Excellent Catholic Perspective on Health Care

Homily on health care  by Fr. John De Celles, of St. Mary Catholic Church in Alexandria, VA.

Scripture constantly reminds us of the healing power of God, especially in the life of Jesus, as he repeatedly heals lepers, the paralyzed, the hemorrhaging, the blind, the mute, and, as we read today [Mk 7:31-37], the deaf. It also makes it clear that as Christians we’re called to share in Christ’s special care for the sick, as we read: “And the people brought to him a deaf man…and begged him to lay his hand on him.”

It is a fundamental duty of the Christian to care for the sick. And today we find ourselves in the middle of a spirited debate about how best to do this, as Americans ponder health care reform. And as much as we might like to stay out of it, as Christians we cannot.

Recently Bishop William Murphy, writing as chairman of the United States Conference of Catholic Bishops’ committee on health care issues, released a statement outlining what he called “criteria” for understanding the “basic ethical principles” that must be considered in the debate. You may have seen a summary of those criteria in last week’s bulletin.

All of the principles he listed are important. The most important was “respect for human life and dignity.” This is very clear and absolutely uncompromisable: whatever plan we come up with has to respect the right to life of all innocent human beings, especially the unborn and the aged.

But there are some things we need to keep in mind. First of all, remember, as helpful as this letter is, it is merely the letter of one bishop, not all the American bishops together, in union with the Pope, so it’s not binding to our consciences, except to the extent it presents the actual doctrines of the Church.

Sometimes, though, it goes beyond doctrine. For example, the Bishop has clearly concluded that the federal government should be heavily and directly involved in providing health care. That’s fine, but it’s his personal judgment or opinion, not the actual teaching of the Church.

The letter therefore begs the questions: “what is the Church’s teaching about the government’s role in health care?”

To answer that question, we need to first answer another, more basic question: is there truly a “right to health care”?

From the perspective of Catholic social doctrine the answer is very clear: yes, absolutely.

But what does it mean to have a “right”? Fundamentally, rights are most clearly defined and understood by looking at corresponding duties: if you have a right to something that means I have a duty to respect that right in certain ways.

So, what is our duty, how do we respect another person’s right to health care? Unfortunately, official Church teaching tends to be rather vague in explaining this. But perhaps we can understand it by looking at what’s been written about another similar basic right recognized by Catholic social teaching- the right to work.

Does the “right to work” mean that the government has a duty to supply jobs for all it’s cuitizens- to give a job to everyone? Consider what Pope John Paul II wrote in his 1991 encyclical Centesimus Annus:

“[One] task of the state us that of overseeing…of human rights in the economic sector. However, primary responsibility in this area belongs not to the state but to individuals and to the various groups….which make up society. The state could not directly ensure the right to work for all its citizens unless it controlled every aspect of economic life and restricted the free initiative of indviiduals. Rather, the state has a duty to…creat[e] conditions which will ensure job opportunites.”[1]

In short, when it comes to the fundamental right to work, government doesn’t have to supply that work. In fact, it would do more harm than good if it tried to.

So, does government have a “moral obligation” to directly provide or ensure the right to health care for all it’s citizens? I think the Catholic doctrinal position, according to John Paul’s logic, would clearly be, “no.” In fact, it would even seem to be detrimental to society.

Some might say, “well, the right to work is not as fundamental as the right to health care.”[2] Okay, then consider another human right even more basic: the right to food.

The Church teaches that everyone has a right to food, but does that mean that the government has a duty to provide free food to everyone? No. It must protect the citizens’ right to food by keeping others from stealing their food, and defending their ability to work and buy food in the free market, But, no, it doesn’t have a duty to give food to everyone. As St. Paul’s reminds us in his second letter to the Thessalonians [2 Th 3:10]: “If anyone will not work, let him not eat.”

Now, if you are not able to work, that’s a different story. And so Catholic doctrine teaches that the government, or the state, may sometimes have to step in as a safety net.

