes that the debate “should concern all of us.”
Said the bishop, “There is much at stake in this political struggle.”
Steve Weatherbe writes
from Victoria, British Columbia.
Details of the Reform Abortion
The issue is funding: The majority of Americans are opposed to public funding for most abortions, and each year Congress adds the Hyde Amendment to health appropriations, prohibiting public funding of most abortions in the Medicare and Medicaid programs. The U.S. Conference of Catholic Bishops, all pro-life groups and independent observers such as FactCheck.org claim both bills approved by the Obama administration would fund all abortions.
The Public Plan
Those without private health coverage would automatically be enrolled in the public plan. Each would pay a surcharge to fund abortions.
Under the Senate plan, “virtually all” public or private plans cover abortions, while H.R. 3200 would provide for private plans that would not.
The Catholic Medical Association and secular critics claim the public plan would undercut private plans and put most out of business.
Companies currently providing health insurance to their employees may instead “opt” them into the public plan and pay an 8% payroll tax. Critics say health care costs small companies at least 12%. Most will go to the public plan, putting private insurers out of business.
Under H.R. 3200, the new health choices commissioner sets the minimum coverage required of private plans. The choice of many to insure themselves only against catastrophic illness or accident would be prohibited.
Those with incomes ranging from 150% to 300% of the federal poverty level, according to different proposals, would be eligible for subsidized premiums. According to one plan, legal immigrants would be ineligible for their first five years of legal status. The USCCB opposes this restriction.
Secular critics as well as the Catholic Medical Association say H.R. 3200’s Section 1151, “Reducing Potentially Preventable Hospital Readmissions,” imposes rationing of medical care.
Bill 3200’s Section 401 imposes a 2.5% surtax on anyone who has not joined either the public or an “acceptable” private plan.
The Proposals and the Process
The House Energy and Commerce Committee has approved H.R. 3200 and the Senate Health Committee has approved the Kennedy Bill. The bills will likely be voted on by their respective chambers and then combined for resubmission to both the House and the Senate.
Some predict the hostile public reaction during the summer recess precludes passage. Others are counting votes in Congress. Assuming unanimous Republican opposition, 40 Democrats who are either pro-life or otherwise hostile to the measures must be found to defeat the bills.
An alternative to defeating the bills would be to amend them on the floor by adding, for example, a Hyde-like amendment. But the Democrats have a majority in the House Rules Committee and will likely vote for a rule prohibiting amendments from the floor.
— Steve Weatherbe
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