For this week's Common Good Forum, we invited Dr. Mary McDonough to do a Catholic analysis of Obamacare nearly a year after the open marketplace for the program began. McDonough is the author of Can a Health Care Market Be Moral?: A Catholic Vision.
Most Christians are familiar with the circumstances surrounding St. Paul’s conversion. While traveling along the road to Damascus, suddenly a bright light flashed around him. He fell down and then heard the voice of Jesus. Upon opening his eyes he was blind. Although his sight returned 3 days later, his life was never the same. From that point on, St. Paul saw the world in a completely different way.
Conversion stories fascinate me. There are many different kinds of conversions. They do not necessarily have to involve religion but they share something in common: actions or words of others or an unexpected experience forces us to see things in a new way. In fact, the word conversion is related to the Greek word metanoia which means “changing one’s mind.” If you think about it, we change our minds when we see things differently.
In the past year there has been much spectacle, debate, litigation, and misinformation surrounding the Affordable Care Act (ACA). It is so easy to get lost in the mire of opinions about our health care system. When this happens we need to look to Catholic social teaching with its interpretive framework of meaning and unique understanding of the world, its special way of “seeing” that helps us identify underlying values which can be used to assess the health care debate.
Catholics often speak about human dignity. Yet sometimes we overlook an essential element of human dignity, what Paul VI referred to as “a Christian vision of development” (Popularum Progression). He points out that each one of us is born, not only in the image of God, but also with a distinct personality and set of aptitudes. We must have access to basic necessities in order to fully develop these unique gifts so we can use them “toward the destiny intended for us” by God.
Few people, however, can fully develop their potential without access to health care. There is a direct, undeniable link between lack of health insurance and poor health outcomes. Uninsured populations in the US have a 25% higher mortality risk than insured populations. Uninsured children are not only more likely to die prematurely, but they suffer from low birth weights and untreated chronic illnesses at much higher rates than insured children. A direct connection also exists between a lack of health insurance and delayed development in children. Many common, treatable conditions such as ear infections, asthma, and iron deficiency anemia do not get treated in uninsured children resulting in chronic suffering, school absences, and substandard learning.
Moreover, Catholic social teaching recognizes that social justice cannot be understood apart from the labyrinth of social relationality. We are social beings who live in a world where our economic, cultural, and political structures are all interconnected. In 2012, over 47 million people under the age of 65 were uninsured; three-quarters of them for over a year. Between 2003 and 2013, health insurance premium rates rose a startling 80%. The economic impact of large numbers of uninsured people is devastating. Prior to the enactment of the ACA, about half of all bankruptcies in the US were the result of medical debt. Uncompensated medical bills cost hospitals over $41 billion. The social impact is no less devastating. With the burden of uninsurance comes insecurity, an anxiety within families about loss of employment, financial debt, and trying to care for sick family members.
As Catholics we cannot assess health care reform without evaluating how it impacts the poor and vulnerable for “the Gospel instructs us in the preferential respect due to the poor” (Octogesima Adveniens). Yet, the pre-ACA system had a particularly harmful impact on the marginalized in our society. In 2012, 38% of individuals living below the poverty level were uninsured; 55% of those who were uninsured were minorities. And remember, before the ACA, the sickest in our society—people with pre-existing conditions—lost their insurance, were denied coverage, or could not afford the cost of premiums if they were actually able to find coverage. While some gaps in coverage remain, the ACA has helped the poor and vulnerable significantly through premium subsidies for low and middle income Americans and a ban on insurance companies denying coverage to those with pre-existing conditions.
Catholic social teaching also has an answer for people who bemoan the expanded role of government in the ACA. The Church values government because it is best suited to serve the public interest and promote the common good. On the other hand, Catholic social teaching has traditionally been suspicious of market ideology for its emphasis on profit and self-interest. Pope Francis has continued this tradition by recently criticizing capitalism for its "trickle-down theories which assume that economic growth, encouraged by a free market, will inevitably succeed in bringing about greater justice and inclusiveness in the world. This opinion, which has never been confirmed by the facts, expresses a crude and naïve trust in the goodness of those wielding economic power and in the sacralized workings of the prevailing economic system” (Evangelli Gaudium).
One of the reasons the US health care system fell into such disarray in the first place stems from its reliance on market practices. The use of market mechanisms, such as private insurance, managed care, and high deductibles, has steadily increased over the past 45 years. Market ideology, with its bias toward profit, individual preferences, the creation of demand for products, and total lack of consideration for the common good, has little to contribute to the health care system. When it comes to the oversight and management of health care, however, the government can focus on the public interest by coordinating local, regional, and national health care programs toward a common goal: a universal, equitable, quality system.
Finally, the Catholic vision of the common good also informs our underlying vision of health care. The good of the community is more important than the good of the individual. No one can make a credible argument that our former health care system with its disparities, inaccessibility, and unsustainability is the best system to serve the common good
While the ACA is not perfect, it is a step in the right direction. We cannot return to the broken system of our past. Instead we should let Catholic social teaching open our eyes to a new vision of health care. One founded on principles of social justice.