A Christian Approach to Healthcare Reform

For better or worse, well its definitely worse, but it looks like barring Divine intervention we are going to have a national healthcare program. However unless we want to see the inevitable bankruptcy to the country caused by such a program we ought to still work to influence the ultimate direction healthcare reform takes. Dr. Robert Condit has a well written article on A Christian Perspective for Healthcare Reform.  We would have been better off if this were followed before the passage of the Bill from Hell but we cannot give up the fight. 

How should health care in the United States be reformed? The principles of social justice outlined in Catholic social teaching can be considered by all those of good will as guidelines for ethical health care reform. Those principles, are the dignity of the human person, the common good, solidarity, and subsidiarity. These four social-justice principles provide a foundation for a virtuous and economically sound improvement in medical resource allocation; a Christian prescription for health care reform.

It is clear that we have a duty to improve access, affordability, and quality of care for all citizens because of their human dignity. Frequently missing from the discussion of health care reform is the role of personal responsibility. Pope Benedict XVI has emphasized the point: “In the name of freedom, there has to be a correlation between rights and duties, by which every person is called to assume responsibility for his or her choices.” [This is a huge issue than will not be resolved simply by giving people a health insurance card and telling them to go see a doctor when they are sick.  Some time back I quoted the late Fr. McNabb O.P. on this same issue where he said it is time we stop hearing about the rights owed us and instead start recognizing the duties we owe to God.]

Behavior and responsibility for the consequences of personal health choices need to be linked for significant health care reform. If patients participated more directly, at the point of service, in paying for their care or for their medical insurance, medical resource consumption would diminish. More health care resources could be used for prevention of disease than spent on chronic illness associated with modifiable risk factors. The 38 percent of American deaths caused by the behaviors of smoking, diet, physical inactivity, and alcohol use could be mitigated.  Patients with stronger incentives to stay healthy could decrease expenditures associated with smoking, obesity, diet controlled diabetes, atherosclerotic heart and peripheral vessel disease, strokes, alcoholism, and osteoporosis, to name a few. Two-thirds of Americans are overweight, which directly correlates with chronic disease and increased health care spending.  [A couple years ago the Belgian Minister of Public Health gave a talk at the Brookings Institution which highlighted among other issues the significant obesity problem in America compared to Belgium and the rest of Europe. This factor must be taken into account when trying to draw comparisons to the national healthcare programs in other countries. He also said that America has to deal with the issue of tort reform, something ardently fought against by the Democrat Party beholden to trial lawyers.  In Belgium everyone is expected to pay something, regardless of income, on a sliding scale]

Christ’s teachings on justice did not omit discussion of personal responsibility. “He will repay all according to his conduct” (Matt. 16:27). Contemporary platforms for health care reform can neither neglect nor discount personal behavior and accountability.  [I have seen numerous times people calling 911 for respiratory distress only to arrive and find them smoking endlessly with a full ashtray and their oxygen tank humming along beside them.  Never mind the obvious danger of mixing smoking and oxygen but again this type of behavior will not change simply because people have access to nationalized healthcare since many of them were already on Medicare/Medicaid.]

Patients’ paying for health care at the point of service are more prudent purchasers of health care than those perceiving health care benefits as an entitlement. They would spend less on health care if they took better care of themselves for modifiable conditions. They seek to be more informed and ask more questions about quality, outcomes, and cost. Furthermore, as consumers, they are more motivated to negotiate regarding costs of elective treatment decisions. Medical inflation would improve. Patients’ directly paying insurance premiums, rather than indirectly through foregone wages or by taxes, would lead to stronger demands and competition for quality of service from insurance companies.

