Sunday, February 15, 2009

A Catholic view of healthcare reform

Reform of the American health care sector is urgent. The current trend of ever increasing health-care spending, superimposed upon technological advancement and an aging demographic, is unsustainable. Approximately 15 percent of Americans lack health insurance and millions are underinsured or struggling with medical bills. Employer based medical care is disintegrating. Well-intentioned leaders often advocate for `comprehensive' or `universal' reform with more government or employer involvement in health care.

Yet our government has a record found wanting in the defense of human dignity. Broad mandates threaten those whose consciences are committed to the sanctity of life. Furthermore, approximately 50 percent of medical spending is already government funded and expenses continue to escalate. Medicare faces insolvency by 2019, or earlier. United States firms struggle to compete in the global marketplace against firms not similarly responsible for medical benefits.

How ought health care be reformed?

Pope John Paul II, in the 1991 encyclical Centesimus Annus, wrote that "the Church offers her social teaching as an indispensable and ideal orientation." These principles of social justice can be considered by all those of good will as guidelines for ethical health care reform.

Catholic social teaching prioritizes the dignity of the human person, created "Imago Dei" (Gen 1:27), in the image and likeness of God. We respect human dignity by recognizing both a duty to care for the sick and personal responsibility for maintaining our own health.

Cognizant of this first principle, we must improve access, affordability and quality of care for all United States citizens. Knowing the second, we are obligated to care for ourselves and family. Patients with stronger incentives to stay healthy could decrease expenditures associated with smoking, obesity, diet-controlled diabetes, atherosclerotic heart and peripheral vessel disease, strokes, alcoholism, and osteoporosis, to name a few.

If patients participated more directly in paying for their care, medical resource consumption would diminish. Patients paying at the point of service are more prudent purchasers of health care than those perceiving health-care benefits as an entitlement. They seek to be more informed. They ask more questions about quality, outcomes, and cost. Patients directly paying insurance premiums would lead to stronger demand for better service. The affluent elderly could bear more financial responsibility.

The Second Vatican Council defined the common good as, "the sum total of social conditions which allow people, either as groups or as individuals, to reach their fulfillment more fully and more easily." This precept contemplates the allocation of scarce resources. The common good would be better served with market-oriented reforms rather than expanding government or employer based health-care. Third-party responsibility for health care promotes resource overconsumption. The $250 billion federal tax subsidy for employer based health-care could be more justly deployed. Increasing insurance industry competition would improve affordability and quality, including allowing insurance purchase from states without expensive mandates.

The principle of subsidiarity places a duty on those closest to a need to provide care: "A community of a higher order should not assume the task belonging to a community of a lower order and deprive it of its authority. It should rather support it in case of need" (Catechism of the Catholic Church). Subsidiarity encourages assistance for those unable to access the health care market. It motivates care by those closer to the sick than government or employer.

Pope Benedict XVI recently stated, "we do not need a state which regulates and controls everything, but a State which .generously acknowledges and supports initiatives arising from the different social forces and combines spontaneity with closeness to those in need." Lower order groups such as community organizations, unions, and churches could help individuals and families purchase insurance at more competitive rates than on the individual market. Insurance obtained outside the workplace would be portable. Workers would be less susceptible to the double jeopardy of income loss and health care loss with layoff or job change. The doctor-patient relationship could be strengthened with less third-party intrusion by government, employer, or insurance carrier. Primary care physicians can assist their patients and families in cost conscious decision making, in addition to encouraging lifestyle and diet changes that can have tremendous impact on preventable or modifiable chronic disease.

Finally, the principle of solidarity concerns responsibility to the less fortunate. Health care reform will be judged by our commitment to the poor and vulnerable. We ought to love our neighbor, feed the poor, cloth the naked, and care for the sick (Mt 25:40). Vouchers or tax credits could facilitate access to the medical marketplace. A safety net for immigrants, the marginalized, and those with chronic disease, is necessary for those who might have still have difficulty obtaining insurance despite market-oriented reform.

Those advocating greater government control of health care ought to reflect on Pope Benedict XVI's 2005 encyclical Deus Caritas Est: "Love-caritas-will always prove necessary. the State which would provide everything, absorbing everything into itself, would ultimately become a mere bureaucracy incapable of guaranteeing the very thing which the suffering person-every person-needs: namely, loving personal concern." These social justice principles provide a foundation for a virtuous and economically sound improvement in medical resource allocation: a Christian prescription for health-care reform.


No comments: