Catholic Values on the Cusp of Health Care Reform

by Rev. Thomas A. Nairn, OFM, Ph.D.
Senior Director for Ethics, Catholic Health Association USA

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In June of 1993, while the U.S. Congress was debating the Clinton health care plan, the United States Conference of Catholic Bishops (USCCB) published “A Framework for Comprehensive Health Care Reform,” indicating that health care reform needed to be values-based and articulating eight values that needed to be considered.  The bishops ended their introduction to the document with the words:  “We are pastors, teachers, and leaders of a community deeply committed to comprehensive health reform.  Our urgency for reform reflects both on our traditional principles and everyday experience.”

In May of this year, Bishop William Murphy, Chair of the USCCB’s Committee on Domestic Justice and Human Development, issued a statement naming the same eight values as the criteria for evaluating a health care reform policy that is faithful to Catholic moral principles.  The values that both documents list are:

• Respect for life: Whether health care reform affirms and respects the sanctity and dignity of human life from conception to natural death. Whether it preserves the longstanding prohibition on federal funding for abortion.
• Priority concern for the poor: Whether it gives special priority to meeting the most pressing health care needs of the poor and underserved, ensuring that they receive quality health services.
• Access for all: Whether it provides ready access to quality, comprehensive and affordable health care for every person living in the United States.
• Comprehensive benefits: Whether it provides comprehensive benefits sufficient to maintain and promote good health; to provide preventive care; to treat disease, injury and disability appropriately; and to care for persons who are chronically ill or dying.
• Pluralism: Whether it allows and encourages the involvement of the public and private sectors, including the voluntary, religious, and nonprofit sectors, in the delivery of care and services; and whether it ensures respect for religious and ethical values in the delivery of health care, for patients and for individual and institutional providers.
• Quality:  Whether it promotes the development of processes and standards that will help to achieve quality and equity in health services, in the training of providers, and in the informed participation of individuals and families in decision making on health care.
• Cost controls: Whether it creates effective measures to reduce waste, inefficiency, and unnecessary treatment; measures to control rising costs of competition that provide incentives to individuals and providers for effective and economical use of limited resources.
• Equitable financing: Whether it assures society’s obligation to finance universal access to comprehensive health care in an equitable fashion, based on ability to pay; and whether proposed cost-sharing arrangements are designed to avoid creating barriers to effective care for the poor and vulnerable.

Even though we currently do not know what the reconciled bill will look like, there are some things that we can say regarding how it might possibly reflect these values.

(1) Respect for life. Most discussion regarding the bills has focused on the issue of abortion and what Bishop Murphy characterized as “preserving the longstanding prohibition on federal funding for abortion.”  Although both the Senate and the House bills ban direct federal funding of abortion, the bills differ regarding indirect funding.  The House bill also bans any abortion coverage by any plan that is part of the new insurance exchanges that would be mandated.  The Senate bill would allow private insurance sold by means of the exchanges to cover abortion, but the abortion coverage would need to be paid for separately.  Furthermore, everyone who would buy an insurance plan that contains abortion coverage would have to pay for that coverage (in a separate payment).

(2) Access for all; priority concern for the poor; comprehensive benefits.  Neither plan provides access for all or a priority concern for the poor.  It is estimated that the House bill would cover 96% of all citizens by 2019, while the Senate bill would eventually cover 94%.  Both of these figures cover a significantly higher percentage of the population than the status quo.  Both bills would expand Medicaid coverage to help the poorest citizens.  Undocumented immigrants would not be covered. 

(3)  Equitable financing.  Both bills offer subsidies to those who cannot afford insurance, but at different levels.  The House bill seems to offer better subsidies for lower-income families; the Senate bill seems to offer relatively better subsidies for the middle-income families.  The taxes that would pay for these subsidies are different in both bills. According to the Congressional Budget Office, both bills would be deficit neutral over the next decade.

(4) Pluralism.  Both plans seem to offer conscience protections.

(5) Quality.  There seems to be a movement from fee-for-service payment to outcomes-based reimbursement.  The House bill would use pilot projects to help determine best practices.  The Senate bill would have an independent board within Medicare, which would also recommend changes to other programs.

As we review the values and consider how a reconciled bill might relate to them, it is easy to say that the bill will go part-way to embodying most of the values that the bishops articulated but will not fully meet any of the eight criteria.  It will therefore be an imperfect bill from the perspective of these values.  What we need to consider is whether half a loaf regarding health care reform is better than nothing at all.  I am sure that this debate will continue well after the bill has been voted on.

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Rev. Thomas A. Nairn, O.F.M., Ph.D., is senior director of ethics for the Catholic Health Association of the United States (CHA). He is a Franciscan priest. Before coming to CHA, he was the Erica and Harry John Family Professor of Catholic Ethics at Catholic Theological Union in Chicago and Director of its Health Care Mission Leadership Program. He holds a Ph.D. from the University of Chicago Divinity School and has taught in several schools the U.S. and also in Melbourne, Australia; Harare, Zimbabwe, and Singapore. He has also been a board member of the Center of Compassionate Care of the Illinois Catholic Health Association and of the journal Human Development. He served as an ethical consultant for the CMSM/LCWR Task Force on Health Care for Religious. He has published many articles on heath care ethics and has recently edited two volumes on Cardinal Bernardin’s consistent ethic of life.

January 7, 2010