The Medicare Trust Fund is expected to become insolvent by 2019. Medicare patients are going to have to bear more financial responsibility for their health care decisions, particularly for elective procedures. Presently, physicians and hospitals rarely are asked about the cost of care by patients and families when they expect insurance to cover their bills. Definitions of extraordinary care could consider financial expenditure. Medical resources are not unlimited. Less futile end-of-life spending could potentially increase resource availability for more preventative and basic care, while at the same time promoting greater respect for human dignity. This is an area in which the Church’s teaching offers invaluable guidance. Cases of withholding ordinary care have rightly garnered national attention and provoked outrage, but it is also true that the technological extension of life by extraordinary means can absorb significant resources without enhancing the prospects for a dignified and natural death.

The affluent elderly could bear more financial burden for their health care. The established social contract where workers’ taxes provide for medical expenses of those over sixty-five has to be reconsidered given demographic changes as well as advances in expensive technology and specialty care. Fewer workers are paying taxes to support the ever expanding percentage of the population that is retired.

Some argue that medical care demand is inelastic; the quantity of care demanded is not sufficiently influenced by prices, and increasing consumer responsibility for payment will not curb health care spending. However, much of health care is not emergent. Many patients are sophisticated enough to become informed health care consumers, as they are for other goods and services. Primary care physicians can assist their patients and families in cost-conscious decision-making, in addition to encouraging lifestyle and diet changes that can have tremendous impact on preventable or modifiable chronic disease. There is opportunity for a more just allocation of the two trillion dollars spent annually on health care in the United States. Half of the United States population spends very little on health care, while 5 percent of the population spends almost half of the total amount. The RAND Health Insurance Experiment, completed in 1982, identified considerable price elasticity, wherein some personal financial responsibility for health care did not significantly affect quality of care.

What if consumers choose not to purchase, or cannot afford, health insurance? Should someone be denied care because they cannot pay? It is reasonable to seek to agree on primary care services or basic safety-net coverage that might be provided to all citizens; for example, children’s health, pregnancy care, and emergent and urgent conditions. Market forces would identify fundamentally desired health care service more effectively than committees or bureaucracies. Furthermore, incentives need to be created to encourage patients to avoid emergency rooms for non urgent conditions. As a society, we cannot turn our backs on the indigent. However, unlimited procedures and treatments are not possible. Patient participation in the cost of their care, even a small percentage, is a more just situation than abdicating total control of payment and what is provided, or denied, to a third party. Human dignity is promoted by reforms respecting both duties to others and personal responsibility.

A Christian Approach to Healthcare Reform

For better or worse, well its definitely worse, but it looks like barring Divine intervention we are going to have a national healthcare program. However unless we want to see the inevitable bankruptcy to the country caused by such a program we ought to still work to influence the ultimate direction healthcare reform takes. Dr. Robert Condit has a well written article on A Christian Perspective for Healthcare Reform.  We would have been better off if this were followed before the passage of the Bill from Hell but we cannot give up the fight. 

How should health care in the United States be reformed? The principles of social justice outlined in Catholic social teaching can be considered by all those of good will as guidelines for ethical health care reform. Those principles, are the dignity of the human person, the common good, solidarity, and subsidiarity. These four social-justice principles provide a foundation for a virtuous and economically sound improvement in medical resource allocation; a Christian prescription for health care reform.

It is clear that we have a duty to improve access, affordability, and quality of care for all citizens because of their human dignity. Frequently missing from the discussion of health care reform is the role of personal responsibility. Pope Benedict XVI has emphasized the point: “In the name of freedom, there has to be a correlation between rights and duties, by which every person is called to assume responsibility for his or her choices.” [This is a huge issue than will not be resolved simply by giving people a health insurance card and telling them to go see a doctor when they are sick.  Some time back I quoted the late Fr. McNabb O.P. on this same issue where he said it is time we stop hearing about the rights owed us and instead start recognizing the duties we owe to God.]

