The U.S. Bishops on Health Care Print
By Robert Royal   
Wednesday, 22 July 2009

Bishop William F. Murphy of the Diocese of Rockville Center, is a highly intelligent, articulate, and modest man. As Chairman of the U.S. Conference of Catholic Bishops’ Committee on Domestic Justice and Human Development, he provides a voice of realism and even self-deprecating Irish humor in dealing with issues that – he knows as well as anyone – are daunting, even for the experts. The last time we were together (at a conference on the economy and Catholic social teaching sponsored by the Lumen Christi Institute at the University of Chicago), he winsomely laid out for a group, mostly professors of economics at prestigious universities, both the Church’s religious and humanitarian goals in economic matters, and her need to rely on people with technical knowledge for how to implement that vision.

In short, Bishop Murphy is about as intelligent and engaging a spokesman as you could want on Catholic social teaching in America.

On Tuesday, he sent a letter to Congress encouraging legislators to pass “comprehensive health-care reform,” something just about everyone agrees we need. And in the very first paragraph, Bishop Murphy expresses the hope that “the serious efforts of the Congressional committees will bring genuine life-affirming reform to the nation’s health care system. The USCCB looks forward to working with you to reform health care successfully in a manner that offers accessible, affordable and quality health care that protects and respects the life and dignity of all people from conception until natural death.”

Our bishops show here astuteness in recognizing that “comprehensive” reform, which will inject the federal government into every nook and cranny of our medical services, may pose serious threats to Catholic physicians and Catholic hospitals, which treat one-sixth of patients hospitalized each year. And in successive paragraphs they warn about abortion coverage and that “Health care reform needs to reflect basic ethical principles.” In fact, they repeat these points in various ways in this brief document.

And yet. . . .It may be helpful to point out that issuing a letter like this, just a day before the president went on television to try to save his hurried “comprehensive” health-care bill, probably invites a serious misreading. In the blunt-trauma ways of Washington, many will discount the page-and-a-half (out of only two-and-a-half) devoted to the full cause of life, and will only see the bishops as siding with the president in his rush to get reform, any reform, as soon as possible.

To be sure, the bishops are not. They mention – but only mention – the need for “pursuing the common good and preserving pluralism including freedom of conscience and variety of options.” But it’s here, really, that Catholic social teaching has something useful, and also quintessentially American, to say. It’s the details of the legislation, the institutional safeguards, that are crucial. Catholic teaching on subsidiarity and the American tradition of federalism – to say nothing of simple realism about what happens when large state bureaucracies get extensive power – should here join hands in proper wariness about the unintended consequences of efforts to do good.

It’s only right for the bishops to go on record favoring coverage of everyone, for example, or with concerns about how marginalized poor or immigrants will be treated (though an intellectual tradition as rich and pointed as ours might hesitate to characterize such things as basic “rights”) . But those are just vague and general – though real – ends. It would have been even better if they had weighed in more heavily about the need for precise and careful means, so that covering everyone does not become coercing everyone.

William Galston, a Democrat who worked in the Clinton White House, said in the Washington Post yesterday, a day after the bishops’ letter appeared, that even moderate Democrats, “won’t support a version of the public option that weakens or eviscerates the private sector in the provision of health insurance.” You don’t have to be a policy wonk to know that today’s private sector is not doing very well at health care. You only have to visit a doctor or an emergency room. But there’s a reason why Americans have instinctively reacted against the remedies so far proposed. Yes, there are costs no one knows how to contain, largely because of expensive high-tech procedures and an aging population. And private insurers seem stingy in trying to hold down costs by denying care. But it takes a simple faith of a kind a Catholic should not indulge in to think that our or any government will do better at such a complex task than a reformed private sector.

We have the example of Massachusetts before us, which inaugurated “comprehensive” health-care reform some years ago and is now facing medical chaos and fiscal disaster. Catholic social doctrine cannot be a system of abstract principles of justice that bankrupts the very private and public institutions needed to preserve a modicum of freedom and fairness in this world. Unfortunately, in the letter, when the bishops get specific, they seem not sufficiently aware of this dimension, opposing even simple measures such as co-payments that might deter people from seeking treatment. It’s a tough balancing point, but things like co-payments provide an essential social service. They prevent all of us, not just the poor, from using the system frivolously. Where there are no immediate costs, demand can be infinite. And then in the end, there will still be costs, greater costs that we will all incur.

Our bishops have done rather well in laying out the vision, a little less so in offering advice about how to get from here to there. But the key thing now is whether bishops and Catholic politicians alike will have the grit needed to slow down and really think through measures that could radically redefine life and death in America forever.

Robert Royal is editor-in-chief of The Catholic Thing, and president of the Faith & Reason Institute in Washington, D.C. His most recent book is The God That Did Not Fail: How Religion Built and Sustains the West.

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