This year, the Congress has been engaged in the crafting of legislation to repeal and replace the Affordable Care Act (ACA—also known as Obamacare). President Trump has announced certain principles, and the Republican-controlled House and Senate have devised plans. It may be useful to look at the issue of health care in the light of the principles of Catholic social teaching. Compared to much of the current debate, these principles shed a new and hopefully clarifying light on the issue of health care reform. This essay will consider these principles on their own relation to the issue of health care reform, and not in the context of whether they support the Democratic or Republican positions on health care reform. However, Catholic principles may indicate that certain aspects of the Democratic or Republican positions may be correct. Health care is a very complicated issue. This essay will discuss basic principles of Catholic social teaching and apply them only to some of the many issues regarding health care. It is hoped that these examples will show how principles of Catholic social teaching can be applied to other specific issues of health care reform.
First, we can look at the basic right to health care in the light of Catholic principles. The Fifth Commandment says “Thou shalt not kill.” This establishes the basic right to life that is the foundation for the Catholic Pro-Life position on issues such as abortion, euthanasia, the death penalty, etc. By extension, the right to life implies the right to reasonable care for health (Catechism of the Catholic Church, 2288). Every person has the right to basic health care. Thus, health care is not a consumer good by which the wealthy have a right to better health care than the poor. All people have basic human dignity and thus all have a right to basic health care. This can also be stated in terms of the cardinal virtue of justice. Justice ensures that each person has that to which he or she is due. Health care is a basic good that is due to each person. Thus, the Catholic principles of the right to life, human dignity, and justice all combine to indicate that basic health care is a right that should be ensured to all people regardless of wealth or the degree of health or sickness they may have. Obamacare had the basic objective of ensuring that all Americans had basic health care, and thus in this respect would seem to be in accord with Catholic social teaching.
A key set of Catholic social principles of those of solidarity and subsidiarity. Solidarity holds that the community has a responsibility to care for the well-being of all of its people in the interest of the common good (Catechism of the Catholic Church, 1908, 1939-1940). Subsidiarity holds that matters should ideally be handled at the lowest level—that closest to the individual and family (Catechism of the Catholic Church, 1883, 2209). One of the issues in the current health care reform debate is whether it is best handled at the state or federal level. The principle of solidarity would indicate that perhaps health care is best handled at the federal level, as is done to a great extent with Obamacare, in order to ensure basic health care for all Americans as a common good. On the other hand, subsidiarity would indicate that health care is best handled at the state level as being the level closest to the individual and family. No one of these principles overrides the other; thus it would seem that at least tentatively on the basis of these principles alone there should be a balance of health care being handled at the state and federal levels. Further, subsidiarity would hold that perhaps health care should be handled at the individual and/or family level—i.e., that each individual and/or family should provide for their own health care, rather than depending on the state or federal government. But again, this would tend to allow the wealthy to have better health care than the poor, and would need to be balanced by the principle of solidarity to provide basic health care to all in the interest of the common good.
Third, there is the issue of cost. Both Democrats and Republicans say their plan would cost less for Americans who use health care. Of course, both cannot be right, and this is because the two parties are considering different groups of people when they say health care will cost less under their plan. In general, without getting into details, the Republican plan would cost less for wealthy or middle class people who have to buy private insurance, and the Democratic plan would cost less for lower middle class or poor people who depend on health insurance subsidies under Obamacare or Medicaid. However, the basic principle (a basic economic principle, not specifically a Catholic one) is that any product must be paid for—“There’s no such thing as a free lunch.” Thus, to increase health care for all Americans (as under the Democratic Obamacare plan), it is going to cost more. To decrease health care costs (as intended by the Republican plans), the quality of health care and the number of people covered by health insurance has to be decreased. Obamacare had the individual mandate that required all Americans to have health insurance; this was done in order to provide sufficient funding for the program. Healthy people who otherwise would not buy insurance were forced to buy it in order to pay for the increased coverage of sick people, including those with preexisting conditions. Obamacare also funded Medicaid expansion, which allowed more poor people to receive health care. Republican plans remove the individual mandate, allow more flexibility in insurance plans to cover less (while keeping coverage of preexisting conditions), and decrease Medicaid funding, all of which would decrease the cost of health care. There are many other factors involved in cost, but basically the dilemma consists in finding the proper balance between coverage (in both quality of care and number of people) and cost. Both good coverage and low cost are goods that need to be balanced out. Reasonable people may find a number of points at which the two factors can be balanced—higher coverage and higher cost, or lower coverage and lower cost. Another factor here, however, is that if one accepts the idea that it is a right for all people to have health coverage, then that requires a certain level of high cost to ensure that that be accomplished.
Another moral issue regarding cost is whether it is just for the wealthy to effectively pay for better health care (again, including quality and/or number of people covered) for the poor. This is what was done with Obamacare, in which the extension of health coverage to the poor was funded by increased taxes on the wealthy. This is an aspect of the general issue of just distribution of wealth. Catholic social teaching does not provide a simple answer to this question (Catechism of the Catholic Church, 2411; Compendium of the Social Doctrine of the Church, 201, 325, 355). Some Catholic thinkers outside of the magisterium hold that individuals have a right to all that they earn and that there is no duty outside of voluntary almsgiving to redistribute any of their income to the poor (i.e., the government should not force such a redistribution). Other Catholic thinkers outside of the magisterium hold that it may be allowable for the government to redistribute a limited amount of wealth from the wealthy to the poor. The Catholic principles of the universal destination of goods (Catechism of the Catholic Church, 2402) and preferential option for the poor (Catechism of the Catholic Church, 2448) provide for the use of the community’s goods for the needs of the poor, but do not clearly provide for the redistribution of goods by the government from the wealthy to the poor (Compendium of the Social Doctrine of the Church, 182; in general, 171-84). Thus, one can very tentatively conclude that taxes on the wealthy to provide better health coverage for the poor is a matter of prudence that should be calculated based on the economic circumstances of the American people at any particular time.
Besides the general structure of health care reform, a particular issue for Catholic social teaching regarding health care is insurance coverage for abortion and other procedures considered immoral by the Catholic Church. Obamacare originally mandated that health insurance cover abortions and contraceptives. Catholics and others objected on religious grounds for being forced to have this coverage, and various court cases have weakened the Obamacare mandate under certain circumstances. Also, Obamacare provided funding for Planned Parenthood, the nation’s largest abortion provider. Both the abortion/contraceptive mandate and the funding of Planned Parenthood are immoral under Catholic social teaching. The killing of unborn children, artificial pregnancy prevention, and payments to abortion providers are not “health care,” according to a Catholic definition. Thus, in these respects, by Catholic social teaching, Obamacare should be changed to remove these provisions, and the proposed Republican alternatives, which do remove them, are morally preferable.
Catholic social teaching does not provide all of the answers to the problem of health care reform. Many issues must be left to prudence and general economic principles (not to even mention what can be accomplished politically). However, it does set up some parameters within which morally-acceptable courses can be chosen. According to Catholic principles, it would seem that basic health care should be provided for all (as in Obamacare), solidarity and subsidiarity should both be taken into consideration, costs should be reasonable (as both Democratic and Republican plans attempt to do in different ways), and abortion, contraceptives, and Planned Parenthood should not be covered by insurance or paid for by the people (as in the Republican plans).
David S. Bovée
Photo: Calvary Hospital