I write this as the new health insurance exchanges, a key part of the “Affordable Care Act” (a.k.a. “Obamacare”) are about to open for business. The exchanges are only one part of the ACA. Its overall purpose is
- to make health care more affordable by sharing the risk among more people through mandatory insurance. More insured patients will also reduce the burden for Catholic hospitals, who are often a source of “last resort” charity care for the uninsured.
- to increase efficiency and lower overall costs by finding a “medical home” for each patient and by collecting evidence of best practices through electronic medical records;
- to focus on health and prevention rather than sickness and intervention.
- Despite these apparent benefits, many Americans are fearful. Some fear the loss of freedom to choose their own doctor or the kind of care they receive. Others see it as a free handout to those who didn’t work to earn it. But health care is a social good, not just a commodity. We must decide together how to allocate these basic human goods.
Every law limits freedom for the sake of the common good in some way, and the ACA is no exception. But it does so because health care is one of those things we cannot provide for ourselves. Health care is a human good that requires the cooperation of many people. Even doctors have doctors. Like education, music, sports or military defense, health care is a “team sport.” Making it work for all of us means that each of us has to relinquish some individual freedoms for a big payoff in terms of a social good.
Others argue that the ACA will cost too much, but the amount of money we spend on health is not the problem. The United States already spends twice as much on health care as any other industrialized nation ($8,600 annually for every man, woman and child), but our outcomes are not twice as good. In many areas (longevity, infant mortality, and management of chronic illnesses) we do a worse job than many other countries. On top of that, there are 40 million people with no health insurance coverage at all. The problem isn’t that we don’t spend enough money on health care. The problem is that we don’t spend it wisely.
Others worry about “socialized medicine” – but “socialized” means many different things. It can mean government-owned health care (like England’s National Health Service or the Veterans Health Administration in the US); it can mean government as a single payer (as in Canada); or it can mean government sets standards for health insurance, penalties for poor performance by hospitals, and subsidies to help the poor buy private insurance. That’s what the ACA does.
“Socialization” is not a dirty word for Catholics. For us it means “acting for social good or for the common good” rather than just for private interest. This is what Catholic Social teaching refers to. It is rooted in the conviction that basic human goods belong to everyone and must be allocated as justly as possible.
There are also fears that this new legislation will violate individual conscience or religious freedom by forcing providers to cooperate in procedures they find morally objectionable or that Catholic institutions will be forced to contribute to insurance plans that pay for birth control or abortion. In fact the bill provides explicit conscience protection for providers and specifically prohibits any new federal funding for any abortions.
This has been spelled out since 1976 in the Hyde Amendment and reiterated in the Stupak amendment to the ACA, which forbids the use of federal funds, “…to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion” except in cases of rape, incest or danger to the life of the mother. It does not even allow federal subsidies for insurance coverage for those who can’t afford it to cover abortion. Anyone who wants abortion coverage must choose a special plan that uses no federal money.
Professor Timothy Jost, a professor of health care law at Washington and Lee University, has said “The ACA may be the most pro-life piece of legislation ever adopted by Congress.” This is because it will provide life-saving coverage to millions of Americans. It will emphasize preventative care and management of chronic illness eliminating a great deal of suffering and expense.
Of course the ACA is not risk free. It is a huge and complicated piece of legislation that could have unforeseen consequences. However, I believe that its primary goals – increased access, more equitable coverage, and greater efficiency and quality – are thoroughly consistent with Catholic social teaching. The obvious benefits make the risks worth taking.
Catholics may not like details of this particular piece of legislation, but its overall goals are not optional.