Capital Commentary is the weekly current-affairs publication of CPJ, written to encourage the pursuit of public justice.

For a Passing Grade, Healthcare Reform Needs More Cs

Stanley Carlson-Thies


July 31, 2009

The vital Washington debate on reforming the healthcare system revolves around three Cs. How can Coverage be expanded to those currently without health insurance? How can Choice be preserved for people satisfied with their existing arrangements? And how can Costs be controlled?

But there are two other Cs that should be at the center of the debate: Conscience and Care.

Conscience has nudged its way into view. Pro-life groups and members of Congress have sought, though so far in vain, for assurance that a new system will not require taxpayers to fund abortions, every insurance plan to cover abortions, and all doctors and hospitals to perform or refer for abortions.

Yet conscience involves more than abortion. Hearing the term should remind us that health care includes a long list of ethical issues on which people differ: euthanasia, IVF, screening for genetic defects, care of the profoundly handicapped, and more.

Thinking about conscience should remind us, too, that healthcare isn’t just about government programs and big-business drug companies, insurers, and hospital chains. A significant part of the system is faith-based. For example, about 15 percent of hospital care is provided in Catholic institutions. The Christian Community Health Fellowship supports a national network of clinics serving low-income and uninsured people. Many thousands of religious doctors and nurses work in local medical practices. Some medical schools are faith-based.

These faith-based entities, religious professionals, and ethical concerns should be central, not marginal details, in the reform effort. The truth is, government administration isn’t inherently pluralistic. As officials take more control to increase coverage and curtail costs, conscience and faith will be squeezed out unless there is a specific effort to honor them.

The much-praised Massachusetts health care reform, which has expanded coverage, though with less success in controlling costs, shows the dangers. Caritas Christi Healthcare, the Catholic system in Boston, recently had to end its partnership with a secular network to offer a state-approved health-insurance plan. Because of the state’s requirement that insurers offer abortions, sterilization, and contraceptive services, there was no way the Catholic system could participate in the insurance partnership without violating its pro-life standards.

But at least Catholic hospitals in Massachusetts are able with integrity to serve patients covered by the insurance plans offered by others. Or maybe not. NARAL Pro-Choice Massachusetts says it discovered two Catholic hospitals that were unwilling to offer emergency contraception to rape victims, and it has proclaimed this to be a violation of state regulations for providers. Massachusetts, it seems, wants to be sure that everyone has immediate access to what it calls reproductive health services, but the state is much less concerned to respect the convictions of pro-life doctors, hospitals, and patients.

And that brings us to the final C, for Care. Care is supposed to be the point of the whole reform effort—making sure that everyone can get the healthcare they need in our rich society with its many health resources. However, ensuring that people will get genuine care requires much more than expanding access while controlling costs. There is no society-wide agreement on what care is. Worse, the standard of care increasingly favored by governments and powerful professional societies can be harmful to the unborn and to some vulnerable and powerless patients.

Christians, if no one else, should demand that healthcare reform respect, not confine, conscience, pro-life doctors, and faith-based hospitals.  For genuine care to be the outcome, the reformed system must provide not just more coverage but better coverage: the opportunity to obtain insurance and services that respect life from beginning to end.

—Stanley Carlson-Thies, President
    Institutional Religious Freedom Alliance

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Capital Commentary is a weekly current-affairs publication of the Center for Public Justice. Published since 1996, it is written to encourage the pursuit of justice. Commentaries do not necessarily represent an official position of the Center for Public Justice but are intended to help advance discussion. Articles, with attribution, may be republished according to our publishing guidelines.”