The Bishops and Obamacare

dolanThis past weekend, Cardinal Timothy Dolan of New York—who recently finished his term as President of the USCCB—went on NBC’s “Meet the Press” where he discussed, among other things, the Catholic bishops’ complicated relationship with the Affordable Care Act. His Eminence was very supportive of the law’s goals, pointing out that the Catholic bishops have supported health care reform since 1919. So he laments that the bishops’ initial excitement at the prospect of comprehensive health care reform was ultimately frustrated by the administration’s intransigence over abortion funding and the exclusion of immigrants. Then came the concerns over conscience protections:

So that’s when we began to worry and draw back and say, “Mr. President, please, you’re really kind of pushing aside some of your greatest supporters here. We want to be with you, we want to be strong. And if you keep doing this, we’re not going to be able to be one of your cheerleaders.” And that sadly is what happened.

In the end, it was with reluctance, perhaps great reluctance, that the bishops opposed the bill.

As the widening gulf between Obamacare as it was sold to the American people and the law’s real world consequences becomes more apparent, Catholics who were, shall we say, less than reluctant in their opposition to Obamacare might be asking themselves, “If the bishops’ concerns over abortion and conscience protections had been addressed, would the bishops really have thrown their support behind the law? And would Catholics be required to follow the bishops’ lead and support the law, too?”

The answer to the first question is quite possibly, Yes. The answer to the second is, with respect, No. There are many policy issues for which the Church has no “official position” regarding which means are most appropriate to a given end. Discerning the means appropriate to even an admittedly worthy end—in this, case expanding access to basic health care—requires the exercise of prudence.

But you don’t have to take my word for it. Here’s how the bishops themselves put it in Forming Consciences For Faithful Citizenship:

Prudential judgment is also needed in applying moral principles to specific policy choices in areas such as the war in Iraq, housing, health care, immigration, and others. This does not mean that all choices are equally valid, or that our guidance and that of other Church leaders is just another political opinion or policy preference among many others. Rather, we urge Catholics to listen carefully to the Church’s teachers when we apply Catholic social teaching to specific proposals and situations. The judgments and recommendations that we make as bishops on specific issues do not carry the same moral authority as statements of universal moral teachings.

Even in cases where the bishops collectively support a particular policy, such judgments are—with some important exceptions—not binding on the consciences of Catholics. (Though Catholics are still obliged to “listen carefully to the Church’s teachers.”)  In such cases—and the uber-complex field of health care policy is one of them—a well-formed conscience and prudent judgment can lead to legitimate conclusions that diverge from the position of the bishops. Appeals to prudential judgment don’t absolve us from responsibility for our decisions. The final measure of our actions and decisions in the political realm remains, as always, the common good.

As the Catechism puts it, “Prudence is the virtue that disposes practical reason to discern our true good in every circumstance and to choose the right means of achieving it.” (My emphasis in bold.) In this regard, Catholics—including bishops—who urge their fellow citizens to alleviate the intolerable situation in which many lack access to basic, even life-saving care, are correct to do so. That end is clearly worthy, and lays a claim on our consciences.

Unfortunately, while the road to Obamacare was paved with good intentions, good intentions are no substitute for good policy. Justified opposition to Obamacare was, and remains, opposition to a bad law, not to the benevolent motives of the law’s supporters. And it would be hard to find an example in which major legislation was passed with less regard for prudent evaluation of means than in the case of Obamacare. Then-Speaker Nancy Pelosi’s infamous line—“We have to pass the bill so that you can find out what’s in it”—is the very definition of imprudent approach to policy making.

Obama-worriedThe litany of Obamacare’s broken promises is by now familiar: We already know that, even if you like your old plan, you likely won’t be allowed to keep it. (It’s not just the individual market—tens of millions of employer-based plans are likely to be cancelled in the medium term.) Having lost your plan, you may well have to switch doctors, too. As for bending the cost curve downward and lowering average family premiums, that’s not happening either. All of this, according to the Congressional Budget Office, will leave 31 million uninsured by 2023, if everything goes according to plan. Of course, not everything has gone according to plan, and the law may well increase the number of uninsured, at least in the near term.

