Thursday, December 15, 2016
I thought I'd offer a few, rather abstract thoughts in reaction to Rick Garnett's post about health care. Abstract because health care policy makes my head spin, and (hence) I know little about it; and also because I have little to add to Rick's substantive points, which seem entirely sound to me. But Rick's discussion brings out one important point I do wish to underscore: a Catholic approach to health care policy can and indeed should be entirely comfortable with consequentialist tradeoffs and with attention to the design of optimal incentives -- within certain boundaries.
Cardinal Newman, in a mini-treatise on constitutionalism, once wrote that "no one in this world can secure all things at once, but in every human work there is a maximum of good, short of the best possible." The point applies not just to constitutions, but to any institutional system of any degree of complexity operating under conditions of scarcity; and in any event the health-care system is a kind of constitution for human well-being. Every natural-law theory of which I am aware, such as Finnis', admits a domain of prudential judgment in which it is entirely legitimate for policymakers to pursue overall well-being, subject to limited side-constraints on permissible means and on admissible motives. There is no reason in principle to shy away from incentive-based mechanisms and market-based mechanisms in the health-care system, including the sorts of incentives for healthy behavior that Rick discusses -- subject as always to the further welfarist constraint that those incentives must plausibly contribute to a maximum of overall attainable human well-being.
What, if anything, is distinctively Catholic about this picture? Beyond its undoubted function of ruling out morally impermissible means, does the Church have any further role to play in complex policy domains? Certainly it does. The best two-sentence account I have seen is a tweet (yes, a tweet) by the Abbe Grosjean, a brilliant priest of the Diocese of Versailles, who wrote that "le discernement des solutions et stratégies n'est pas le rôle des clercs. Notre rôle est de rappeler le but." (My emphasis). Figuring out solutions and strategies is not the role of the clergy; their role is to remember the purpose or goal. The Church's role in complex policy domains is to act as a guardian of memory -- a kind of conservator of original and ultimate purposes, acting to remind policy makers that the ultimate aim of the health care system is to promote the common good of human flourishing.
The practical import of that further role is twofold. First, the guardian of memory reminds policymakers of the vulnerable, those whose interests and moral standing are constantly at risk of being forgotten or discounted in the hurly-burly of conflicting demands and pressures, such as the unborn. Second, the Church stands ready to guide and admonish policy makers who, lost in the details, constantly tend to forgetfulness or myopia even when acting in the best of faith. Myopia or forgetfulness takes the form of elevating a partial or subordinate good of undoubted value -- the alleviation of pain, for example -- into an ultimate aim, in a way that distorts the system's operation and actually detracts from pursuit of the overall aim itself. Even from a consequentialist point of view, myopia results in substitution of partial for ultimate goods in a way that amounts to a form of idolatry -- something that the Church has a bit of experience combatting.
(Thanks to Fr. Dominic Legge, O.P., for helpful comments).