This week, in anticipation of a long-awaited spring-break, I asked the professor/theologian/scholar Charles Bouchard if he would be willing to contribute an article for your reflection. As with everything Charlie writes, or presents, I think you will find this essay clear and thought and provoking.
Fr Bouchard is a moral theologian who has taught health care ethics for many years and worked for Ascension Health as well as the Catholic Health Association of the United States. One of his main areas of interest is the intersection of public policy and Catholic Social Teaching.
The Affordable Care Act (also known as Obamacare) became law in 2010 and was implemented in 2014, already ten years ago. Even though 21 million Americans have gained coverage today because of subsidies it provides, Obamacare remains controversial. Candidate Trump says he still plans to repeal and replace it, even though he has offered no details on what his replacement would look like. Other candidates have pledged the same.
The main goals of the ACA are simple: making health insurance more affordable so we can increase access (and spread the risk among more people); increasing efficiency and lowering overall costs by using evidence of what works best (electronic medical records); covering pre-existing conditions; and focusing on health and prevention rather than sickness and intervention.
So what’s not to like?
Some fear the insurance mandate violates freedom and increases federal spending. Yet if health care is a social good that does not radically belong to any one person or company, we must all share the burden of paying for it. Others fear that making health care too widely available will result in long waits or rationing. Yet, health care and the resources that pay for it are not infinite. We have only so many dollars to pay for health care, as opposed to education, defense and public safety. And within those dollars, we have only so many to pay for pre-natal care, end of life care, transplants, drugs and coronary bypasses. One understanding of freedom is simply “every man for himself,” but that approach is impossible to reconcile with the Catholic tradition which insists that “I” only exist as part of “we.” We are social by nature and must acknowledge that reality when we allocate goods
Others fear that the ACA will raise the cost of health care. In fact, for most of us, including employers, healthcare costs are likely to fall because more people will be contributing to it. Second, money is not the issue. The United States already spends twice as much on health care as any other industrialized nation, but our outcomes are not twice as good. In fact, in many areas (longevity, infant mortality, management of chronic illnesses) we do a worse job than many other countries. We spend plenty of money on health care, but we don’t spend it wisely.
Others fear government control or socialized medicine. “Socialized” means many different things – it can mean government-owned health care (like England or like the Veterans Administration in the US); it can mean government as a sole payer (as in Canada); it can mean government standards and subsidies for health insurance (as the Affordable Care Act proposes). “Socialization” is not a bad thing if it means “acting for social good or for the common good” – this is what Catholic Social teaching refers to. (If you read the Acts of the Apostles, the communal life of the early church is far closer to socialism than it is to free market capitalism.)
Many fear that health care reform will limit freedom. If freedom means unfettered choice, that’s probably true. But we must remember that health care is one thing we cannot provide for ourselves. Health Care is a human good that requires the cooperation of many people — even doctors have doctors. Maintaining health and providing health care is a vast undertaking that requires that each of us give a little. Anything we do that is valuable requires a little (or a lot) of self-surrender. Education, music, athletics, military defense are all “team sports” that require relinquishing some freedom in return for a big payoff in terms of a social good.
When the bill was being debated the most contentious issue for many Catholics was the “what if” question. What if the ACA allowed or funded more abortions? Of course, it is possible that one day there will be a more permissive law about abortion, or that more abortions will be funded by the government. But it is also possible that one day public schools will be required to teach bomb making or that Social Security will mandate euthanasia after age 55. Prudent citizens make the best choices they can, given the evidence they have now. Law professor Timothy Jost says that “The ACA may be the most prolife piece of legislation ever adopted by Congress.” It will provide life-saving coverage to millions of Americans, including mothers and children who make too much to qualify for Medicaid but too little to afford private insurance; and it will put preventative care first, eliminating a great deal of suffering and expense. That has surely proven to be true.
In my view, the possible risks posed by the ACA are well worth taking because the benefits will be far greater. Taking the safest course – allowing no change in the status quo, or pulling out of the health care debate entirely—would deny our basic convictions about how we function in the world as a faith community. It would be a great blow to justice and to the common good.
Obamacare is a good start but it cannot solve all our health care problems. There are still far too many people who are uninsured or underinsured (e.g., those who have insurance but have high deductibles that make it almost useless, especially for preventive care, mental health care and dental care). We still spend far too much money. The current trajectory of health care expenses is unsustainable. We need to put aside political bickering and ask not whether we need to continue health care reform, but how.