Even if one assumes that each of these promises was made in good faith (an admittedly generous assumption), it doesn’t change the fact that by the President’s own metrics, Obamacare is failing. While it remains difficult to see how any Catholic could in good conscience oppose making healthcare more widely accessible (on what grounds?), it is increasingly easy to see why Catholics (or anyone else for that matter) would oppose Obamacare. To repeat: Good ends are ill-served by ineffectual and counterproductive means.

That said, it is incumbent upon those who oppose Obamacare—myself included—to rally around the cause of health care reform. Fortunately, promising alternatives do exist. Whether any politicians—here’s looking at you, Speaker Boehner!—will pursue such alternatives, rather than contenting themselves to reap the political rewards of the President’s policy disasters, remains to be seen.

Which brings us to one last point: The problems with Obamacare extend beyond questions of administrative, bureaucratic, and technical competence.  They extend beyond the architecture of the law itself, which supposes, for example, that more young, healthy Americans will buy insurance despite the fact that its cost (for them) has drastically increased while the incentive to have it has just gone down (since waiting until you’re already sick doesn’t increase the cost of insurance.)

The deepest problem with Obamacare touches on fundamental questions about the proper role of the state in the lives of citizens. The state bears responsibility for the common good; of this there should be no doubt. But neither should there be any doubt that entrusting the state with ever greater authority over ever greater swaths of civic life—however well intentioned—opens doors to unwanted, often unjust, intrusions upon the rights and consciences of citizens. To this, the Church’s ongoing battles over the HHS mandate all too vividly attest (to say nothing of the President’s manifest dedication to causes that directly and unequivocally contravene the common good.) Prudence would suggests this is a lesson we can’t afford not to have learned.


  • Angelica Korbas

    i do not get this either, this party things, to fight for an organization that clearly needs reforms and have a church here who could really help with, quite a few, who would jump at the chance at Universal Health care but not when it advocates for woman, especially unwed and vulnerable woman to make the biggest mistake of their lives. this i just do not get…why advocate so much of an organization that clearly needs laws to reform it, and to help them not advocate for abortion-i am praying here that people stop voting with their party here. and start voting with their conscious as far as the abortion issue .. because Cardinal Dolan said what I was thinking over here,…Thank You Cardinal Dolan. As i said before this is a good President,I wish Mr. President and Cardinal Dolan could have a friendly chat over some coffee…. I know President Obama is really trying, sitting up night and day worried about how to make this a better place , I pray Christians can start advocating for the Lords rights and let this President know we are with him here and his healthcare is not all bad he did work so hard i could tell…and he wants to help the poor and the sick that is what strikes me,.., but just explain to him our views, I am praying…here and make this country what is was meant to be, thank you for sharing this with me

  • John Gardner

    Nice try to get the USCCB and the CHA off the hook — but fail. The USCCB was all for Obamacare as long as there was an exception for contraception/abortion and Catholic institutions were exempted. None of the other (i.e., conservative) approaches to improving health care for the poor while preserving a private market allowing freedom of conscience were considered by the USCCB. So, they were hooked. There were no objections to the Obamacare provisions to which so many people are now objecting, probably due to lack of careful reading of just what was in the bill. As far as I’m concerned, they OWN Obamacare!

  • Matt

    Michael, I don’t agree with your statement that ACA was designed to fail. However, Republicans really do want it to fail. We will see.

  • Maggie

    Nah my Church will continue to support socialism regardless of what harm it has done in other countries and they will support the idiots that support it, all the while telling them that is what Jesus would do. The ignore the “teach a man to fish” part of our religion and continue to demean the poor by keeping them poor and helpless, missing the part about how special each and everyone of us is. Helping the poor reach their full potential as one of God’s children is harder than redistributing the wealth. Help those truly in need and assist and insist all others become all that they can be!

    • Slats

      So, Maggie, where in the Holy Bible or in the Sacred Tradition can we find that “teach a man to fish” thing which is supposedly part of our religion? Sounds a lot more like some of our separated brethren (the Calvinist branch) who came to see poverty as a sign of God’s disfavor. Unfortunately, that runs contrary to the Gospel (cf. Jesus and the camel in the eye of the needle, St. Luke’s reporting of the Beatitudes). The Prophets, the Gospel, and the deposit of the faith teach that God has a special love for the poor as His little ones. Scripture and Sacred Tradition (e.g. St. John Chrysostom and St. Thomas Aquinas) teach that the fish belong to the poor. “The crippled, the blind, the lame” cannot fish, and we withhold the fish from them at the risk of our salvation.

