In my last blog post, I discussed a problem that is impairing our ability as Catholics to discuss the idea of a right to health care, which is relevant to the proposed health care reform initiatives. I suggested that the basic difficulty is that as Americans, we tend to think of “rights” in legalistic terms. In particular, we pigeonhole the concept of “rights” into two main categories: “negative rights” (which protect us from the action of the government) and “positive rights” (which entitle us to some kind of benefit guaranteed by the government). I further suggested that the Catholic way of approaching the issue didn’t follow that pattern, but instead described how the question of health care as a “right” had to be viewed from the outlook of the Catholic social teaching principles of solidarity and subsidiarity.
Let me explain now how I can use those principles to sketch out an authentically Catholic perspective on the right to health care.
The principle of solidarity requires that we view all persons as linked to us as members of one family, and that we have an obligation to be concerned with their welfare. It entails a willingness to sacrifice oneself for the good of our neighbors, particularly those in need, even at the cost of any individual interest. In other words, when we are considering social policies — like laws involving access to health care and health insurance — we cannot think only of ourselves, as if we were in a zero-sum competition with others. Instead, we must be directly concerned with the interests of our brothers and sisters, especially the poor. It’s a Good Samaritan approach to social relations — the needy have a “right” to our assistance, in solidarity.
From this perspective, we cannot be satisfied with the callous view that those who lack health insurance are just plain out of luck, either through some fault of their own or through the operation of the market. That isn’t satisfactory — we would never accept that approach with a member of our nuclear family, so we cannot accept it with a member of our extended human family either. We must construct some kind of response that will address it. Again, our brothers and sisters have a right to our assistance in attaining a truly human life.
However, in fashioning a solution to the problem, we must be attentive to the principle of subsidiarity. As Pope Benedict says in his encyclical, Charity in Truth, “The principle of subsidiarity must remain closely linked to the principle of solidarity” (58).
Subsidiarity requires that, in developing social policies, we must defer to the most local level that can handle the problem adequately. So, the primary responsibility for virtually all issues falls on individuals and families. We must respect their freedom, and insist on their duty to take care of themselves. In the case of health care, the great majority of Americans already do so, for instance by seeking employment that provides health insurance as a benefit. Since most people take care of themselves and their families, no further social action would be necessary for them.
But there are many Americans who are unable to handle the problem in that way. Many are unable to obtain employment that has health insurance benefits, or perhaps the benefits available to them are either too expensive or inadequate. In this case, these people have a “right”, in solidarity, to our assistance and that of society as a whole. Subsidiarity tells us, however, that help should first come through family members, fraternal organizations, or community groups. If those intermediate levels of society cannot respond adequately, then we may turn to the government for solutions — first the local governments, then the national government.
A central problem with the current health care reform proposals is that they run rough-shod over the principle of subsidiarity. They seek to impose a top-down, one-size-fits-all solution, even upon those who do not have any problem — those who have already taken care of themselves and their families by getting health insurance. Some of the proposals would even infringe upon the freedom of an individual to choose not to have health insurance at all, and to choose what kind of coverage to have (or not have). As such, the proposals are not consistent with Catholic principles. (Note — I am not addressing the issue of whether the proposals violate fundamental moral principles on the respect for human life. I covered that in an earlier post)
I think that much of the strong opposition to the current proposals reflects the natural human understanding of the importance of subsidiarity. It also reflects a legitimate fear of government intrusion into the zone of personal and family liberty that results when subsidiarity is not respected.
There are many ways that one could imagine health care reform that would be consistent with both solidarity and subsidiarity. On such prudential questions, there is no one “Catholic” solution. But a satisfactory proposal could include some of the following:
- Permitting people to carry their health insurance from job to job, and letting them choose what kinds of coverage they want, even if they want no coverage at all. (As an aside, it is passing strange to me that the gekko lets me tailor my auto insurance to my needs, and take it wherever I drive, but my health insurance — which is much more important — is forever locked in my office.)
- The freedom of private companies to carry on business in health insurance would have to be guaranteed, subject, of course, to reasonable regulations to ensure fair practices.
- Any plan certainly would have to guarantee access for all, including immigrants.
- To accomplish universal access, a plan could offer sufficient subsidies (such as tax credits or vouchers) to help people purchase private insurance, with a free or heavily subsidized public insurance option as a backup (e.g., like Medicare, Medicaid, etc.).
This kind of plan would satisfy both solidarity and subsidiarity. Other elements would also have to be addressed, in particular an absolute exclusion of abortion and euthanasia, but this kind of plan would be a workable and Catholic framework.
When viewed from this Catholic perspective, the path to health care reform actually becomes clearer, more attainable, and more justifiable. We can understand how a person can have a “right” to health care that does not threaten us, but instead invites us to help them out of human fellowship. Our task as Catholics is to bring this perspective into the public arena, for the common good of all.