A False Assumption

In the last few months, the bishops have joined in the national debate over health care reform. Many haverightly concentrated their rhetoric on the importance of protecting the right to life and conscience. But their public statements often take for granted that the federal government should be heavily and directly involved in providing health care. The assumption underlying their statements ignores a fundamental question: What exactly is the Catholic Church’s teaching about the government’s role in health care?

To answer that question, we need to answer other fundamental questions. First of all, is there truly a “right to health care”? From the perspective of Catholic social doctrine, the answer is very clearly yes. But what does it mean to have this “right”? In short, how do we respect another person’s right to health care?

Although official Church teaching tends to be vague on this particular point, we can find the answer by looking at papal teaching with regard to another similar basic right—the “right to work.”

Does the right to work mean that the federal government has a duty to supply jobs for all its citizens—to give a job to everyone? Consider what Pope John Paul II wrote in his 1991 encyclical Centesimus Annus:

[One] task of the state is that of overseeing and directing the exercise of human rights in the economic sector. However, primary responsibility in this area belongs not to the state but to individuals and to the various groups…which make up society. The state could not directly ensure the right to work for all its citizens unless it controlled every aspect of economic life and restricted the free initiative of individuals. Rather, the state has a duty to…[create] conditions which will ensure job opportunities. (48)

Applying this logic to the right to health care, it seems clear that the federal government does not have a moral obligation to provide or guarantee the right to health care for all its citizens, and in fact, such an undertaking would require the detrimental level of state control mentioned above.

Consider also another basic human right: the right to food. The Church teaches that everyone has a right to food, but it does not teach that the government has a duty to provide free food to everyone. It must protect the citizens’ right to food by keeping others from stealing their food, and defending their freedom to work and buy food in the market, but it doesn’t have a duty to give food to everyone. As St. Paul reminds us: “If any one will not work, let him not eat” (2 Thess. 3:10).

Now, if you are not able to work, that’s a different story, and Catholic doctrine teaches that the state may sometimes have to intervene and provide a safety net. But when would the state have to step in? The answer to that question lies in the moral principle of subsidiarity.

Although often overlooked, subsidiarity has been one of the key principles of Catholic social teaching since Pope Leo XIII wrote the foundational social encyclical Rerum Novarum in 1891. As Pope Pius XI wrote in 1931, it is a “most weighty principle, which cannot be set aside or changed, [and] remains fixed and unshaken in social philosophy” (Quadragesimo Anno 79).

Pope John Paul II defined the “principle of subsidiarity” as follows: “a community of a higher order should not interfere in the internal life of a community of a lower order, depriving the [lower] of its functions, but rather should support it in case of need and help to coordinate its activity with the activities of the rest of society” (CA 48).

For example, the family is the most basic unit of society, “a community of a lower order.” Government as a “community of a higher order” may never interfere in the internal life of a family except in cases of need. Similarly, a neighborhood, a locality, or state government must be left to do the things they can handle on their own without the interference of the federal government. And this applies to any organization in society, including businesses and unions.

The principle of subsidiarity is based on the fundamental dignity of the individual human person, who is created to live in personal relationship with others. This is the foundation of society, at all its graduated levels of family, neighborhood, city, etc.—up to the national and even global level. The more we get away from real interpersonal relationships, the easier it is to lose sight of the person and compromise his dignity and personal freedom.

Now some functions are clearly and naturally the province of national governments, because individuals, families, and localities couldn’t possibly perform them. For example, defense of the nation is a natural function of a nation’s government. But historically in America the health care of individuals does not fall into this category, particularly for its federal government.

Think about it. Who is best suited, on a simply natural level, to give aid and care to a sick person? Those closest to that person: his family, the neighbors— including fellow parishioners—and the local doctor or nurse. Health care is fundamentally about persons tending to the real immediate needs of other persons. Government, especially a remote federal government, just isn’t very well suited to that task (cf. CA 48).

You might say in response to this: “Well, big insurance companies and big hospitals aren’t very personal either.” True, but that only makes my point: the same problems we see with big insurance companies are found on an almost geometrically larger scale with big government. Because of the free market you can choose to leave one insurance company and go to another, but you can’t easily “leave” one government and go to another.

You might say: “But not everyone in America gets to choose his health care provider or insurance company, especially the poor.” True, but does that mean we move away from choice and freedom and toward an impersonal system? Or do we try to find solutions that promote greater choice and freedom for all, that move us toward a more personcentered system?

Pope John Paul II wrote:

By intervening directly and depriving society of its responsibility, the social assistance state leads to a loss of human energies and an inordinate increase of public agencies, which are dominated more by bureaucratic ways of thinking than by concern for serving their clients. (CA 48)

Pope Benedict XVI echoes this in his encyclical Caritas Veritate:

Subsidiarity…fosters freedom and participation through assumption of responsibility. Subsidiarity respects personal dignity by recognizing in the person a subject who is always capable of giving something to others. (CV 57)

This does not mean that governments should never assist when absolutely necessary. But if government does step in, local and state governments should be the first to do so. As Pope John Paul II wrote, “in exceptional circumstances the state can also exercise a substitute function, when social sectors or business systems…are not equal to the task at hand” (CA 48).

One thinks of natural disasters, like Hurricane Katrina, where local and state governments were absolutely overwhelmed and the federal government had to step in. Yet even in these circumstances Pope John Paul II offers a caution:

Such supplementary interventions, which are justified by urgent reasons… must be as brief as possible, so as to avoid removing permanently from society and business systems the functions which are properly theirs, and so as to avoid enlarging excessively the sphere of state intervention to the detriment of both economic and civil freedom. (CA 48)

Pope Benedict XVI writes in Caritas in Veritate that “subsidiarity is the most effective antidote against any form of allencompassing welfare state” (CV 57).

Still, some might say “solidarity” with the poor trumps subsidiarity, that government always has a moral obligation to intervene to provide health care for the poor. But solidarity and subsidiarity are not opposed. Indeed, separating them leads “to paternalist social assistance that is demeaning to those in need,” says Pope Benedict XVI.

Finally, even if the health care crisis today were as dire as those calling for a government-run plan claim, simple prudence about the present moral character of the federal government should make us hesitate. Such a plan means turning over vast numbers of moral questions and decisions involved in health care to the government. Can we entrust our health care to a government presently dominated by people—elected and unelected—who don’t understand the dignity of life from conception until death, who already fund abortion and experimentation on human embryos, and whose understanding of the meaning of the words “family” and “marriage” has been thoroughly corrupted?

As Catholics continue the debate over health care, they should remember first and foremost the serious obligation Christians have to care for the sick, a responsibility that cannot be lightly shifted to bureaucrats and politicians. Let us be guided in this debate by the wisdom of Christ, which is laid out before us in a full, not partial, treatment of the social doctrines of his Church.