The great health care reform debate of 2009

Sausage anyone? The old adage about the similarities between witnessing the production of sausage and watching the creation of new laws applies in force to the great health care reform debate of 2009.

Judging from comments this author has received, many Catholics in particular are confused. What is Congress up to? What does our faith have to say about health care reform? Do the bishops have a take on what should and should not be done?

Compounding the trouble is the complexity of the topic, involving questions in medicine, economics, insurance, federal and state relations, the roles of government and the private sector, and careful moral analysis.

Bring your eggs and ketchup--an overview is now going to be served.

With respect to what is going on in Congress, the first thing to understand is that President Barack Obama, whose election spurred the great health care debate, has not produced specific reform legislation.

Nothing can be voted on in Congress unless there is a bill proposing a new law. When the president referred to “my plan” in his address to Congress earlier in September, there was no specific legislative proposal with his name on it spelling out his plan in black and white.

By not reducing his promises to a bill, the president has avoided making specific commitments to actual language that can be examined, analyzed and evaluated. He has made some good promises, such as indicating support for restrictions on abortion subsidies and for conscience protection. These promises need to be reduced to concrete legislative language and put in any of the bills working their way through Congress before the promises can be adequately assessed.

The second thing to understand is that the health care reform bills already filed will continue to change in content as the process moves forward. Three particular bills have moved to the top of the congressional calendar.

In the House there is H.R. 3200, entitled “America’s Affordable Choices Act of 2009” (the “H.R” stands for House Resolution). This bill was approved by three different committees and it is ready to come to the floor of the House for debate in that chamber.

There are two prominent Senate bills, one ready for a floor vote and the other still in committee. Senator Tom Harkin’s bill, S. 1679, entitled “Affordable Health Choices Act,” was approved in July by the Senate Health, Education, Labor and Pensions Committee. Senator Max Baucus’s bill, “America’s Healthy Future Act,” just introduced at the time of this writing, was not yet given a bill number and was still in the Senate Finance Committee where over 500 amendments to the bill were filed for committee consideration.

Any bill that reaches the Senate and House floor after amendments are added in committee can be amended yet again during floor debate. If there are any differences between the versions of a bill passed by both chambers, then even more amendments can be made by a conference committee appointed to iron out the differences. A bill that reaches the president’s desk can look very different from the bill’s original version as a result of these multiple stages of debate and accompanying votes.

This means that the specific bills proposing reform are shifting, changing targets. It is often difficult to urge specific grassroots action in the face of the rapid developments.

What does our faith have to contribute to this debate? Church teaching on health care access supplies certain basic principles. Here’s my summary.

First, since life and health are intertwined, and life is a fundamental right, then access to health care is itself a fundamental right.

Second, since the right to life is universal, access to care should be universal. All persons deserve to qualify for essential health services. This includes the unborn, older persons, individuals with disabilities and both documented and undocumented immigrants.

Third, some procedures offered under the guise of being “essential” are harmful to life and should not be included in any mandated package of “basic” health care coverage. Taxpayers should not be forced to subsidize abortion and other objectionable procedures. Conscientious freedom should be protected.

Fourth, health care is not an unlimited resource and prudential choices will have to be made about how best to accommodate access for everyone under principles of good stewardship. Yet cost control should not use forms of rationing that violate human dignity.

Fifth, since economy of scale (distributing the total burden of paying for care across a large population) is an important means for keeping the costs of health care affordable for individuals, there is a vital role for government, and even more so for the national government, in health care financing.

This vital role, however, does not justify “top-down” dictates that violate the principle of subsidiarity. This doctrine teaches that the power to make decisions should not be moved upstairs to more bureaucratic levels absent an absolute necessity. Subsidiarity respects the role of private initiative and faith-based outreach.

What actions have the U.S. Bishops, through their national office at the United States Conference of Catholic Bishops (USCCB), been taking? Key bishops and other USCCB representatives have provided Congress with their analysis of bills at different stages, calling for changes when specific provisions would violate the common good.

Copies of these communications, along with an excellent Q and A and other educational materials, including alerts and updates, are available online at

Some participants in the health care debate argue against all reform. That is not the Church’s position. The bishops’ overall message is: healthcare reform, yes; violations of human dignity, no.

Daniel Avila is the Associate Director for Policy and Research of the Massachusetts Catholic Conference.

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