      In modern day terms, the application of this teaching is that the vast majority of those who are poor in this country, for example, suffer from substance addictions and/or major mental illnesses. Many have physical incapacities as well. These folks can’t fish, and God will punish us if we fail to give them the fish they need at a given moment. Of course, I have a feeling that the two of us would agree that it doesn’t help that our stupid government punishes people at the margins who are struggling to better themselves with what little resources they have by making sure they make less working than they would by being on welfare.

      The Church does affirm the right to private property and does condemn Marxism, but she has also condemned unfettered free market capitalism consistently since Pope Leo XVI.

      I am not advocating for universal, socialized, single-payer health care. But Catholic hospitals should continue to do what many of them already do – help those who can’t help themselves (i.e. treat those among the poor who can’t pay their ludicrously exorbitant bills and who don’t have insurance).

      • Mike

        You can find the “teach a man to fish” idea in 2 Thess 3:7-10 which says, “For we did not act in a disorderly way among you, nor did we eat food received free from anyone. On the contrary, in toil and drudgery, night and day we worked, so as not to burden any of you. Not that we do not have the right. Rather, we wanted to present ourselves as a model for you, so that you might imitate us. In fact, when we were with you, we instructed you that if anyone was unwilling to work, neither should that one eat.”

        Harsh, but there it is. I feel we all have an obligation to care for the poor, out of love for our fellow man and in thanksgiving for the gifts we have been given. I don’t think the government should forcibly compel us to comply with its plan for help regardless of its own inefficiency and without respect for the moral consequences.

      • Slats

        Excuse me – Pope Leo XIII.

  • Richard

    “Mr. President, please, you’re really kind of pushing aside some of your greatest supporters here. We want to be with you, we want to be strong. And if you keep doing this, we’re not going to be able to be one of your cheerleaders.”
    Obama was one of only a few Illinois state senators who voted AGAINST the Born-Alive Infants Protection Act. How could any Catholic be among his “greatest” supporters. Cardinal Dolan does not speak for this Catholic.

    • Stephen White

      Richard: I think it’s pretty clear that the Cardinal means “greatest supporters” with respect to health care reform, not Obama’s entire legislative history, including his record in as a State Senator. Obama’s BAIPA record was not lost on the Cardinal, I assure you. And the bishops’ desire to support reform was, of course, conditional. Their conditions weren’t met, and they opposed Obamacare on, primarily, pro-life grounds. And, of course, Cardinal Dolan was instrumental in keeping the bishops strongly unified in their opposition to the HHS mandate. He deserves a lot of credit.

  • Michael

    The (Un)Affordable Care Act/Obamcare was never meant to succeed. It’s meant to be so bad that people will demand the government take over the health care system entirely. The biggest obstacle to that are the Catholic hospitals, thus the HHS mandate.

    • Slats

      Well-said. Perhaps I’m just a sucker for buying into Dinesh DeSouza too much, but I think the other major intention of Obamacare was to bring the country and the government to their knees financially (this health-care plan is a government fiscal crusher) with the minimal goal of crippling the U.S. as a world power and with further hopes of constitutional collapse and the rise of a socialist state, if not all-out Stalinist Marxism.

      I know it’s out of step with the free-market assumptions held by many here, but to me, the answer to the pre-Obamacare healthcare crisis was pretty simple – very heavy government cost regulation of the hospitals, pharmaceutical companies, and insurance companies that caused the crisis with their towering greed. They should have been told, you will provide treatment x and service y for price $z if you want to stay in business, and you will continue to provide the treatments and services because you have a moral obligation to do so if you want to remain in business. Fat cat greed caused the health care crisis.

      • joseph wascalis

        Catholics supported Obama in 2012 by a margin of 50 to 48 %. My guess is they would do so again if he were a candidate at this time. Yeh, he may be in favor of Abortion, but look at all the other things he does for us. This would be the line of reasoning they would employ to justify their position. In other words, “so what”. This should be one of the subjects raised in the Vatican’s poll/survey of this year. In fact, it should be the first question that would then shed light on subsequent views.

    • Stephen White

      There’s little doubt that many, including the President, would have preferred a single payer system. And surely many still hope, over time, to move in that direction. Still, I find very unpersuasive the theory that a massive government excursion into healthcare was designed to fail in order to rouse public support for…and even bigger government excursion into healthcare.



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