For months, the Bishops have been insisting on several key points in their advocacy on the health care reform bills. Two points raised by the Bishops, in their letter to Congress in October, are worth recalling:
1. Exclude mandated coverage for abortion, and incorporate longstanding policies against abortion funding and in favor of conscience rights. No one should be required to pay for or participate in abortion. It isessential that the legislation clearly apply to this new program longstanding and widely supported federal restrictions on abortion funding and mandates, and protections for rights of conscience. No current bill meets this test.
2. Adopt measures that protect and improve people’s health care. Reform should make quality health care affordable and accessible to everyone, particularly those who are vulnerable and those who live at or near the poverty level.
Now that the House has passed the first of the health care reform bills, it’s worth reflecting on how what the bill means, in comparison to these criteria.
Abortion. In my last post, I discussed the effect of the Stupak Amendment to the House bill, and how significant it was to establish that abortion is not heath care, and should not be paid for with federal funds. The challenge ahead is to ensure that this provision is put into the Senate bill, and then survives in whatever bill (if any) finally passes Congress. And, if a bill is ultimately signed into law, we will have to be eternally vigilant to ensure that abortion doesn’t sneak in the back door through some regulations.
Conscience protection. The House bill has some favorable conscience protection provisions, and actually improves upon current federal law by writing some clear protections into statute, rather than leaving them to the annual appropriations bills, which have to be renewed each year. However, there are still some deficiencies, since the protections do not extend to pharmacists, and there is nothing in the bill about conscience protection for end-of-life care. We will have to do some more advocacy in the Senate to try to correct these problems.
Improving health care for all. There is no doubt that universal insurance coverage is a good idea, and that the House bill moves forward towards that end. However, there are still significant reasons to be concerned. For example, the House bill contains a provision that could be used to develop standards for care that would effectively deny medical care to certain people based on a judgment about their quality of life. In addition, the bill would also penalize doctors who prescribe care that is too expensive. When added to the general pressure that would exist to cut costs, these provisions could result in passive euthanasia for the elderly and disabled. We’ve already seen this in the United Kingdom, and we need to be very careful about it coming here.
There are other reasons to be concerned about the effect of the federalization of health care insurance on everyone’s health insurance. The Catholic principle of subsidiarity specifies that problems should be handled by the people closest to the problem, such as individuals and families. Government certainly has a role in helping to solve social problems, but it is not the first or the preferred way of addressing a social problem.
Yet this bill turns that principle on its head, and overrides the decisions of individuals and families about their health insurance, and restricts their freedom to decide about their own health care. This is particularly a problem, since there are other reforms that could be pursued that could address the need for greater access to insurance while respecting the freedom of individuals and families (e.g., allowing people to shop across state lines for insurance, letting them carry it from job to job, and fixing the tax system so individuals can buy insurance apart from their employer).
In addition, the very, very high price tag on the House bill raises significant concerns. Over and over, we have seen in New York an effort to restrain the high cost of Medicaid, the health insurance for low income people. The result of this is cutting payments to doctors and hospitals, and limitations on care. If the House bill were to become law, we would see even greater pressure across the country to reduce or restrain the cost of medical care. The inevitable result of these pressures is rationing — limiting health care to those who are judged worthy, and the denial of care to others.
There is a long way to go in the health care debate. But we have reached an important milestone — the end of the beginning, even if not the beginning of the end (to paraphrase Churchill). We must continue to press our legislators to ensure that whatever bill is finally agreed upon satisfies our criteria for justice and respect for human life.