Health Care and The Free Market
by Robert Cavanaugh, Jr.
The Health and Human Services (HHS) mandate has brought out the best in our bishops. From the moment the Obama Administration first floated the idea of comprehensive healthcare that would include mandatory coverage of abortifacients and contraceptives, the United States Conference of Catholic Bishops (USCCB) made no bones about what their objections to such a plan would be. And when this legislation ultimately passed as the Affordable Care Act (ACA), the USCCB wasted no time mounting a legal challenge to the implementation of this onerous clause, which they rightly declared a violation of religious liberty.
Seeing Church teaching publically reaffirmed in such a dramatic way has been a long time coming. While the bishops’ recent action has been exemplary, to a vast swatch of the American public their current stance is nothing short of baffling. Most people simply had no idea the Church has maintained any sort of official objection to the practice of artificial contraception. Our clergy has been all but silent on the subject since 1968, and our parishes are populated for the most part with two-child families, like every other denomination tethered to the gospel of prosperity.
Even if the hierarchy wins repeal of the federally-mandated obligation to fund contraceptive coverage, they have another, far more daunting challenge ahead of them. Namely, reasserting Church teaching on sexual morality to the rank-and-file in the pews. Not long ago, an archdiocesan representative gave a presentation on “Women’s Health and Family Planning” at a neighboring parish. His talk centered on the method of monitoring a woman’s fertile cycle known as Natural Family Planning (NFP). In the Q&A session that followed, this gentleman stressed that if we want to pursue NFP further, we should expect no formal support from either our pastors or Archdiocesan headquarters. In this age of massive Catholic contraction, there are no resources available for anything new. What a shame. Natural Family Planning is the appropriate Catholic antidote to the contraceptive mentality that is today’s coin of the realm. And it needs to graduate from its current status as a quirky, grassroots movement.
There are now multiple NFP programs available, including the Couple-to-Couple League (CCL), founded by John and Sheila Kippley in 1971. It may be too late to save my wayward generation (b. 1954), but there is still time to help the children and grandchildren coming up behind us. Whenever the USCCB decides to pursue the widespread re-promulgation that is so desperately needed, it should enlist the Couple-to-Couple League to spearhead an all-inclusive, no diocese-gets-to-opt-out teaching initiative. NFP should become a mandatory part of every Pre-Cana program across the country.
INDIVIDUAL CONSCIENCE AND FREE MARKET PRINCIPLES
As our bishops have taken their principled stand, “liberal” and “conservative” Catholics have responded in predicable fashion. The former, citing the primacy of individual conscience, have complained the Church has no business telling them what they can and cannot do. While the latter, barely able to contain their glee over the political ramifications of the botched healthcare.gov roll-out, have given the bishops’ action scant attention. They are focused instead on turning the President’s gaffe into an electoral windfall in the next elections.
It is unfortunate these political partisans are monopolizing the healthcare discussion. And it is even more unfortunate Catholics who consider themselves “traditional” and “orthodox” are being swayed by the talking points. We are daily inundated with descriptions of “a vast government take-over of the healthcare system” that will result in “the loss of freedom to choose one’s own provider”. We’ve also been warned of “massive inefficiencies that will lead to increased costs”. And finally, in an attempt to rein in those costs, we will see the “rationing of care” for the old and marginalized, in the form of “death squads”.
None of which makes any sense, no matter how often it gets repeated. Obamacare was inspired by a similar plan successfully implemented by a Republican governor of recent vintage, based on principles outlined by a highly respected conservative think tank. The “individual mandate” that is now the centerpiece of Obamacare was in fact the conservatives’ alternative to a mandate on employers. The health care exchanges are yet another conservative alternative to government-provided medicine on the Medicare model. (In a final bit of irony, the roll-out was supposed to happen at the state level, not the federal level, but the sitting Republicans governors refused to set up the necessary state exchanges.) Does anyone seriously think “free market” healthcare offers any real “choice”? Or not realize care is already being rationed under our present adversarial system of competing interests? And that care will only be further rationed if we maintain our existing system, and costs continue to escalate at their current annual clip?
Apart from the mandate for contraceptive coverage, which is of course completely untenable, the ACA may very well have shortcomings worthy of legitimate criticism. But things should be kept in perspective. The only reason our clunky, uninspired government is trying to introduce a new healthcare paradigm is the existing free market paradigm does not work very well. At least not for the majority of citizens it is supposed to serve. We may not like what the administration has come up with so far. But we should at least admit the federal government is once again being forced into trying to clean up a mess left behind by the free market, as per usual.
