September 16, 2009

Questions a Catholic should ask about health care, Part 3

By Helen Alvaré, J.D., & E. Christian Brugger, Ph.D.  

The following column is Part 3 in a series (see DCR Archives at www.archden.org/dcr and click on Aug. 25 and Sept. 9 for Parts 1 and 2, respectively). The full column addresses 12 points to consider when weighing legislative health care proposals. Part 3 below outlines points 6-9.

6. Does the legislation respect the moral “principle of subsidiarity,” which requires that larger social entities (for example, the federal government) should leave to smaller groupings (that is, those intermediate associations within the local community) those functions and responsibilities which the smaller communities can reasonably fulfill (and often fulfill much better) on their own?  Or will particular decisions about health care be made by persons or groups of persons or bureaucracies far removed from knowledge of the particular person and his or her situation?

Note: It is reasonable to doubt whether federally administrated oversight will be able to adequately attend to the particular needs of patients.  We are all familiar with HMO bureaucrats denying treatments or altering treatment decisions for patients whom the bureaucrats have never seen or examined, even contrary to the judgment of the physicians who have.  Is a federalized plan likely to re-personalize health care or will economics unreasonably drive treatment decisions?  One provision of the Senate and House health-care bills appears to allow an existing government entity within the Department of Health and Human Services—The Agency for Healthcare Research and Quality—to carry out comparative effectiveness research (that is, it would determine the most cost-effective treatment for a specific medical condition which could effectively override a particular doctor’s decision for a particular patient).  There’s no problem in principle with an agency of experts assigned to carryout effectiveness research and to establish policies regarding resource allocation based on unbiased “best use” criteria; in fact, such an agency undoubtedly will be necessary within any nationalized health care system. A problem more likely arises if at a distance far removed from the particular needs of patients, it gets involved in individual diagnostic and treatment decisions.  Again, this raises fears of the selection of inappropriate or ineffective treatments for patients, whose health could unfairly suffer as a result. 

7. Is there sufficient accountability upon the persons or groups authorized to make crucial decisions about any of the above matters?  Are these persons or groups likely to be unreasonably influenced by ideological factors or by those with profit motives in mind (insurance companies, health care provider groups) rather than by the citizens whose health care is determined by the legislation?

Note: As stated above, the legislation presently calls for a new health-benefits advisory committee that has the authority to define benefits for all health plans in the United States.  It is an unelected committee named by the Secretary of HHS; there will be no accountability to the citizenry for what the committee determines will be the necessary components of health coverage.  Moreover, in the bill approved by Democrats on the Senate Health, Education, Labor and Pensions (HELP) Committee, states would have the authority to limit the number of insurance offerings provided to consumers in “exchanges.”  Exchanges, which might be state or regional, are groups of health insurance providers, which may or may not include a “public option,” which could be offered either to everyone, or to more restricted groups of traditionally more marginalized consumers of health care.  Government-run agencies will oversee consumer enrollment in insurance plans.  Qualified insurers seeking to offer coverage to “exchange” participants may or may not get to do so.  It would be up to government bureaucrats, who could deny market entry to an insurer for apparently any reason. It’s possible that this broad authority will be abused to benefit politically connected providers—at the expense of consumers.

8. What effect will the cost of health care reform have on the public monies available for other important services (e.g., social services to the poor, education, job stimulation, crime prevention and criminal justice reform, environmental services, etc.)?

Note: Because answering this question involves extensive access to national budget information coupled with a specialized knowledge of economic dynamics, it’s near impossible to answer for the layperson.  The fact is, however, that questions like this are rarely answered well even by experts.  As a pebble tossed into a still pond generates disturbances far beyond the place it landed, so too radical transformations of social systems as essential to a community’s wellbeing as health care can have wide-ranging and unanticipated effects far from the specific areas being reformed.  Concerned citizens need to press their elected leaders for answers to these questions, or at least for intelligent reflection upon them, before the stone is launched, since once it’s released, much of the change it generates cannot be undone.

9. Would the proposed nurse-home-visit services impinge inappropriately on families’ private decisions about parenting, intervals between pregnancies, or childbearing generally? 

Note: General language in the House bill recommends home visits by nurses in order to counsel mothers and families about parenting practices and intervals between pregnancies.  These have left many worried.  Worries stem from past government policies—failures all—in the areas of explicit sex education, birth control and abortion.

Helen Alvaré, J.D., is senior fellow in law at the Culture of Life Foundation and is an associate professor of law at the George Mason University School of Law in Arlington, Va.  E. Christian Brugger is an associate professor of moral theology at St. John Vianney Theological Seminary in Denver. This column originally appeared on the Culture of Life Foundation Web site: culture-of-life.org/content/view/582/1/.