There's major crisis brewing in Catholic health care that threatens the viability and even the existence of Catholic hospitals in the United States.

As Ann Carey notes in our In Focus section, ever-increasing health care costs have forced Catholic systems to examine their bottom line more closely to remain solvent (see Pages 9-12). In real terms, this has led to sometimes uncomfortable partnerships with secular health systems, accusations of excessive profits and claims that too little pro bono health care is extended to the poor and uninsured.

Such concerns go to the heart of the Catholic health care mission. Women religious first established Catholic hospitals in this country to serve the poor and indigent. As health care became more sophisticated, Catholic hospitals had to rely less on voluntary contributions and more on government subsidies, insurance payments and fees for services from those who could afford them.

Problems arise when the business of health care conflicts with the Catholic mission. When Catholic hospitals turn a blind eye to abortions performed by their secular partners or provide contraceptive services in defiance of the U.S. bishops' directives, it's fair to ask whether the Church ought to get out of the health care business rather than allow this erosion of Catholic identity.

In a political climate where a fictional "wall of separation" between church and state runs in only one direction, special interests often seek to impose libertarian values even on private entities. Lawmakers and regulatory bodies try to force Catholic employers to provide employees with contraceptive coverage in company health plans. They deny "conscience clauses" to pharmacists and try to coerce Catholic hospitals to offer "reproductive services" that are incompatible with Catholic morality.

It's the same concern some Catholics have about federal tuition vouchers for Catholic schools: The more government subsidizes, the more government controls.

Some Catholic institutions take the painful high road rather than cave in for the sake of licensing or governmental funding. Catholic Charities in Boston recently quit offering adoptions rather than comply with a new Massachusetts law forbidding agencies from discriminating against same-sex couples who want to adopt. Some struggling Catholic hospitals have closed rather than curtail charitable care or compromise their mission by moving into lucrative but problematic markets.

Bishop Joseph Sullivan, a retired auxiliary of the Brooklyn diocese who has worked extensively in Catholic heath care concerns, said last year that in order to survive, Catholic hospitals must be clear about their mission, provide formation for lay administrators and maintain close ties with the local diocese. He suggested that Catholic health institutions may have to shift their focus from acute care to long-term care to remain viable.

Bishop Sullivan may be on to something. Catholic hospitals must deal effectively with modern realities without diminishing Catholic identity. Lacking solvency, the Catholic mission cannot continue; yet if Catholic hospitals become indistinguishable from secular providers, the Church has no business remaining in the field.

As sharers in the Church's mission, all Catholics must remain vigilant against coercive laws and to protest loudly whenever legislatures or regulatory bodies seek to trump the principles of the bishops' health care directives.