The business of insurance has always been a managed affair, based on actuarial tables, designed to spread the risk of exposure over a broad segment of the population. The objective is always to sign up as many policy holders as possible who will never need the coverage they dutifully pay for, year after year. To criticize Obamacare because it requires the addition of young, healthy people onto the rolls, to bring down costs for the unhealthy people who need the most medical attention, is to perpetuate a willful ignorance about the nature of insurance. We may initially recoil at the conscription, and at the fines for failure to sign up. But this should be weighed against the astronomical costs of the medical product for those who require it. Along with contemplating that the odds of our one day getting older and falling into the same “needs serious health care” category are quite high.
Medical insurance differs from other types of insurance. Every single one of us has a body that will most likely require the attention of a medical professional at some point in time. Whereas not everyone owns a house or a car or some other object that typically benefits from being insured. This is why universal healthcare should be the law of the land. The only thing standing in the way of adopting such universal coverage is our devotion to the principles of free market capitalism. Where profit (not the common good) is the only motivator and competition (not cooperation) is the only regulator.
Free market slogans such as “personal choice” may appeal to our sense of rugged individualism, but have a hollow ring in this context. As do phrases such as “trusting people to make their own healthcare decisions.” When one has symptoms in dire need of immediate diagnosis, one is not in a position to carefully consider the options, as if buying a refrigerator. After suffering a heart attack, one does not proceed to shop around for a more affordable heart surgeon. Simply put, healthcare by its very nature does not lend itself to a market-based solution. But we keep trying to fit a round peg into a square hole. We have adopted the free market as our one, true religion, and assume its inner dynamic can be applied to solve every societal problem.
Invoking the beautiful Catholic concept of subsidiarity cannot salvage routine criticism of the new healthcare law, and render that criticism relevant. It’s hard to search out one’s local mom-and-pop cardiologist or neurosurgeon for a personal one-on-one consultation, without involving a higher order of authority. These specialists are in all cases affiliated with large, multi-million dollar institutions. When one falls ill, one has no choice but to confront the medical Leviathan, whether one wants to or not.
There is a veritable army of dedicated souls employed in the healthcare field, who give their all whenever a needy patient crosses their path. This debate is not in any way an indictment of such devoted practitioners. The discussion is centered on the system within which these individuals are forced to function. Like all free market activity, healthcare is a profit-generating enterprise. It is difficult to reconcile the profit motive that animates capitalism, with the common good which according to Catholic social teaching should be the object of all economic activity. And nowhere is the contradiction more evident than in the realm of healthcare. The natural inclination of caregivers may indeed be altruistic and noble, but the economic structure in which they operate is oriented to the bottom line.
Though we never hear it debated in these terms, any attempt at serious healthcare reform immediately runs afoul of vested interests prepared to fight to the death rather than see their profit margins compromised. And who can blame them? Why should one component of this money-making machine, say, medical specialists, relinquish their share of the bounty, if another component of the system, say, insurance companies or the pharmaceutical industry, does not agree to relinquish theirs? “Profit”, apart from any other social consideration, has been firmly established as a perfectly legitimate modus operandi. None of the system’s moving parts sees themselves as doing anything wrong. They are managing millions, in terms of payroll, equipment, and infrastructure. They and their organizational charts deserve to be compensated accordingly. That’s how our present system works. With everyone’s respective golden goose designated as off limits before the discussion even begins, any attempt at reform inevitably results in making an already complicated and convoluted system even more so. With the net effect of the Sturm und Drang amounting to little more than the proverbial rearranging of deck chairs on the Titanic.
This is not to suggest our healthcare system should operate “at cost”. One does not expect, for example, the supreme sacrifice routinely provided by the consecrated religious who used to run our hospitals. Or the zeal of the missionary orders of priests and nuns and doctors without borders who are today bringing healthcare to the Third World. One is only suggesting a degree of proportionately, a sense of “just price”.
But under the tenets of our present economic system, those few with leverage can charge whatever they like for their product or service, under the guise of “what the market will bear”. This leaves the vast majority who have no leverage with making a choice between paying those prices, or doing without. This may be an acceptable construct when the object in question is a non-essential, such as the latest iPhone. But this formulation should be rejected out of hand when essential medical care is at issue.
One need not be a dreaded liberal to realize our present healthcare system is well past due for a major overhaul. One only need not be a card-carrying conservative. In other words, a Catholic perspective needs to be resurrected and applied, to improve how healthcare is dispensed. Would that we were not so programmed to be political partisans, and so wedded to free market capitalism – first, last, and always. We might be able to see things as they should be, instead of so willing to reconcile ourselves to the way they are.
Railing against the perceived failure of Obamacare is futile, unless we are prepared to simultaneously recognize the underlying need for serious reform of the present system. The partisanship being encouraged by conservatives merely lends our voices in support of the status quo.
This article was published in the April 2014 issue of Culture Wars.