The Linacre Quarterly

The Patient Protection and Affordable Health Care Act of 2010 accelerated bureaucratic appropriation of health care in the United States. Persuaded by laudable intentions of expanded access to care for millions of uninsured Americans, healthcare cost control, and improved medical quality, supporters are now confronted by the unintended consequences of greater government control of health care. The four primary principles of Catholic social teaching guide a best response to our neighbor's healthcare needs. The presence of these principles in the founding documents of the United States facilitates advocacy the public square.

Lay summary: Catholic social teaching presents a Magisterial gift to each generation to help build a just society. The four principles, Human Dignity, Common Good, Solidarity, and Subsidiarity, can guide reform of a healthcare system in crisis. These precepts, clearly present in the United States founding documents, and persuasive in the public square, serve as a foundation upon which to improve the medical care of the sick and injured.

Catholic social teaching provides the essential framework for thinking clearly about societal problems, but it cannot be applied like a recipe in a cookbook. It is the responsibility of informed citizens to take what Catholic social teaching offers and use their own knowledge and reason to advance concrete approaches for addressing complex issues of public policy.

Lay Summary: In health care, full governmental control would lead to a decline in the quality of services provided to all patients. It is possible to build a market-driven system of universal insurance enrollment that provides full protection to the lowest income households while also providing space for private initiative and innovation.

Health care is at a critical stage: doctors and patients, the central protagonists in this field, are less and less satisfied with the outcomes. Much of the debate about health care has focused on the choice between large public or corporate solutions. This creates a false dichotomy and wrongheaded solution. As we evaluate proposed healthcare solutions, we ought to apply the frameworks of Catholic Social Doctrine. We can have a medical system that both meets financial objectives and makes a radical commitment to the person.

Many Catholic leaders supported passage of legislation designed to achieve the humanitarian goal of universal or near-universal health coverage. These leaders could not imagine that the resulting law would lead to a severe assault on the practice of Christ-centered medicine. The legislative focus now is on conscience protection and making the Hyde Amendment permanent. But the real change that is needed is a culture that values life and puts doctors and patients, not secular bureaucracies, at the center of healthcare decisions. Many new proposals are being offered with the shared goals of expanding access to affordable health coverage, allowing people to make their own choices without oppressive government mandates, helping the most vulnerable, and protecting the right of citizens and medical professionals to live and work according to their religious values and principles.

Catholic teaching is emphatic on the need to “guarantee adequate [health] care to all,” as Pope Benedict XVI has stated. America has been slower than other advanced countries in progressing towards this goal. Reasons for this delay can be found in certain attitudes that have long been present in American culture, and have been reinforced by the wave of libertarianism (free-market ideology) that swept the world in the late twentieth century. Catholic theology and social/economic teaching can help us understand the flaws in these attitudes, which involve fundamental philosophical and theological principles, but which are far from academic, since they have serious and very practical consequences. In the light of Catholic teaching, we can look towards a sounder understanding of healthcare needs and effective ways of meeting them.

Lay Summary: This article argues that access to healthcare, at least up to the level of basic necessity, falls under the heading of distributive justice. It is a human right owed by the community to each of its citizens. And since rights entail obligations, this right entails an obligation upon each citizen to contribute, as circumstances permit, to the costs, which need to be shared equitably; they cannot be met simply by each individual providing solely for oneself. Also discussed are the problems of excessive costs in healthcare administration and in pharmacological research, as well as harmful tendencies in private-sector firms to over-reward top management and to target maximum (rather than adequate) profits.

The basis of a just and moral economic model for health care is examined in the context of Catholic social teaching. The performance of the current model of “central economic planning” in medicine is evaluated in terms of the core principles of the social doctrine of the Catholic Church and compared to freedom-based economic models. It is clear that the best way to respect and serve human dignity, the common good, subsidiarity, and solidarity in medicine is through the establishment of a true, free-market health economy.

Lay Summary : This article reviews the impact of recent healthcare reforms as well as traditional “third party payment” models for healthcare financing in America (insurance). Impact on patients and doctors are evaluated in the context of Catholic social doctrine and the Catechism. The many shortcomings and negative consequences of an economy planned centrally by government are compared to the benefits of a true free-market medical economy with empowered individuals. The analysis shows that interference in the patient–physician relationship and the centrally planned medical economy itself violates Catholic teachings, harms patients and doctors, and create morally evil outcomes and economic structures.

The debate on the meaning of the Religious Freedom Restoration Act (RFRA) is rapidly developing. Taking three snapshots in the bill's history (in 1993 at its origin, in 2014 during Burwell v. Hobby Lobby, and in 2015 after Obergefell v. Hodges), this essay evaluates the stances taken on the RFRA by the American Civil Liberties Union (ACLU) and the US Conference of Catholic Bishops (USCCB). Although the ACLU initially supported the bill, it now campaigns against it. In contrast the USCCB, once hesitant to endorse the RFRA, fervently defends it today. Evaluating these pivoting positions, this essay suggests that at the heart of the debate on RFRA lies a difference in understanding the right to follow one's conscience in the public square.

Lay Summary: This essay evaluates how the ACLU and the USCCB differ in their understanding of conscience. Next, the essay demonstrates that this difference leads to opposing viewpoints on the Religious Freedom Restoration Act today. Although both initially supported the Religious Freedom Restoration Act at its signing in 1993, the ACLU has now disavowed the bill after it had been used to permit following religious-based conscience in the public square.

This exposition is not intended to be a scientific or theological treatise, but rather a testimony to a personal call by Padre Pio, a commitment in faith, to duplicate St. Pio's model of healthcare delivery as a “Beacon of Light” in our increasingly secular country, an example of truly faithful Catholic health care fully faithful to the Magisterial authority of the Church, and a model for other Catholic hospitals to emulate in their ministries.