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December 16, 2009
The many moral questions in health-care reform
The Catholic Church in the United States has done a public service during the recent health-care debate by keeping a crucial proposition in play: no reform should reverse the 32-year-old national consensus that keeps the federal government out of the business of funding abortions. Defending that proposition will not get any easier in the weeks ahead, but it must be done.
The defense of the inalienable right-to-life is not the only moral principle involved in the health-care debate, however. There are several other such principles and social justice concerns at stake. Here are some of the most important:
• The principle of solidarity teaches us to cherish a sense of responsibility across generations. How is that principle honored in a reform of health care that dramatically reduces the funding of Medicare for senior citizens, as bills in Congress now do?
• The principle of cross-generational solidarity also raises grave questions about the real costs of the plans that have emerged from the House and the Senate—real costs, as distinguished from the numbers being pulled out of hats on Capitol Hill. One experienced Catholic public-policy analyst estimates that the bill brought before the Senate will increase total federal spending by about $4.9 trillion (that’s $4.9 million million) over the next 20 years. There is no way to pay for this, even with spending reductions and tax increases. Does saddling our grandchildren with an Everest of debt satisfy the demands of cross-generational solidarity?
• The principle of subsidiarity teaches us to be wary of concentrating too much power in the national government. Yet the House bill that (barely) passed in November puts the federal government squarely on the hook for controlling health care costs because it requires Americans to buy government-approved insurance. Voters will rightly turn to their representatives and insist that the government make that insurance affordable. Thus the sea change: the U.S. government will become responsible for containing all health-care costs, which will inevitably involve both rationing and a decline in the quality of care.
Moreover, does anyone seriously propose that a federal government incapable of producing and distributing flu vaccine efficiently is capable of managing a national health-care system well? Subsidiarity teaches us to be deeply skeptical about affirmative answers to that question. Common sense suggests that any government, given such power, will never give it up. If we make a mess of this now, we’re stuck; ask the British and the Canadians.
• The principle of the common good teaches us to avoid public policy that destroys jobs; that moral imperative becomes even more urgent under current circumstances. The taxes that proposed health-care reforms will impose on all but the smallest employers who don’t offer health insurance, and the tax surcharge that will be laid on higher income persons who own small businesses, are both likely to discourage hiring and force layoffs. That’s bad public policy at any level of unemployment. It’s unconscionable when the unemployment rate hovers around 10 percent.
• The politicization of medical decisions—which will inevitably follow the kind of health- care reform now being proposed—will put new pressures on the right-to-life principle, as well as on the principles of the common good, subsidiarity and solidarity. Decisions that should be made by patients and doctors will be made by regulators as governmental intrusion trumps moral and medical judgment. How this builds a free and virtuous society, as Catholic social doctrine bids us do, is not clear.
For all its virtues, today’s American medical system does not afford access to needed care for some, so it fails the tests set by Catholic social doctrine. We can meet those tests and fix the system’s gravest problems by working incrementally, testing results as we go: changing the liability laws that distort insurance costs, reforming the insurance industry to mandate portability and coverage of pre-existing conditions, lifting the ban on interstate competition in health insurance, and covering the uninsured by tax credits and small business reforms. That would be health-care reform that satisfies Catholic principles across-the-board.