But when would government, the state, have to step in? And how would that come about?

The answer to that lies in the moral principle of Catholic social justice called “subsidiarity.” In the last several decades many Catholics seem to have forgotten about subsidiarity.[3] In one form or another, it’s been part of Church teaching from the beginning, and has been one of the key principles of Catholic social justice since Pope Leo XIII’s wrote the foundational social encyclical in 1891, Rerum Novarum;[4] and has been reaffirmed by every Pope since. As Pope Pius XI wrote, in his 1931 encyclical Quadragesimo Anno, it is a “most weighty principle, which cannot be set aside or changed, [and] remains fixed and unshaken in social philosophy.”[5]

So what is “subsidiarity”? As Pope John Paul II defined it in Centesimus Annus, this principle holds that:

“a community of a higher order should not interfere in the internal life of a community of a lower order, depriving the [lower] of its functions, but rather should support it in case of need …”[6]

So for example, the family is the most basic unit of society—“a community of a lower order”—so governments—“communities of a higher order”—may never interfere in the life of a family except to genuinely help it.[7] Similarly, a neighborhood must be left to do the things it can handle on it’s own, as must a city, and the commonwealth of Virginia, without the interference of the federal government. And this applies to any organization in society, so that government must also leave businesses and unions to what they can on their own without unnecessary interference.[8]

Subsidiarity is based on the fundamental dignity of the individual human person, who is created to live in personal relationship with others. This is the foundation of society, at all it’s graduated levels of family, neighborhood, city, etc…up to the national and even global level. And the further we get away from real interpersonal relationships, the more easy it is to loose sight of the person, and compromise their dignity and their personal freedom.

Now, some things are clearly and naturally the province of governments. For example, defense of the nation—militaries— is a natural function of the national government.

But historically, the health care of individuals does not fall into this category, especially when it comes to the national government. Think about it: who is best suited, on a simply natural level, to give aid and care to the sick? Clearly the family, and the neighbors, including fellow parishioners, and the local doctor or nurse. Because health care is fundamentally about persons tending to the real immediate needs of other persons.[9] Government just isn’t very well suited to that.

You might say: “but Father, what about big insurance companies and big hospitals? Those aren’t very personal.” Believe me, I know.

But that only serves to make my point: the same problems we clearly see with big insurance companies are found in an almost geometrically larger scale with big government. But because of the free market you can easily choose to leave one insurance company and go to another, but you can’t “leave” one government for another, especially a national government, so easily. That’s why the Church embraces the free market —especially under the papacies of 2 men who grew up under socialist totalitarian governments, John Paul II in Communist Poland and Benedict XVI in Nazi Germany.

You say, “but not everyone in America gets to choose their health care provider or insurance company—especially the poor.” True. But does that mean we move away from choice and freedom, and move toward greater impersonalism? Or do we try to find solutions that promote greater choice and freedom, and move us toward a more person-centered system?

As Pope John Paul II wrote in Centesimus Annus:

“By intervening directly and depriving society of its responsibility, the social assistance state leads to a loss of human energies and an inordinate increase of public agencies, which are dominated more by bureaucratic ways of thinking than by concern for serving their clients….”[10]

And as Pope Benedict XVI writes in Caritas in Veritate:

“Subsidiarity …fosters freedom and participation through assumption of responsibility. Subsidiarity respects personal dignity by recognizing in the person a subject who is always capable of giving something to others….”[11]

Now, does this mean that the government can never step in and assist?

No. But if government does step in, local and state governments, should be the first intervene or lend assistance.

Still, in some cases the federal government can and should intervene. Again, as John Paul II wrote in Centesimus Annus:

“in exceptional circumstances the state can also exercise a substitute function, when social sectors or business systems …are not equal to the task at hand.”[12]

One thinks of natural disasters, like Hurricane Katrina, where local and state governments are absolutely overwhelmed and the federal government has to step in. Perhaps the recent banking and credit crisis was also such a case–perhaps. And maybe health care is a similar situation today.

