“Perhaps it would be better to forgo long-needed changes in health-care financing and delivery in the short-term if these would lead to a long-term, systemic policy lacking respect for life, for religious freedom, and for the goods served by the principle of subsidiarity.”
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Ethical responses are needed during this health care crisis
By Bishop Robert Vasa
BEND — Much has been said and written about the proposal for a change in how health-care in America is provided and funded. In an open letter to Catholics and Catholic Organizations dated Sept. 21, the Catholic Medical Association, an association of Catholic physicians and health-care professionals, presents its views. The letter is a little too long to fit in my allotted space and so I have taken the liberty of editing it to such an extent that it is unfair to fully attribute the result to the CMA. I recommend the entire letter which can be found at Cathmed.org.
The thoughts offered by the CMA reflect years of experience serving patients and families in medical practice while endeavoring to apply the full spectrum of Catholic medical-moral and social teaching. The CMA acknowledges that we are facing a crisis, not only in health-care financing and delivery, but in the health-care reform process itself. The United States has the opportunity and obligation to craft effective, ethical responses to the crisis in health-care financing and delivery but there also exists a real danger that misguided legislation could make our current problems even worse. This is a critical time for Catholics to work together to help formulate solutions based on authentic moral, social, and economic principles. Many people lack consistent access to affordable health insurance and are unable to obtain appropriate health-care services in a timely manner. Health-care services are expensive and fragmented. These problems result largely from misguided incentives in tax, employment, and government policy. One unfortunate result of this has been increasing third-party payer intrusion into the patient-physician relationship, with significantly deleterious consequences.
There are certain fundamental ethical and social principles proposed by the Church with which all Catholics should agree. The question we are faced with, after decades of misguided policies, is how should we apply these teachings so as to provide universal access to quality health-care insurance and services in a cost-effective, ethical manner?
Bills passed out of committees in the House and Senate this summer rely heavily on the federal government to provide solutions. They empower a small group of unelected government bureaucrats and committees to determine the composition and cost of health insurance policies, the reimbursement of providers, the approval of treatments, etc. This government-controlled approach is flawed in principle and ineffective, if not dangerous, in practice.
This approach clearly violates the principle of subsidiarity first articulated by Pope Pius XI in Quadragesimo anno, n. 79, the first of several “social encyclicals.”
This approach has been and will be ineffective. The federal government has a very poor track record of managing large programs in a cost-effective manner. For instance, Medicare costs have run out of control in most states, and 40 percent of physicians no longer accept Medicaid because low reimbursement rates do not even cover the overhead expense of providing care.
This approach, moreover, is dangerous given the current Administration’s repeated failures to accord proper respect for the dignity of human life. Reversing the Mexico City Policy and providing federal funding for human embryonic stem-cell research are only the best known of a whole series of proposals further eroding respect for human life.
It is preferable to seek legislation which makes it possible for individuals and families to purchase health insurance that meets their needs and respects their values. One way this could be achieved would be to re-assign the tax deduction for health insurance from employers to individuals. Bringing appropriate incentives from the market economy to health insurance companies would increase competition and correct the problem of regional insurance monopolies. This would reduce costs both of insurance and medical care.
It is necessary to encourage greater individual accountability in health-care spending. Since 70 percent of health-care spending is for conditions directly influenced by personal behavior, there is considerable potential for improved health and reduced spending simply by encouraging healthier lifestyles. Greater accountability on the part of the individual for the costs of his own health-care provides an immediate financial incentive for healthier behavior.
All Catholics and Catholic organizations ought to reaffirm their support for the foundational ethical and social teachings of the Church. These provide a fitting framework for authentic health care reform. Further, there is a need for an uncompromising commitment to defend the sanctity of life and the conscience rights of all health-care providers as essential parts of health-care reform. The principle of subsidiarity needs to be remembered and applied across the spectrum of issues in health-care financing and delivery. Experience indicates that medical decisions are best made within the personal context of the individual patient-physician relationship rather than at some remote, impersonal, and bureaucratic agency, whether governmental or corporate. If this important principle of Catholic social teaching is not correctly upheld, then short-term measures to defend the right to life and respect for conscience will ultimately fail and the patient-physician relationship will be irreparably compromised. As indicated above we face not only a crisis in health-care financing and delivery, but a crisis in the current legislative process. We must ensure that well-intentioned efforts to bring about needed change and reform do not further erode respect for human life and the integrity of the patient-physician relationship. Perhaps it would be better to forgo long-needed changes in health-care financing and delivery in the short-term if these would lead to a long-term, systemic policy lacking respect for life, for religious freedom, and for the goods served by the principle of subsidiarity. Rather than accept such an outcome, we should take the time required to implement reform measures that are sound in both principled and practical terms.