The Bishops and Obamacare

Published December 4, 2013


This past weekend, Cardinal Timothy Dolan of New York—who recently finished his term as President of the USCCB—went on NBC’s “Meet the Press” where he discussed, among other things, the Catholic bishops’ complicated relationship with the Affordable Care Act. His Eminence was very supportive of the law’s goals, pointing out that the Catholic bishops have supported health care reform since 1919. So he laments that the bishops’ initial excitement at the prospect of comprehensive health care reform was ultimately frustrated by the administration’s intransigence over abortion funding and the exclusion of immigrants. Then came the concerns over conscience protections:

So that’s when we began to worry and draw back and say, “Mr. President, please, you’re really kind of pushing aside some of your greatest supporters here. We want to be with you, we want to be strong. And if you keep doing this, we’re not going to be able to be one of your cheerleaders.” And that sadly is what happened.

In the end, it was with reluctance, perhaps great reluctance, that the bishops opposed the bill.

As the widening gulf between Obamacare as it was sold to the American people and the law’s real world consequences becomes more apparent, Catholics who were, shall we say, less than reluctant in their opposition to Obamacare might be asking themselves, “If the bishops’ concerns over abortion and conscience protections had been addressed, would the bishops really have thrown their support behind the law? And would Catholics be required to follow the bishops’ lead and support the law, too?”

The answer to the first question is quite possibly, Yes. The answer to the second is, with respect, No. There are many policy issues for which the Church has no “official position” regarding which means are most appropriate to a given end. Discerning the means appropriate to even an admittedly worthy end—in this, case expanding access to basic health care—requires the exercise of prudence.

But you don’t have to take my word for it. Here’s how the bishops themselves put it in Forming Consciences For Faithful Citizenship:

Prudential judgment is also needed in applying moral principles to specific policy choices in areas such as the war in Iraq, housing, health care, immigration, and others. This does not mean that all choices are equally valid, or that our guidance and that of other Church leaders is just another political opinion or policy preference among many others. Rather, we urge Catholics to listen carefully to the Church’s teachers when we apply Catholic social teaching to specific proposals and situations. The judgments and recommendations that we make as bishops on specific issues do not carry the same moral authority as statements of universal moral teachings.

Even in cases where the bishops collectively support a particular policy, such judgments are—with some important exceptions—not binding on the consciences of Catholics. (Though Catholics are still obliged to “listen carefully to the Church’s teachers.”)  In such cases—and the uber-complex field of health care policy is one of them—a well-formed conscience and prudent judgment can lead to legitimate conclusions that diverge from the position of the bishops. Appeals to prudential judgment don’t absolve us from responsibility for our decisions. The final measure of our actions and decisions in the political realm remains, as always, the common good.

As the Catechism puts it, “Prudence is the virtue that disposes practical reason to discern our true good in every circumstance and to choose the right means of achieving it.” (My emphasis in bold.) In this regard, Catholics—including bishops—who urge their fellow citizens to alleviate the intolerable situation in which many lack access to basic, even life-saving care, are correct to do so. That end is clearly worthy, and lays a claim on our consciences.

Unfortunately, while the road to Obamacare was paved with good intentions, good intentions are no substitute for good policy. Justified opposition to Obamacare was, and remains, opposition to a bad law, not to the benevolent motives of the law’s supporters. And it would be hard to find an example in which major legislation was passed with less regard for prudent evaluation of means than in the case of Obamacare. Then-Speaker Nancy Pelosi’s infamous line—“We have to pass the bill so that you can find out what’s in it”—is the very definition of imprudent approach to policy making.

The litany of Obamacare’s broken promises is by now familiar: We already know that, even if you like your old plan, you likely won’t be allowed to keep it. (It’s not just the individual market—tens of millions of employer-based plans are likely to be cancelled in the medium term.) Having lost your plan, you may well have to switch doctors, too. As for bending the cost curve downward and lowering average family premiums, that’s not happening either. All of this, according to the Congressional Budget Office, will leave 31 million uninsured by 2023, if everything goes according to plan. Of course, not everything has gone according to plan, and the law may well increase the number of uninsured, at least in the near term.

Even if one assumes that each of these promises was made in good faith (an admittedly generous assumption), it doesn’t change the fact that by the President’s own metrics, Obamacare is failing. While it remains difficult to see how any Catholic could in good conscience oppose making healthcare more widely accessible (on what grounds?), it is increasingly easy to see why Catholics (or anyone else for that matter) would oppose Obamacare. To repeat: Good ends are ill-served by ineffectual and counterproductive means.

That said, it is incumbent upon those who oppose Obamacare—myself included—to rally around the cause of health care reform. Fortunately, promising alternatives do exist. Whether any politicians—here’s looking at you, Speaker Boehner!—will pursue such alternatives, rather than contenting themselves to reap the political rewards of the President’s policy disasters, remains to be seen.

Which brings us to one last point: The problems with Obamacare extend beyond questions of administrative, bureaucratic, and technical competence.  They extend beyond the architecture of the law itself, which supposes, for example, that more young, healthy Americans will buy insurance despite the fact that its cost (for them) has drastically increased while the incentive to have it has just gone down (since waiting until you’re already sick doesn’t increase the cost of insurance.)

The deepest problem with Obamacare touches on fundamental questions about the proper role of the state in the lives of citizens. The state bears responsibility for the common good; of this there should be no doubt. But neither should there be any doubt that entrusting the state with ever greater authority over ever greater swaths of civic life—however well intentioned—opens doors to unwanted, often unjust, intrusions upon the rights and consciences of citizens. To this, the Church’s ongoing battles over the HHS mandate all too vividly attest (to say nothing of the President’s manifest dedication to causes that directly and unequivocally contravene the common good.) Prudence would suggests this is a lesson we can’t afford not to have learned.

Stephen P. White is a fellow in the Catholic Studies Program at the Ethics and Public Policy Center in Washington, D.C. and coordinator of the Tertio Millennio Seminar on the Free Society.

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