On subsidiary and health care

I’m still working on Part 2 of my analysis of the abortion coverage issue in the House and Senate health care reform bills. It’s taken longer than I had hoped (primarily because the issue involves some fairly arcane accounting rules), but I wanted to take a minute to address another point of interest related to health care reform from a Catholic perspective: the principle of subsidiary.

In brief, the principle of subsidiary holds that problems should be solved, and authority invested, “at the lowest possible level of an institutional hierarchy” (definition from Answers.com). In Catholic social teaching as explained and developed by the Popes of the 19th and 20th centuries, subsidiary serves as a counterweight to the principle of solidarity (the idea that society has an obligation to take care of all of its members, with a preferential focus on the poor and vulnerable). If solidarity is the “liberal” part of Catholic social teaching, subsidiary is the “conservative” part; from a practical perspective in the modern age, subsidiary discourages people from looking instantly to the central government for solutions to problems, and encourages community-based solutions since individuals tend to feel closer to and more invested in community-based institutions (churches, local businesses, local government, etc.) In other words, it encourages institutions and policies to have as much of a “personal touch” as possible.

Applying these abstract concepts to the concrete question of health care reform, many Catholics point to subsidiary as an argument against federal involvement in the health care system. Certainly, when it comes to the issue of health care itself, this idea is very compelling. The vast majority of us would prefer to be treated by the traditional “family doctor” with whom they can build a long-term relationship than by a doctor who works for the government  (or a large corporation) and treats patients like customers at the DMV. For this reason, subsidiary provides a good reason to reject a single-provider health care system.

However, on the question of health insurance, the means by which we pay for this personalized care, I think that the subsidiary debate is largely a red herring. Let’s be honest: would anyone really try to claim that a large multinational insurance company is any more “personal” than the federal government? Indeed, the argument could be made that a federal single-payer (as opposed to single-provider) system would be more in keeping with the principle of subsidiary than our current system of private insurance companies; after all, in our representative democracy, the federal government is directly accountable to the voters (i.e. the people who would both pay the taxes for and receive the benefits from a single-payer system). In contrast, a private insurance company is accountable not to its customers, but to its shareholders (many of whom are not even individuals, but institutions like banks and mutual funds). So when it comes to debating the relative merit of government-run health insurance (not government-run health care) versus private health insurance, the question of subsidiary seems somewhat irrelevant. The only relevant question is this: which system would provide higher-quality care for patients, and reduce administrative burdens for doctors so that they can spend more time with their patients? From this perspective, there are lots of arguments in favor of single-payer (chief among them the effectiveness and popularity of Medicare in the United States). I won’t expand upon those arguments here, because my purpose is not to advocate in favor of single-payer (at least not right now); I only wish to note that these arguments can’t all be thrown out simply by invoking subsidiary.

Of course, the entire debate is completely irrelevant to the reform plans currently under consideration by the House and Senate. Despite unfounded claims from the Right, neither proposal brings us anywhere close to a single-payer system; indeed, it is highly unlikely that the final bill will include even an optional government-run alternative to private insurance. It is almost certain that health care reform in the United States, at least for the foreseeable future, will consist primarily of subsidies to private insurance companies so that low-income Americans can purchase coverage at lower prices. This is a good thing as far as it goes, since it will vastly reduce the number of Americans who go without health insurance. However, if this model fails to bring down overall health care costs (a task that will be difficult if not impossible without a public option), the debate over the merits of government-provided health insurance versus private coverage will probably be rekindled at some point. If and when that happens, it would be a mistake for Catholics to reject such proposals out of hand due to a false understanding of subsidiary.

Nelson vs. Stupak: abortion and health care (Part I)

Though the battle over health care reform has covered some very contentious ground, it is safe to say that the biggest sticking point thus far has been abortion, specifically the question of how to maintain the current prohibition against federal funding of abortion in the final bill. As is usually the case in matters related to both abortion and health care policy, the debate has been extremely emotional and often extremely confusing. This post represents my humble attempt to make sense of the question as a Catholic who is both pro-life and relatively liberal on the general issue of health care reform. Because I want to be fairly comprehensive, I’m actually going to divide this into two posts. In this first one, I will start by outlining the political and moral background behind the question of abortion funding; provide some general information on the bills currently under consideration by the House and Senate; and describe the provisions on abortion funding in each bill. In the second post, I will perform a comparative analysis of each bill’s abortion provisions and come to a final conclusion as to whether the relevant language in the Senate bill (which will probably end up in the final bill) is acceptable from a pro-life perspective.

Predictions for 2010

One thing I’ve noticed after years of blog-reading is that a “Predictions for the Year Ahead” post is pretty much obligatory on New Year’s Day. So here goes, in no particular order: