1. Health Care Reform Robert G Kennedy Department of Catholic Studies 27 January 2012

2. Health Care Reform Some Observations The Catholic social tradition does not fit neatly into the secular categories of liberal and conservative, socialist or libertarian. Instead, it recognizes that human persons are creatures with a social nature, who flourish in community without extinguishing their individuality. As the U.S. bishops observed in their 1981 pastoral letter, health care is the responsibility of individuals, of families, of immediate communities, and of medical professionals. Health care is a broad category. But when we speak to day about “health care” reform, what we really mean is managing and reforming the delivery of professional medical care.

3. Health Care Reform Some Observations Many categories of things are necessary for a decent human life, such as food, shelter, energy, education, and so on. The ordinary way in which we acquire what we need for ourselves and our families is by purchasing them with what we earn through our work (which is why the Catholic tradition considers work to be so important). Professional medical care is one of the things that is ordinarily purchased.

4. Health Care Reform Some Observations But medical care is different in important respects: the demand for medical care has no natural limit the capabilities of medicine are constantly changing but often at great cost we are unwilling to acknowledge and accept different levels of quality and cost medical resources—personnel, equipment, supplies, etc— are always finite people do not always behave responsibly in support of their own health and well-being

5. Health Care Reform Some Observations We aspire to a situation in which every member of the society has access to top-quality medical care without regard to personal situation or ability to pay—but this is impossible to achieve—so what can we really do?

6. Some Catholic Concepts The Good Society and the Common Good The Catholic social tradition conceives of a good society as an ordered and organic whole, a collection of individuals with particular talents and vocations, not a faceless and homogeneous crowd of people nor an aggregate of isolated individuals seeking their own utility. The common good of such a society, in a famous definition, is: “The sum total of those conditions of social living whereby persons are enabled more fully and more readily to achieve their own perfection.” (MM 65)

7. Some Catholic Concepts The Good Society and the Common Good A critical part of well-being of each person concerns the achievement by that person, as far as it may be possible, of his or her own fulfillment. (The Catholic understanding of the integral development/fulfillment of the person is critical here.) We respect the dignity of other persons when we assist them to develop; development is not something we can do to or for others. The fundamental task of government is to establish, sustain and protect the common good of the civil society and thereby to promote the flourishing of each and every member of the community.

8. Some Catholic Concepts Medical Care in the Ordinary Sense In the ordinary case, mature and responsible adults attend to their own health and the health of their family members, making arrangements to purchase medical care services as required. Purchasing medical care is either out-of-pocket (budgeted) or through some form of insurance as a hedge against unforeseeable expenses. There is a right to medical care in the ordinary case but it is a negative (liberty) right.

9. Some Catholic Concepts Medical Care in Extraordinary Cases Extraordinary cases arise either because of general incapacity, emergencies or overwhelming challenges. In such cases, we do not and should not expect individuals to purchase medical care on their own. Charity supplements justice in extraordinary cases. The “right” to medical care in extraordinary cases is a positive (demand) right but it is not unlimited. Limitations, though, will inevitably be arbitrary.

10. What Role for Government? A society can organize itself in a variety of ways, which could include an expansive or a limited role for government in providing medical care. In the ordinary case, government should at least: remove unnecessary impediments to acquiring medical care (unnecessary regulations, disincentives, litigation, etc) ensure public safety (public health, licensing, disclosure, etc) support functioning markets (artificial limits to supply, etc) encourage individual responsibility for health care

11. What Role for Government? In the extraordinary cases, government might at least: encourage private charity (incentives) establish provisions for emergency response act as supplier of last resort

12. What Role for Government? In any case, government should: respect the principle of subsidiarity (proper functions) and tolerate the “messiness” that may result respect conscience and autonomy