By Valerie Schmalz
The debate over health care reform is igniting another, related discussion: What is the proper role of government in the lives of a country's citizens?
The Catholic Church endorses no specific political or economic system -- thus bishops and Catholic thinkers are drawing on Catholic social teaching to support sometimes conflicting solutions to find affordable health care for Americans without health insurance, who number 46.3 million according to the U.S. Census Bureau.
There's little debate in the Church that some sort of health care reform is necessary. Catholic social teaching, from papal encyclicals to U.S. bishops' conference pronouncements, increasingly in recent decades has described health care as a "right," and the U.S. bishops' conference has pressured Congress to take action on improving health care access.
The most notable Catholic opposition, starting with the bishops' conference, to current draft reform bills has been over the bills' failure to exclude federal funding for abortion.
But the structure of the health reform is also drawing fire from a small but growing number of bishops, who are citing the long-standing Catholic principle of subsidiarity, which holds that matters ought to be handled by the smallest, lowest or least-centralized competent authority.
Among the strongest critiques was a joint pastoral letter issued in August by Archbishop Joseph F. Naumann of Kansas City, Kan., and Bishop Robert W. Finn of Kansas City-St. Joseph, Mo., which reviewed Catholic principles applicable to the health care reform debate. The bishops concluded that nothing in the Catholic tradition supports a demand for health care government entitlements.
"The right of every individual to access health care does not necessarily suppose an obligation on the part of the government to provide it," they wrote.
Equally critical was the Catholic Medical Association, which represents about 1,100 Catholic health professionals. It issued a three-page letter rejecting President Barack Obama's health reform plan, saying it "clearly violates" the principle of subsidiarity: "We must ensure that well-intentioned efforts to bring about 'change' are not exploited to create a federally controlled system that promises health care for all, but creates an oppressive bureaucracy hostile to human life and to the integrity of the patient-physician relationship."
Other bishops who have highlighted the importance of the principle of subsidiarity in solving the country's health care disparity include: Archbishop John C. Nienstedt of Minneapolis-St. Paul, Minn.; Bishop R. Walker Nickless of Sioux City, Iowa; Bishop Samuel Aquila of Fargo, N.D.; Bishop Thomas Doran of Rockford, Ill.; and Bishop James V. Johnston of Springfield-Cape Girardeau, Mo., who wrote in a Sept. 4 column: "One might legitimately ask if giving a large, inefficient, but powerful bureaucracy like the federal government control of health care is a wise move."
Denver Archbishop Charles J. Chaput also cited subsidiarity, writing in a Sept. 2 column, "Real healthcare reform need not automatically translate into federal programming."
First articulated by Pope Pius XI in 1931, at the height of the Great Depression, in the encyclical Quadragesimo Anno, subsidiarity is a concept that traces back in Catholic social tradition to St. Augustine in the fifth century. In modern times, it has made an integral part of the Church's condemnation both of pure individualistic capitalism and all forms of socialism.
"Subsidiarity is that principle by which we respect the inherent dignity and freedom of the individual by never doing for others what they can do for themselves and thus enabling individuals to have the most possible discretion in the affairs of their lives," wrote Archbishop Naumann and Bishop Finn in their pastoral letter. Citing Pope John Paul II's encyclical Centesimus Annus, Pope Benedict XVI's encyclical Deus Caritas Est and the Catechism of the Catholic Church, they said, "The writings of recent popes have warned that the neglect of subsidiarity can lead to an excessive centralization of human services, which in turn leads to excessive costs, and loss of personal responsibility and quality of care."
To date, not a single bishop has made the counterargument that the current health reform plans are in tune with the Church's teaching on subsidiarity. But some progressive-leaning lay Catholics have spoken out. One such critic, J. Peter Nixon, a director of metrics and analytics at HMO Kaiser Permanente and Catholic writer for Commonweal magazine, said bishops who cite subsidiarity are rationalizing their "quasi-libertarian" political leanings and called the letter of Archbishop Naumann and Bishop Finn thin on Catholic social teaching. He noted that socialized medicine is provided in most European countries, which have been influenced by centuries of Catholicism.
"I have not seen other documents of Catholic social teaching really try to apply the concept of subsidiarity to health care in the way the bishops [Finn and Naumann] are trying to do in the document," Nixon told Our Sunday Visitor.
A similar critique was issued by Catholics in Alliance for the Common Good, a group that campaigned for Obama. In a statement signed by dozens of theologians and social-justice advocates, it said some bishops' criticism, including that of Archbishop Naumann and Bishop Finn, "echo partisan talking points and give the false impression that the Catholic Church is not a vigorous advocate for reforming our broken health care system."
"The principle of subsidiarity, according to Pope Pius XI, was not designed to create a presumption against government. Instead, he claimed that it would allow government to 'more freely, powerfully, and effectively do all those things that belong to it alone because it alone can do them,'" said the statement, whose signatories included the president of the Catholic Theological Society of America.
Another signatory, Stephen F. Schneck, associate professor of politics at The Catholic University of America and director of the Life Cycle Institute, acknowledged, however, that Catholic principles do not dictate a single practical solution to today's health care debate.
"In truth, nothing in Catholic social teachings requires that health care be addressed with a particular policy approach," he told OSV.
But Schneck argued that "the failure to provide comprehensive coverage in the United States is behind the American bishops' long-standing insistence that as a society we are faced with a moral imperative regarding health care." That lends "special strength to the bishops' occasional use of the language of rights in referring to health care," he said.
Pope Benedict XVI mentions subsidiarity a dozen times in his latest encyclical. In his first encyclical, he wrote: "The state which would provide everything, absorbing everything into itself, would ultimately become a mere bureaucracy incapable of guaranteeing the very thing which the suffering person -- every person -- needs: namely, loving personal concern. We do not need a state which regulates and controls everything, but a state which, in accordance with the principle of subsidiarity, generously acknowledges and supports initiatives arising from the different social forces and combines spontaneity with closeness to those in need."
Valerie Schmalz is an OSV contributing editor.