Behavior and responsibility for the consequences of personal health choices need to be linked for significant health care reform. If patients participated more directly, at the point of service, in paying for their care or for their medical insurance, medical resource consumption would diminish. More health care resources could be used for prevention of disease than spent on chronic illness associated with modifiable risk factors. The 38 percent of American deaths caused by the behaviors of smoking, diet, physical inactivity, and alcohol use could be mitigated.  Patients with stronger incentives to stay healthy could decrease expenditures associated with smoking, obesity, diet controlled diabetes, atherosclerotic heart and peripheral vessel disease, strokes, alcoholism, and osteoporosis, to name a few. Two-thirds of Americans are overweight, which directly correlates with chronic disease and increased health care spending.  [A couple years ago the Belgian Minister of Public Health gave a talk at the Brookings Institution which highlighted among other issues the significant obesity problem in America compared to Belgium and the rest of Europe. This factor must be taken into account when trying to draw comparisons to the national healthcare programs in other countries. He also said that America has to deal with the issue of tort reform, something ardently fought against by the Democrat Party beholden to trial lawyers.  In Belgium everyone is expected to pay something, regardless of income, on a sliding scale]

Christ’s teachings on justice did not omit discussion of personal responsibility. “He will repay all according to his conduct” (Matt. 16:27). Contemporary platforms for health care reform can neither neglect nor discount personal behavior and accountability.  [I have seen numerous times people calling 911 for respiratory distress only to arrive and find them smoking endlessly with a full ashtray and their oxygen tank humming along beside them.  Never mind the obvious danger of mixing smoking and oxygen but again this type of behavior will not change simply because people have access to nationalized healthcare since many of them were already on Medicare/Medicaid.]

Patients’ paying for health care at the point of service are more prudent purchasers of health care than those perceiving health care benefits as an entitlement. They would spend less on health care if they took better care of themselves for modifiable conditions. They seek to be more informed and ask more questions about quality, outcomes, and cost. Furthermore, as consumers, they are more motivated to negotiate regarding costs of elective treatment decisions. Medical inflation would improve. Patients’ directly paying insurance premiums, rather than indirectly through foregone wages or by taxes, would lead to stronger demands and competition for quality of service from insurance companies.

The Medicare Trust Fund is expected to become insolvent by 2019. Medicare patients are going to have to bear more financial responsibility for their health care decisions, particularly for elective procedures. Presently, physicians and hospitals rarely are asked about the cost of care by patients and families when they expect insurance to cover their bills. Definitions of extraordinary care could consider financial expenditure. Medical resources are not unlimited. Less futile end-of-life spending could potentially increase resource availability for more preventative and basic care, while at the same time promoting greater respect for human dignity. This is an area in which the Church’s teaching offers invaluable guidance. Cases of withholding ordinary care have rightly garnered national attention and provoked outrage, but it is also true that the technological extension of life by extraordinary means can absorb significant resources without enhancing the prospects for a dignified and natural death.

The affluent elderly could bear more financial burden for their health care. The established social contract where workers’ taxes provide for medical expenses of those over sixty-five has to be reconsidered given demographic changes as well as advances in expensive technology and specialty care. Fewer workers are paying taxes to support the ever expanding percentage of the population that is retired.

Some argue that medical care demand is inelastic; the quantity of care demanded is not sufficiently influenced by prices, and increasing consumer responsibility for payment will not curb health care spending. However, much of health care is not emergent. Many patients are sophisticated enough to become informed health care consumers, as they are for other goods and services. Primary care physicians can assist their patients and families in cost-conscious decision-making, in addition to encouraging lifestyle and diet changes that can have tremendous impact on preventable or modifiable chronic disease. There is opportunity for a more just allocation of the two trillion dollars spent annually on health care in the United States. Half of the United States population spends very little on health care, while 5 percent of the population spends almost half of the total amount. The RAND Health Insurance Experiment, completed in 1982, identified considerable price elasticity, wherein some personal financial responsibility for health care did not significantly affect quality of care.

What if consumers choose not to purchase, or cannot afford, health insurance? Should someone be denied care because they cannot pay? It is reasonable to seek to agree on primary care services or basic safety-net coverage that might be provided to all citizens; for example, children’s health, pregnancy care, and emergent and urgent conditions. Market forces would identify fundamentally desired health care service more effectively than committees or bureaucracies. Furthermore, incentives need to be created to encourage patients to avoid emergency rooms for non urgent conditions. As a society, we cannot turn our backs on the indigent. However, unlimited procedures and treatments are not possible. Patient participation in the cost of their care, even a small percentage, is a more just situation than abdicating total control of payment and what is provided, or denied, to a third party. Human dignity is promoted by reforms respecting both duties to others and personal responsibility.

