Sacrament and Solidarity: Catholic Social Thought and Health Care Policy Reform
Cochran, Clarke E., Journal of Church and State
The religion and politics border occupied by Catholic social thought and American health care policy contains rich material for reflection. Religious institutions, particularly Catholic, are deeply embedded in both health care delivery and health care lobbying. Each activity is consciously driven by understandings of the imperatives of Catholic social thought and by institutional missions formulated with the intention of realizing commitments that flow from Christian faith lived within the Catholic tradition. Because health care delivery is powerfully shaped by public policies at the federal and state levels, Catholic leaders, Catholic institutions such as hospitals, and Catholic theologians have been driven to reflect on and to deliver health care within a context powerfully political and public. They have also for many years engaged in policy advocacy to influence the economic, social, and legal environment of their activity. Moreover, just as Catholic health care acts and advocates, it reacts to public policies that affect not only the "externals" of health care delivery, but also the essential mission and identity of Catholic institutions. Catholic health care has challenged and been challenged by public policy. This mutual questioning on an important boundary between politics and religion makes the topic of Catholic social thought and health care policy reform intensely interesting for students of church and state.
THE IMMEDIATE CONTEXT
The preceding reflections suggest a complexity deepened by a widely-drawn conclusion and by a conundrum. The conclusion is that American health care (including health care policy) is a disaster from the perspective of Catholic social thought. The system violates principles of justice, stewardship, and care of the poor. It violates human dignity and the common good as well, making into a market commodity what should be a social good. The conundrum is that the Catholic Church and Catholic health care are deeply planted in the very system that violates their principles. It is a version of the Constantinian dilemma faced by Christians for the last millennium and a half. As Bryan Hehir has said, "When you try to be both an actor and an advocate-to represent both effective, efficient action and the vision and voice of the prophets-you have introduced significant tension."' ' A FUNDAMENTALLY FLAWED HEALTH CARE SYSTEM
This is not the place to detail or justify the conclusion that Catholic social thought reproaches the American way of organizing health care.2 A brief summary will suffice. Health care analysts use three large criteria for assessing a health care system: the degree of access of citizens to health care; the financial cost of the system; and the quality of care provided. In most areas of life, two out of three "ain't bad." Every modern, democratic nation in the world provides universal access to health care for its citizens at a cost lower than the United States and with a high quality of care. The American health care system, on the other hand, fails dreadfully on two of the three criteria. Access to care is severely limited for millions of citizens, and cost of health care is by far the highest in the world-absolutely, per capita, and as a percent of GDP. Health care resources are squandered, and the excess social resources flowing into the health care system stymie other social responsibilities. Only on the standard of quality does America look strong. Yet quality of care falls very short in certain respects. Inappropriate care is too often given, especially close to the end of life, and millions of persons cannot afford quality care.
In addition to these well-recognized flaws in the system, fundamental changes now occurring in the system itself seriously challenge Catholic commitments. These too can be only quickly mentioned. Most prominent are the changes that often travel under the heading of "managed care," but which are broader and deeper …
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Publication information: Article title: Sacrament and Solidarity: Catholic Social Thought and Health Care Policy Reform. Contributors: Cochran, Clarke E. - Author. Journal title: Journal of Church and State. Volume: 41. Issue: 3 Publication date: Summer 1999. Page number: 475+. © 1999 J.M. Dawson Studies in Church and State. Provided by ProQuest LLC. All Rights Reserved.