Mirror of Justice

A blog dedicated to the development of Catholic legal theory.
Affiliated with the Program on Church, State & Society at Notre Dame Law School.

Tuesday, December 13, 2016

Camosy on health-care policy, Rep. Paul Ryan, and Catholicism

Prof. Charles Camosy (Fordham) has a piece in the Washington Post called "Millions of Lives Are in Paul Ryan's Hands.  His Catholicism Is Our Only Hope."   He writes, among other things, that "Ryan’s proposal is deeply problematic — especially for the most vulnerable. And for Catholics, that’s a serious problem. Although Catholics had plenty of reasons to critique the ACA, including understandable concerns about the Obama administration’s health policy steamrolling individuals and communities who cannot in good conscience participate in abortion, the overall effort to make health care as accessible as possible is, by Catholic standards, a worthy goal."  And, he concludes with this:

Ryan’s commitment to the Catholic Church means that he ought to rethink his health-care reform proposals and make sure that — instead of privileging the young, wealthy and healthy — they instead lift up the sick, poor and old. It is through these populations, after all, that Christ comes to us today. Indeed, Christians are told that it is how we treat them that will determine our ultimate fate after death.

We found trillions of dollars to fight unnecessary wars overseas. We are likely to find them for a huge, bipartisan infrastructure project. There is no excuse for not finding them to make sure that the least among us have the health care they are owed. To do any less means abandoning people bearing the face of Christ Himself.

Prompted by Charlie's piece, I want to put aside some questions I have about whether "owed" is the best word to use here and instead to ask . . . how should someone who aspires to do the Right Thing with respect to health-care policy (which is, in my view, impossible to separate from other policy matters, including those relating taxation, nutrition, litigation, etc.) approach the matter?  I admit . . . I genuinely don't know.  The more "progressive" sections of my social-media feeds reflect a deep, almost religious (though often unexamined) conviction that the answer is easy:  "A single-payer system in which 'market forces' don't determine the costs or availability of services."  It seems clear to me, though, that it is not possible to eliminate (as opposed to regulate) 'market forces' entirely from this (or almost any other) domain because people -- being people -- respond to incentives.  In the more "conservative" sections, I sometimes sense a failure to appreciate the fact that it is in all of our interests, for many reasons, that the public authority attend to citizens' health and well-being.  So again:  What should we do?  How do we move -- in an effective and, yes, reasonably efficient way -- all of the relevant variables in the right directions?

A few things, that seem relevant to this discussion, seem to me to be the case (I'd like to hear from others whether and in what ways they disagree).  In no particular order (and putting aside my view that some things which are treated in contemporary debates as "health care", e.g., euthanasia and elective abortions, are not):

 - The public money that is available for health-care-related programs is non-infinite (even if one thinks there is more to be had through increased taxation), and so spending on such programs involves, at least to some extent, trade-offs.

 - We should not tax-and-spend (on anything, including health-care programs) at levels that endanger national security, or that cause excessive harm to the economy-in-general, or that impose unfair burdens on the next generation(s).  

 - We should be clear-eyed and candid -- and also always non-negotiably committed to the equal dignity of every human person, regardless of age, disability, etc. -- when deciding how to allocate health-care-related funds as between, say, pre-natal, early-childhood care, and preventive care, on the one hand, and experimental, aggressive, and "futile" care, on the other.  (More bluntly - any conversation about single-payer systems has to include conversations about, e.g., morally defensible triage, rationing, and tort/malpractice reform.)

 - It is not always unfair or otherwise wrong to, when designing a health-care-provision regime, require people to bear the risks of freely chosen unhealthy or dangerous behaviors.

I could probably think of more, but this is enough for now, maybe.  Like I said, I'd welcome other bloggers' "takes" on this.  This isn't a "politics" or a "policy" blog, I realize, and I mean to be inviting a conversation about what the Church's social teachings tell us about the ends, the limits, and the design of legal regimes, in a particular area.

(And yes, I admit:  I'm avoiding grading.)   



Garnett, Rick | Permalink