The American Jesuit John Courtney Murray, who helped craft the declaration on religious freedom at Vatican II, often said that it is difficult to arrive at genuine disagreement. People seem to disagree, but in fact are usually misconstruing one another. It takes serious effort at defining what we mean before we clearly know our real differences.
He is right that reform is necessary, and could do great good. His extremist critics are wrong. I do not believe he simply intends socialist-style control or “death panels” (Charles Krauthammer’s Commentary, however, accurately parses the way government will begin subtly to put pressure on elderly people). In my judgment, Obama sincerely believes that a large government role and – though he’s been reserved about it – ultimately a single-payer system is the best way to organize medical services. Beyond that, it would be difficult to say what he’s committed to because he doesn’t seem to have a settled or clear idea himself.
For me, all this is precisely the problem. Every government in the Western world deals out death and has begun to impose a distorted view of human life on its people. Is there even one you’d trust to make crucial decisions about life and death for you and your family, or the nation as a whole?
Obama, however, seems unable to believe those who fear more of that here are not all mere dupes of greedy healthcare providers or hyper-partisan Republicans seeking to derail hope by appealing to irrational fear.
But Americans on both the right and the left have long feared state power. Governments are not ideal constructs (as history amply shows). They’re clumsy instruments run by politicians and bureaucrats. Any sane person will view government power with both hope and fear and healthy skepticism and even, within limits, justifiable cynicism.
This is not ideology but a Christian, an Augustinian realism. Sin touches even the best intentioned acts. That’s why our Constitution carefully enumerates federal powers. Nowhere among them is control of medicine. We may decide to put such power there, but it must be with an American and Catholic cautiousness about the relationship between state and people, and careful consideration of every detail.
The U.S. Conference of Catholic Bishops just created a website that does a fair job considering some of these issues. It carries Cardinal Rigali’s recent letter to Congress (in addition to the one I wrote about from Bishop Murphy), which criticizes two technicalities in proposed legislation: one makes abortion a “mandated benefit” and the other requires a contribution by every federal employee to a fund covering abortion, among other things. The bishops use some boilerplate that helps further: “The bishops’ conference views health care as a basic right belonging to all human beings. We therefore have long supported healthcare reform that supports human life and dignity from conception to natural death; provides access to quality healthcare for all, with a special concern for immigrants and the poor; preserves pluralism with respect for rights of conscience; and restrains costs while sharing them equitably.”
This is fine, so far as it goes (I do not believe health care is best defined as a basic right, but that’s for another day). Still, it’s not the whole Catholic story, which involves a deep and comprehensive social doctrine. We assert solidarity against America’s tendency towards individualism, but we also want to champion subsidiarity as a limit on state power. Europeans talk about subsidiarity, but mean something different, namely another way for the state to subsidize and, simultaneously, subsume other social formations.
This week, The Tablet, a liberal Catholic newspaper in England, attacked the American bishops because they have supposedly let abortion (which The Tablet allows is important) prevent them from supporting Obama’s reform. Our bishops have failed to serve the Common Good, in that view, a key concept in Catholic social thought.
On this side of the Atlantic, however, the slaughter of a million and more innocents every year seems no small part of defining the Common Good. And we may here have achieved a clear difference, in Murray’s sense. Our British friends argue, “Through their greed and inefficiency, America spends something like double per head on health care compared with a country such as France, whose state-run health system is acknowledged as one of the world’s best.”
But this is mere abstract talk. The Tablet editors should re-read Burke’s Reflections on the Revolution in France. The French people are quite accustomed to a centralized system. Americans are not, and are rightly wary of such confidence in government, which has its price, as Europe has demonstrated over the past century. We are willing to pay a price to be free – and to defend life.
How can we deal with this health care problem, which it seems can only be solved by the federal government? I wonder as well, but am sure we should take time to answer. On the whole, I believe in multiple competing providers – no governmental option, which will only eat up everything else. Proper federal legislation might facilitate that, as it has elsewhere.
And here’s another factor: Without indulging in nostalgia, it’s worth remembering that Catholics here built a vast school system. We created more Catholic colleges and universities than the rest of the world combined. And we erected hospitals that treat about a sixth of all patients even today – all without government monies and while we were discriminated against. As Tocqueville observed in Democracy in America, where in France you see the state, in America you will see a private association.
When it comes to the life-and-death decisions that define the whole society, I want more private associations, because I have more faith and hope in them and greater fear of the state than Mr. Obama and his friends have.