Health Care for All: A Catholic Perspective
Hehir, J. Bryan, Commonweal
The Clinton administration's Task Force on National Health Care is scheduled to submit its report to the president this month. The report, of course, will be a proposal, and its publication will signal the beginning of a new phase of the national debate on health care. The U.S. argument about health care reaches back to the early 1970s, but the Clinton campaign and the Clinton presidency have generated new expectations for change, and its proposal for reform will provide a defined focus for the public debate. Among the institutions which are prepared by ideas and experiences to contribute to the national assessment of health-care reforms is the Catholic church. The church's participation in the policy process exemplifies the diverse dimensions of its public life. There will be space in the public argument for the church to act as a teacher, as a voice of public advocacy, and as an institution deeply involved in health care at the local and national levels.
These distinct roles correspond to the three major concerns which the church has in the U.S. health-care problem. The first is health care as a social justice issue, involving the question of access to health care available to the citizenry. The second is health care and medical ethics (or bioethics), involving a broad range of questions which have been traditional concerns of Catholic moral teaching. The third is the role of Catholic institutions as participants in the ministry of health care in the United States. What follows is an effort to describe the content of each of the church's interests and to highlight points of tension among these complex concerns.
A major part of the national debate in health care is focused on issues of social justice; at the heart of this policy question is the fact that close to 40 million individuals have no access to health insurance.
There are different ways to frame the social justice argument about access to health care, and some of the members of the Task Force are ethicists who have been arguing the justice case over the last decade. Using categories from Catholic social teaching to make the social justice case produces the following structure of argument. The first step is defining the right to health care; the right is a moral claim to a good (health care) which is essential to human dignity. The affirmation of the right finds concise expression in John XXIII's Parera in terris (1963). While the right is declared, the papal text did not spell out the content of the right. Using the common logic of the social teaching, however, one could say that the right to health care should assure for each person a basic minimum of benefits which will vary with the economic capability of the society in which the right is being secured. In the U.S. debate, the church will have to engage the questions of universal access and the definition of which health-care benefits should fall within the category of minimum levels of care.
The assertion of each one's right to health care leads, secondly, to a determination of who has the duty to respond to the right. Hem several elements of Catholic social thinking converge. The duty in the first instance falls on society as a whole; meeting the need for health care is an essential aspect of the common good. Society fulfills the responsibility to provide health care for each person through a multiplicity of agents. Catholic teaching on subsidiarity restrains the notion that the state should be the first agency to respond to the right; but the state clearly has moral responsibilities, and a major role in meeting the health-care needs of the society. Both John XXIII's explanation of socialization in Mater et magistra (1961) and John Paul II's definition of the duties of solidarity in society establish the foundation for a positive and activist role for the state in responding to health-care needs.
But subsidiarity encourages the search for other agents, "lesser than" the state, which also have obligations to meet the right to health care of each citizen. …