But as John Paul continues:

“Such supplementary interventions, which are justified by urgent reasons … must be as brief as possible, so as to avoid removing permanently from society and business systems the functions which are properly theirs, and so as to avoid enlarging excessively the sphere of state intervention to the detriment of both economic and civil freedom.”[13]

And as Benedict XVI writes in Caritas in Veritate:

“.….subsidiarity is the most effective antidote against any form of all-encompassing welfare state. …”[14][15]

Now, maybe you’ve heard it said that the Church teaches that we have a “preferential option, or love, for the poor.” This is absolutely true.[16] But we have to be careful when we talk about a “preferential option”, because, as St. James reminds us in today’s second reading [Jas 2:1-5] Christians must “show no partiality” between rich and poor.[17] So, as John Paul, clarified the “preferential option for the poor” is merely:

“a special form of primacy in the exercise of Christian charity” ….”which is never exclusive or discriminatory toward other groups.” [18]

Charity never involves favoring the poor over the rich, but demands that we always make sure that someone’s looking out for the poor.

Still, some would say “solidarity” with the poor trumps subsidiarity, that government always has a “core ethical and moral obligation” to intervene to directly provide health care for the poor. But as Benedict XVI teaches: “… [solidarity] without [subsidiarity] gives way to paternalist social assistance that is demeaning to those in need.” [19]

And as Blessed Pope John XXIII wrote in Mater et Magister, disregarding the principle of solidarity ” is an injustice, a grave evil and a disturbance of right order.” [20]

Now, it may be that health care situation today is so dire that the federal government must step in, at least temporarily. But even if that’s so, subsidiarity reminds us of one other factor we must consider.

Think about this: what area of human life involves more moral decision making than the human body and it’s health? In the end, beyond the questions of whether or not the bill passed by Congress will provide taxpayer support of abortion or euthanasia, we have to ask ourselves a much more profound question.

That is, are we turning over all the vast numbers of moral questions and decisions involved in health care to a government that will make the right moral decisions for us? Can we entrust our health care, and our family’s health care to a government presently dominated by people who don’t understand the dignity of life from conception until death, or that it’s wrong to experiment on embryonic human beings, or to clone human beings? or even the very meaning of the words “family” and “marriage”?

And even if all 537 elected federal officials were 100% pro-life and pro-marriage, subsidiarity forces us to pause and remember the huge government bureaucracy, full of lots of unelected people. With all due respect for the many good and hard working federal employees, a lot of federal employees have many strange ideas about morality that are very different from Christ’s.

Today we remember Christ’s power and desire to heal and care for the sick, and the serious responsibility that places on us as Christians. We cannot lightly shift this responsibility to others —whether they are our neighbor, or an insurance company or a government official. Let us pray that God will guide our nation in the debate over health care reform. And let us pray that all Catholics may be led by the wisdom of Christ, so wonderfully laid before us in the richness and fullness of the social doctrines of His Holy Catholic Church. [By the grace of Jesus Christ, may “the deaf hear and the mute speak.”]

[1] CA 48.

[2] For the sake of argument we move on, but this contention is patently contrary to Catholic teaching, and demeaning to the dignity and nature of human work.

[3] It is unfortunate that it is not considered in Bishop Murphy’s letter. But in the last 10 days or so at least 4 other American bishops have corrected this oversight, writing letters to their flocks that place subsidiarity right in the forefront of their analysis. See the joint letter of Archbishop Naumann of Kansas City, Kansas, and Bishop Finn of Kansas City, Missouri, as well as the letters of Bishop Aquila, of Fargo, and Bishop Nickless of Sioux City.

[4] See, for example, Rerum Novarum 12, 13, 14, 35, 36, and 45.