The Welfare State = The All Powerful State

Bishop John Wright of the Diocese of Worchester, MA gave an address to 200 presidents and other officers of almost 40 State medical association on June 14, 1951. He warned them against "enslavement by absorption" into a state bureaucracy. As we approach the inauguration of a new President and Congress in the next few weeks who are committed to expanding Governemental intrusion into our lives may these words of the wise Bishop serve as a warning and a reminder to remain firm in our Catholic beliefs. He went on to say,

"You doctors should be the first to insist on morality, for once the moral law goes into eclipse, your profession is doomed to return to the slavery which was the condition of physicians and teachers in the pre-Christian days of amoral pagan totalitarianism."

Let us also pray for wisdom from our Church leaders as they address the problems in our current healtcare system that they not be blinded by the overly simplistic solution of "universal healthcare" offered by those politicians who will ensure that the systems provide numerous immoral practices in open conflict with the teachings of the Church and the consciences of our Catholic healthcare workers.

Hospital of St. John's and St. Elizabeth London

Is the tragic situation which has taken place at the Catholic hospital of St. John's and St. Elizabeth in London a preview of what we can expect in this country if FOCA or similar legislation ever passes here? It should be noted that several members of the previous Board were members of the Order of Malta's British Association who fought vigourously to maintain a Catholic ethic with the Hospital but were nevertheless removed by the Cardinal when he dissolved that Board last year.

A little background on this story courtesy of Fr. Finegan (who has a great blog BTW, The Hermeneutic of Continuity).

The Hospital of St John and St Elizabeth in St John's Wood is a Catholic hospital, founded in 1856. In 2003, the Hospital invited the St John's Wood Medical Practice to become a part of the hospital. At the time, Catholics familiar with the present workings of the National Health Service warned that such an invitation would present problems for a Catholic hospital since an NHS medical practice is bound to offer "sexual health services" which conflict with Catholic moral teaching.

Last week, the Hospital Board approved a new Code of Ethics which, on the surface, looks good. It specifies that such things as euthanasia, sex-change operations, the fitting of intra-uterine devices, and IVF are forbidden. However, the Code does not mention abortion referrals or the prescription of the (abortifacient) Morning After Pill.

Today, there are two articles in the National Press which highlight the Linacre Centre's criticism of the Code of Ethics: in the Daily Telegraph Celebrity hospital in abortion row and in the Daily Mail Cardinal caught up in Catholic row... Abortion referral is a "hot button" issue for Catholics in Britain today. Catholic doctors and others who will not kill unborn children cannot in conscience refer patients to other doctors who will. Many secularists would like to try and force them to do so or leave the profession.

It cannot be acceptable for a Catholic hospital to allow such referrals, nor can these referrals in any way be "approved by the Catholic Church."

Fr. Finegan received the following letter from Mr. Luke Gormally, Honorary Fellow of the Linacre Centre for Healthcare Ethics

Dear Fr Tim,

The situation at John&Lizzies is one of grave scandal. The Cardinal has the authority in the constitution of the Hospital to determine the ethical norms that should govern clinical practice there. When objections where referred to the Cardinal in 2004 to admission of the St John's Wood Medical Practice, which is contractually committed to providing the full range of 'family planning services', including referrals for abortion, he in turn referred the matter to the Congregation for the Doctrine of the Faith (CDF) - though in truth the issue was clear cut.

The Hospital Management (which has long been non-Catholic) argued that there was no clear prohibition in the existing Code of referrals for abortion. The case was presented in somewhat unsatisfactory terms to the CDF who asked the Cardinal to establish a Committee to enquire into practice at the Hospital and what might be required to render the existing Ethics Code unambiguous in its directives. The Cardinal after some delay established the Brennan Committee (under Lord Brennan), a Committee which included Professor John Finnis in its membership.

