Fr. Roger J. Landry
The Anchor
Editorial
August 7, 2009
Everyone knows that our health care system is in need of reform. Rising costs are crippling the budgets of families, small businesses and even large corporations. Insurance plans are charging more to cover less. Roughly fifteen percent of Americans have no health insurance at all. Doctors, saddled with astronomical medical school loans and even higher annual malpractice insurance rates, often are forced to adopt working hours and styles contrary to their own good and their patients’ care. There is a critical shortage of nurses.
At the same time, parts of the system remain the envy of the world. In terms of medical training, advanced equipment, research and diagnostic capabilities, surgical and trauma care, America is without equal. Few Americans, if they or a loved one had a life-threatening medical emergency, would prefer to be in Toronto or London, rather than in Boston or any other major American city.
Any legitimate reform needs to seek to fix what’s broken, rather than break the parts that are in no need of repair. It’s not the whole system that is ailing, but only parts of the system; prudent reform will seek not to replace the entire system with foreign models that have never produced excellence, but to fix the evident problems while maintaining the conditions that help foster the excellence. Otherwise, we might not achieve genuine reform, but a deformation and worsening of our health care system — essentially killing the patient as a whole rather than treating what’s diseased.
Because our health care system is complex, real reform is obviously complicated work. That’s why it is alarming and absurd that the presidential administration and certain legislators on Capitol Hill were in a frantic rush to ram through what they were calling “reform” by an artificial deadline, before the president himself and many of the legislators had even had a chance to read what was in the proposed bills under discussion. To ensure that change doesn’t end up for the worse, it’s important that all aspects of the proposed legislation have a chance to be reviewed, not merely by the legislators but by concerned citizens, institutions and experts. This is the way that we can seek to ensure that we get real reform, rather than are forced for no reason other than Congressional impatience to accept the bad with the good.
Leaders of the U.S. Bishops Conference, which has long advocated comprehensive health care reform, have had a chance to review the bills in the House of Representatives and in the Senate and have called attention to two of the most problematic aspects. The first involves abortion coverage. Cardinal Justin Rigali of Philadelphia, Chairman of the Pro-Life Activities Committee of the U.S. Bishops, wrote in a July 29 letter to Congress that “much-needed reform must not become a vehicle for promoting an ‘abortion rights’ agenda or reversing longstanding current policies against federal abortion mandates and funding.”
He specified three ways that the proposed legislation in the House of Representatives can be used to promote abortion. First, “the legislation delegates to the Secretary of Health and Human Services the power to make abortion a basic or essential benefit in all health plans, or in the ‘public plan’ created by the legislation.” Second, “because some federal funds are authorized and appropriated by this legislation without passing through the Labor/HHS appropriations bill, they are not covered by the Hyde amendment and other provisions that have prevented direct federal funding of abortion for over three decades.” He says that the legislation needs to add a provision to prevent funding abortion. Third, “provisions such as those requiring timely access to all benefits covered by qualified health plans could be used by courts to override and invalidate state laws regulating abortion, such as laws to ensure women’s safety and informed consent and to promote parental involvement when minors consider abortion.” He said that the legislation must be reworked to make clear that such laws will not be preempted.
Dr. Louis Breschi, president of the Catholic Medical Assocation, spoke out directly about the ethical concern Catholic doctors have about the proposed legislation. “Most analysts think that, without explicit exclusion, abortion will be mandated by the Secretary of HHS and/or by the courts. … Few people realize that, as things stand, abortion could be a required benefit in all health insurance plans, and it would be subsidized not only in health-care premiums, but also through taxation. This unjust mandate must be excluded.”
The second major threat Cardinal Rigali specified was to the conscience rights of health care providers not to have to participate in practices — like abortion, euthanasia and sterilization — that violate the well-informed conscience of any Catholic. The executive director of the Catholic Medical Association, Dr. John Behany, noted, “The House Tri-Committee bill does not even mention the topic of conscience rights of health-care providers, and Democrats on the Senate H.E.L.P. Committee voted against an amendment that would have prohibited forcing health-care providers to perform or participate in abortion. This issue is very timely, since the department of Health and Human Services canceled a Conscience Protection Rule earlier this year and has not announced what will replace it.” Since the Department of Health and Human Services, which is slated to be the lead agency in the implementation of health care reform, has just this March already weakened conscience protections, the bishops and Catholic doctors want to make sure protections are in place ahead of time.
Doctors at the Catholic Medical Association listed additional problems. “Apart from ethical concerns, the CMA finds significant shortcomings in the economic and clinical aspects of current legislation. First, as the Congressional Budget Office points out, the legislation does nothing to reduce long-term costs. Rather, current legislation increases costs by hundreds of billions of dollars even after tax increases and creative accounting measures. Second, the bills’ attempts to control costs and increase access rely on heavy-handed government control that is antithetical to the rights of patients and physicians, and to good clinical care.” It is contrary to the principle of subsidiarity — one of the central principles of Catholic social justice that teaches that authority should always be vested at the lowest feasible organizational level — to locate so much authority for medical care and decision-making at the federal level with the Secretary of Health and Human Services and with the “Health Choices Commissioner.” Although there are obvious inefficiencies in the current health care system, which need to be fixed, few would consider the inefficiency of a massive government bureaucracy a genuine solution.
The CMA also points out, “This heavy-handed federal control is made worse by two additional provisions. First, House bill regulations make it almost impossible for any current health insurance plan to survive in a new government-controlled regime. … Second, House and Senate bills plan to extend health insurance coverage to millions of people by moving them onto the Medicaid rolls. However, the flaws of Medicaid are well-known—its costs have run out of control in most states, and forty percent of physicians are compelled to refuse Medicaid patients because Medicaid’s low reimbursement rates do not even cover the overhead cost of office visits. Adding millions of people to this flawed system will not constitute meaningful health insurance coverage.” These problems would be exacerbated by a ‘public option’ plan which would ‘compete’ with private health insurance, as called for in the House Tri-Committee bill. But there is no way that private companies can fairly compete with the federal government. … The result is that everyone, sooner than later, will be forced to become participants in the ‘public option’ plan and fully subject to the costs and regulations of government health care. When this happens, the American people will have lost the freedom to make important decisions about their life and health.”
The CMA summarizes its review of the bills by stating, “Sound reform must be based on sound ethics and economics; but so far, the House and Senate bills meet neither standard.” Genuine health care reform deserves both.