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Health-Care Reform Won't Work without Justice

By Barnet, Robert J. | U.S. Catholic, November 1994 | Go to article overview

Health-Care Reform Won't Work without Justice


Barnet, Robert J., U.S. Catholic


I interned in Boston when the legend and legacy of Mayor James Michael Curley was still alive. Food was supplied to the needy of South Boston, Roxbury, and Dorchester from the loading dock of City Hospital. Politically expedient or not, there was an attempt to provide for the basic needs of the community. Like many other public institutions, City Hospital played an important role in that effort. I never knew my paternal grandmother. She died of childbirth fever on a cold January day in northern Indiana when my father was three weeks old. Thirty years later a physician removed my tonsils in his office to pay off the pharmacy bill that he owed my father. Both society and American medicine have undergone profound changes. It is time for a reevaluation.

There are political, social, cultural, and economic forces that have combined to create in the United States a health-care system that is unjust and inadequate in terms of meeting basic human needs. Institutional and entrepreneurial forces have typically defined our needs; our system is currently driven by profit, often without needs being independently established and with benefits claimed that are not adequately documented. We need to replace those forces with policy initiatives that are consistent with Catholic social teachings, Catholic moral principles, and the American democratic tradition.

Reform of the current health-care system has been the goal articulated most often in the current debate. Much of the rhetoric and planning has dealt with how to make more available and how to finance what is now in place. Reform typically refers to the removal of faults and abuses. What is needed is comprehensive and fundamental change in attitudes and in structure. As part of the discussion on health care, there is a need to examine the deeper social problems and to explore ways in which they can be resolved. There must be a return to real communities, ones that define their own needs and pursuits, identify their own values, and recognize that social policies are best sustained by the community itself.

The current U.S. health-care system is manifestly unjust because millions are deprived of significant access to basic health care because of their economic situation, educational background, social standing, or the nature of our social structures. Considering what other countries have, it is evident that the U.S. has adequate resources to meet societal needs, including basic health care. There is not, I grant, a formal constitutional or legal right to health care. However, there is a derivative moral right to at least some level of health care. This is based on the fact that in our society at this time, access to basic health care is necessary to ensure and nourish the fundamental worth and dignity of the human person. That dignity is unrelated to the merits of the individual. It exists independent of the strengths or weaknesses, successes or failings of the person in need. Because the foundational principle on which justice is ultimately based is the dignity of the person, it is crucial in health-care reform to focus on needs and how the dignity of the person is best guaranteed rather than on the distribution of available goods. We could guarantee everyone an equal share, but unfortunately not everyone begins with equal natural or material assets and their needs differ. Therefore, those who would be most likely excluded from access to health care would often be those with the greatest need.

We all are part of a social community. As Americans and especially as Christians, we are challenged to feed the hungry, clothe the naked, and shelter the homeless. That concept, central to both democratic and Catholic social thought, is made explicit when we speak of exercising a preferential option for the poor. What is new in the past 40 years is that, because of changes in our society and in health care, the provision of universal access to basic health care has become part of that mandate.

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Health-Care Reform Won't Work without Justice
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