Foreword

Provision of health care has ever been an integral part of the Christian mission. From the early centuries of the Church, followers of Jesus sought to reflect the kind of charity that he demanded in the parable of the Good Samaritan. “Visit the sick” became one of the customary works of mercy, a set of practices to guide Christians in living out the faith to which they adhered. Congregations of religious men and women under the leadership of saints such as Camillus de Lellis and Louise de Marillac have been major—sometimes primary—suppliers of medical assistance, palliative care, and spiritual succor to the ill since the Middle Ages.

Given this history, Christians ponder health care delivery in the twenty-first century from a position of long experience. Yet the advance of technology, changing societal mores, and economic development create new contexts in which to apply the venerable principles of the gospel message.

Donald Condit, a practicing physician, brings together careful reflection on Catholic social teaching, a mass of empirical data, and his firsthand experience of medicine in this outstanding treatment of health care from a Christian perspective. Although this monograph focuses on the situation in the United States, parts of the analysis will be relevant to other national contexts. Many of the questions are universal: Which principles of social doctrine are pertinent to health care? How can health care be made accessible to all without ceding control to central authorities? How can the rapidly rising costs of care be curbed? Which kind of medical system will most consistently reflect the central directive of the Church’s social teaching: honor the human dignity of every person?

These are daunting questions that Dr. Condit approaches with circumspection. Failing to answer them to the best of our ability, however, is not a viable option for responsible citizens. Dr. Condit furnishes informed and intelligent guidance for those trying to understand the problems troubling health care provision and searching for ways to address them.

—Kevin Schmiesing, Acton Institute

Introduction

“Every generation has the task of engaging anew in the arduous search for the right way to order human affairs.”

-Pope Benedict XVI, Spe Salvi, no. 25

The ethical allocation of health care resources is an exigency of our time. As the third millennium begins, “new things” contributing to injustice in United States health care include technologic advance, the demographic “silver tsunami,” and the globalization of business. Forty-six million uninsured, and millions more precariously insured, serve as witness to a dysfunctional system. Dissatisfaction propagates among patients, providers, employers, and taxpayers as costs continue to escalate. Medical spending in the United States was $2.2 trillion and constituted more than 16 percent of gross domestic product (GDP) in 2007. In ten years it is expected to exceed $4 trillion and comprise nearly 20 percent of GDP. The Medicare Trust Fund is expected to be insolvent by 2019. Small businesses are increasingly unable to afford insurance premiums, and health care costs to large businesses undermine their ability to compete in the global marketplace. In certain fields, and in some locales, physician shortages are compromising communities’ health care. The poor and vulnerable, who deserve special attention from Christians, can expect greater difficulty accessing medical care without significant change in our health care system.

How ought those committed to the common good proceed?

Well-intentioned leaders seeking to improve the health care situation in the United States often advocate “comprehensive” or “universal” reform which, in reality, calls for more government involvement in health care. However, the present extent of government involvement in health care has been weighed and found wanting. Over 50 percent of health care is currently government funded, and spending is increasing exponentially. Moreover, 86 percent of medical spending is by a third party, that is, by someone other than the consumer of those services, yet much of health care spending is the result of factors under individual control. Chronic diseases, which account for 75 percent of health care expenditures, are influenced by modifiable risk factors. Smoking, diet, physical inactivity, and alcohol use account for 38 percent of all United States deaths. The National Center of Health reports that two-thirds of American adults are currently obese or overweight.

More critically, our three branches of government have failed to protect the universal and inviolable rights deserved by human beings, created imago Dei, from conception to natural death. Early in his administration, President Obama has authorized the use of tax dollars to fund abortion-providing organizations in other countries and to pay for research that destroys human embryos. In this climate, is it prudent for men and women of good will to advocate for more government responsibility? “The common outcry,” Pope John Paul II wrote in 1988, “which is justly made on behalf of human rights—for example, the right to health, to home, to work, to family, to culture—is false and illusory if the right to life, the most basic and fundamental right and the condition for all other personal rights, is not defended with maximum determination” (Christifideles Laici, no. 38). More recently, the Congregation for the Doctrine of the Faith has reiterated forcefully, “The dignity of a person must be recognized in every human being from conception to natural death” (Dignitas Personae, no. 1).

If government cannot be trusted to handle health care in a morally sensible way, what then? Any suggestion that the sick, injured, poor, and vulnerable can meet the prerequisites for a market transaction that does not fail social justice deserves serious scrutiny. Prerequisites for genuine market transactions include adequate information, absence of duress, consumer choice, and competition. These elements are frequently compromised in health care encounters. Nonetheless, “A truly competitive market is an effective instrument for attaining important objectives of justice” (Compendium of the Social Doctrine of the Church, no. 347). The challenge, it seems, is to create a workable health care market and enable all to participate in it equitably.

This monograph seeks to promote understanding and deliberation concerning the critical circumstances of health care in the United States. While its focus is the United States, various pieces of the analysis can be applied to other countries. Furthermore, it discusses more socialized health care systems in comparison. Our intention is to improve the health status of the poor and vulnerable, paying special attention to the benchmark of human dignity, while fostering innovation in medical care. We suggest that morally guided and market oriented reform is more just and sustainable than increasing government responsibility for health care. In this proposal, we seek to apply the principles of a Christian social ethic to the circumstances of our time. We recognize that there are other approaches to the problem, and that others may reach other conclusions based on sincere attempts to make the same application. “The moral imperative to respond to the needs of our neighbors—basic needs such as food, shelter, health care, education, and meaningful work—is universally binding on our consciences,” the United States bishops have insisted, but this imperative, they continue, “may be legitimately fulfilled by a variety of means.”

We begin with a consideration of the unsustainable and unjust nature of current conditions. A discussion of Catholic social teaching and its relevance for health care reform follows. A historical review of the evolution of health care in the United States provides insight into our dysfunctional circumstances. The two succeeding chapters examine the deficiencies in the existing employer-based system and the movement toward more socialized health care. Finally, we offer a prescription for reform based on the inherent dignity of the human person.