This Committee eventually reported to the Cardinal in early 2006 and on 6 March that year following the advice of the Committee the Cardinal wrote to the then Chairman of the Hospital Board, Lord Bridgeman, requiring specific additions to the Code which made it unambiguously clear that no doctor practising at the Hospital was to refer for procedures, including abortion, which were contrary to moral truth as identified in the teaching of the Church. He asked that the Code be revised along these lines by the end of 2006, and that the following year the Hospital should set up a system of ethical governance to ensure that the Code was being observed. Lord Bridgeman disbanded the previous Ethics Committee, three of whose members,including Dr Helen Watt, had been at the forefront of complaining about unethical practices at the Hospital (it had, among other things, become the major centre in the UK for female to male transgender surgery), and established a new Ethics Committee.

This first met in September 2006 and I was, somewhat to my surprise, recruited to the Committee in October 2006. Lord Bridgeman's chosen Chairman of the Ethics Committee was extremely reluctant to proceed to the revision of the Code as required in the Cardinal's letter to Lord Bridgeman, but some of us managed to produce a revision of the Code in early 2007 precisely along the lines specified in the letter of 6 March 2006. This revised Code was then formally agreed by the Ethics Committee. Before it was presented to the Hospital Board however it was presented at the insistence of Management and Lord Bridgeman to the Medical Advisory Committee (MAC) of the Hospital. This is composed of a group of doctors not one of whom is a Catholic. They rejected the Code.

It subsequently emerged at a meeting with this Committee that they regarded the Code as having no authority over them and indeed viewed the Hospital as already a secularised institution. The view of the MAC was then invoked as a reason for non-acceptance of the Code by the majority of those on the Board with a secularising agenda for the Hospital. However, in the later part of 2007 there were a number of resignations from this group and towards the end of the year those members of the Board who had been faithful to the terms of the Hospital's Trust Deed and had sought to retain its catholicity found themselves in a sufficient majority to approve the Code.

At this point the Cardinal intervened and demanded the resignation of those faithful few. Though he had no legal authority to do so, his wishes were complied with by a number who felt obliged to defer to his moral authority. Lord Guthrie was then installed as the new Chairman of the Board and he accepted this position on condition that he would be able to re-populate the Board with his own nominees. One of these is Sir Mark Allen who from a career as a spy master has now assumed Chairmanship of the Hospital's Ethics Committee. He has produced a Code which to anyone who knows about the controversy over the past 4 years about the ethical norms which should govern clinical practice at the Hospital is manifestly a complete capitulation to the demands of the MAC that certain key demands of Catholic moral teaching should have no authority over what they decide and do with their patients in consulting rooms in the Hospital. What happens in the operating theatres may be more restricted than hitherto, but the most striking thing about the new Code is the complete absence of any prohibition of referrals for abortion. I began by saying that the situation is one of grave scandal. It is so because the Cardinal has given his approval to this new Code. The Church's teaching about the grave wrongness of abortion and cooperation in abortion has been sacrificed for essentially financial interests. How can the Church in this country effectively defend the sanctity of life when its Chief Shepherd is prepared to approve a Code which effectively accommodates referrals for abortion? A spokeswoman for the Brook Advisory Centres is reported as welcoming the liberalization of the Hospital's Code. That tells us pretty cleary where the Cardinal has got us to. Urgent prayers, and action by some, are needed to reverse this situation.

Luke Gormally

Today I received a newsletter published by the Restituta Group, which is campaigning to restore the Hospital to Catholicity, recapping further developments between October and December. I will post on that as soon as I can condense it down.

One item that is conspicuously missing from the 2008 Code of Ethics is the preamble from the 2007 Code,

“The following are therefore not permitted in any facility within the Hospital, its precincts or its ownership and may not in any such facility be the subject of referrals with a view to obtaining them elsewhere”.