[5] Quadragesimo Anno 79: “As history abundantly proves, it is true that on account of changed conditions many things which were done by small associations in former times cannot be done now save by large associations. Still, that most weighty principle, which cannot be set aside or changed, remains fixed and unshaken in social philosophy: Just as it is gravely wrong to take from individuals what they can accomplish by their own initiative and industry and give it to the community, so also it is an injustice and at the same time a grave evil and disturbance of right order to assign to a greater and higher association what lesser and subordinate organizations can do. For every social activity ought of its very nature to furnish help to the members of the body social, and never destroy and absorb them” [italics in original].

See also QA 80, which is the first time the principle is called “subsidiarity”, or rather “subsidiary function,” by the papal magisterium: “The supreme authority of the State ought, therefore, to let subordinate groups handle matters and concerns of lesser importance, which would otherwise dissipate its efforts greatly. Thereby the State will more freely, powerfully, and effectively do all those things that belong to it alone because it alone can do them: directing, watching, urging, restraining, as occasion requires and necessity demands. Therefore, those in power should be sure that the more perfectly a graduated order is kept among the various associations, in observance of the principle of “subsidiary function,” the stronger social authority and effectiveness will be the happier and more prosperous the condition of the State.”

[6] CA 48, which continues: “and help to coordinate its activity with the activities of the rest of society, always with a view to the common good.”

[7] See also CA 11: “the individual, the family and society are prior to the state and inasmuch as the state exists in order to protect their rights and not stifle them.”

[8] NB: “society” is not the same as “the state”—“society” is all of us and our associations: individuals, families, businesses, parishes, churches, etc.; and “the state” is the government.

[9] CA 48: “In fact, it would appear that needs are best understood and satisfied by people who are closest to them and who act as neighbors to those in need.”

[10] CA 48.

[11] CV 57.

[12] CA 48.

[13] CA 48.

[14] CV 57. See also CA 48: “In recent years the range of …intervention has vastly expanded, to the point of creating …the so- called “welfare state”… However, excesses and abuses…have provoked very harsh criticisms … Malfunctions and defects …are the result of an inadequate understanding of the tasks proper to the state. Here again the principle of subsidiarity must be respected….”

[15] See also RN 36. “Whenever the general interest or any particular class suffers, or is threatened with harm, which can in no other way be met or prevented, the public authority must step in to deal with it. …in such cases, there can be no question but that, within certain limits, it would be right to invoke the aid and authority of the law. The limits must be determined by the nature of the occasion which calls for the law’s interference–the principle being that the law must not undertake more, nor proceed further, than is required for the remedy of the evil or the removal of the mischief.”

[16] CA 57: “The church’s love for the poor…is essential for her and a part of her constant tradition.”

[17] Leo XIII, RN 37: “…the poor …have a claim to special consideration. The richer class have many ways of shielding themselves,…whereas the mass of the poor have no resources of their own…”

[18] CA 11 and 57.

[19] CV 58. Love for the poor, and the solution to poverty rests not first in more government bureaucracy or intervention, or government redistributing wealth, but in promoting the free market’s creation of wealth. As Benedict wrote in his “Message of the World Day of Peace,” on January 1, 2009: “the illusion that a policy of mere redistribution of existing wealth can definitively resolve the problem must be set aside. …Wealth creation therefore becomes an inescapable duty… if the fight against material poverty is to be effective in the long term.”

[20] Mater et Magister 53. Note, here Bd. John is quoting Pius XI in QA, 79; see above quotation above.


One Response to Excellent Catholic Perspective on Health Care

  1. Kimberly Yamanaka says:

    Hello there,
    I feel very called to learn and speak about health care reform within Catholic social teaching in the Seattle area. I love this homily and would like to read more from this perspective. I will read the recommended readings mentioned above; if you have more reading or networking recommendations regarding this imperative issue, I would be grateful for your guidance.
    Kimberly (yamanaka.kimberly@gmail.com)

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