Healthcare with a Conscience

Published November 18, 2008

First Things -- On the Square

Healthcare institutions owned and operated by the Catholic Church are, and always have been, an important component of the nation's healthcare infrastructure. By 1872, there were seventy-five Catholic hospitals in operation around the United States, founded and staffed mainly by women's religious congregations–the Sisters of Charity, the Benedictine Sisters, the Daughters of Charity, the Sisters of Mercy, the Ursulines, and many others. These women were motivated by a vocational call to care for the sick, which they did with distinction despite considerable hardship.

The institutions they founded have undergone massive transformation in recent years. As vocations to religious congregations have fallen, lay administrators have taken on leadership roles. Most Catholic hospitals in the United States are now part of regional “systems”–such as Catholic Healthcare East, with thirty-three hospitals in eleven states–and governed by boards that include ample numbers of experts in hospital finance as well as the original sponsoring congregations.

Still, despite the changes, Catholic hospitals remain, by and large, strong and vibrant institutions, and they have earned the gratitude of the communities they serve. Today, 615 hospitals in the United States–or about one of every nine–are sponsored by the Catholic Church. These facilities employ 725,000 workers and serve 5.5 million overnight patients annually, and many millions more on an outpatient basis.

What explains this staying power in an era of technology-intensive medicine and ultra-specialization? Part of the explanation is probably incumbency. But it's also true that many sick and vulnerable patients and their families would prefer–all else being equal–to be cared for in settings that bring to mind compassion and human concern as well as professionalism. Hospitals named Providence and Holy Cross and St. Vincent's communicate through their very names and histories a sense that they understand human beings are souls as well as bodies, and that human dignity is not dependent on physical health.

But, despite a long history of faithful service, the future of Catholic healthcare in the United States is far from assured because of the wide cultural divide between secular elites and those motivated by religious conviction. The same principles and ideals that move Catholic hospitals to care for the weakest and neediest also compel them to oppose abortion, sterilization, and other practices at the juncture of medicine and morality. And at that juncture, Catholic hospitals are running into an increasingly hostile public-health establishment with very different values.

There have been a number of flashpoints in this ongoing struggle in recent years. In 1995, the Accreditation Council for Graduate Medical Education tried to require abortion training for medical-school accreditation. Last year, the American College of Obstetricians and Gynecologists issued an ethics opinion suggesting it is the duty of physicians opposed to abortion and other services at least to make referrals of patients to providers who do not have such moral objections. And, earlier this year, Denver Archbishop Charles Chaput had to publicly defend the purchase of two Denver-area hospitals by a Catholic regional system as state politicians attempted to scuttle the deal or coerce the Catholic facilities into performing services contrary to their principles.

All of this has increased the nervousness among sponsors of Catholic hospitals as well as Catholic physicians, pharmacists, and others that cultural trends may put them out of business.

In August, the U.S. Department of Health and Human Services (HHS) weighed in with a proposed regulation to extend and solidify existing legal conscience protections for healthcare providers. On the surface, the HHS efforts would seem innocent enough, as it largely clarifies how existing conscience-protection laws will be implemented. But that's not how abortion's defenders see it. Above all else, they fear marginalization. They believe–one hopes rightly–that an expansive conscience regime might allow the vast majority of practitioners to divorce themselves entirely from the abortion culture. For this reason, abortion's defenders came out swinging. In September, twenty-seven Democratic U.S. senators and one independent sent a letter to HHS secretary Mike Leavitt that claimed the regulation would damage “the healthcare needs of women.” (Incidentally, senators Barack Obama and Joe Biden were among the signatories.)

But even if the HHS regulation were to survive (it won't), it wouldn't solve the problem. Indeed, as long as Catholic-sponsored healthcare providers and individual practitioners are financially dependent on insurance payments from those who fundamentally oppose their vision of human dignity, they will be at considerable risk.

Can anything be done?

Perhaps, although there is no easy solution here. One promising initiative was pioneered by Robert F. Vasa, now the Bishop of Baker, Oregon. While serving as vicar general in Lincoln, Nebraska in the 1990s, Fr. Vasa was in charge of organizing health-insurance coverage for diocesan workers and their families. After studying the matter, he was horrified to discover that the diocese's insurance plan covered abortion and other objectionable services–and nobody knew it.

Fr. Vasa moved quickly to correct the situation. He chose to pull as many people as he could into a single, church-sponsored plan, which would self-insure. The church, not a private insurer, would decide what was and was not covered. With full control, the diocese was able to design an insurance plan consistent with Catholic principles.

The formula for Lincoln, Nebraska could be scaled up so that tens of thousands, not hundreds, of workers are covered. Consider, for instance, the Archdiocese of Chicago. There are 364 parishes, 217 parochial schools, and 40 secondary schools in Chicago. There are five colleges and universities with a combined faculty of about 3,500, not including staff. All in all, the archdiocese directly employs around 14,000 people, not counting the employees of the twenty-one Catholic hospitals in the region.

That's more than enough workers to form an attractive insurance pool that could be pulled out of the current marketplace and placed in a separate insurance arrangement consistent with Catholic moral principles. With control over the premiums, the archdiocese could also build a network of preferred providers that steers patients to the various Catholic-sponsored facilities found all around the city and suburbs. It would be a win-win proposition. The archdiocese would gain control over premiums, and Catholic hospitals and physicians would gain access to at least a modest amount of fees free from pressure to compromise their principles.

Once started in one large diocese, it might be possible to begin building regional networks of insurance coverage and service provision. In healthcare, bigger tends to be better. In time, it might even be possible to open up such coverage to individual purchasers attracted to an insurance product they could trust.

None of this would be easy, politically or administratively. And there would be risks. But the November election results should be a wake-up call that doing nothing also brings risks. The drumbeat for submission to the dominant, secular healthcare culture will only get louder in the years ahead. Given the threat, now is a good time to investigate all available alternatives.

James C. Capretta is a fellow at the Ethics and Public Policy Center. In the mid-1990s, he worked as a government relations officer for the Catholic Health Association of the United States. This article is adapted from an essay published in the Fall 2008 issue of the New Atlantis.

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