The Catholic Church’s social teaching is erected on the belief in the basic dignity of the human person. The Compendium of the Social Doctrine of the Church is replete with references to human dignity with regard to social, political, and economic life. The encyclical Pacem in Terris by Pope John XXIII provided a catalog of the natural rights of man, including the right to medical care as part of a more encompassing right to life. The concern about human dignity and making the right to medical care a reality for everyone no doubt prompted the USCCB to support the Affordable Care Act (“Obamacare”), at least absent its requirements to cover contraception, sterilizations, and abortifacients. The much-heightened centralized control over health care heralded by Obamacare is troublesome in light of the basic principle of subsidiarity, but perhaps the USCCB thought it could be justified because of these other considerations. Will the ACA truly make medical care more readily available or will it—is it already—offending human dignity?
Perhaps the central problem of American health care has been cost. The rationale justifying the ACA—as the law’s name suggests—was to make health care affordable. As we witness the rising—indeed, sharply rising—premiums confronting many Americans, it looks like the opposite is occurring.
To be sure, Obamacare promises to subvert human dignity in significant ways. Its mandating and subsidizing abortifacients—the killing of the unborn—is the ultimate affront to human dignity. Contraception and sterilization undermine human dignity by subverting the ends of the sexual faculty and of marriage. The ensuing harm done to families—consider the corresponding rise of children born outside of marriage and marital breakdown, which the easy availability of contraception has stimulated—undermines the dignity of offspring by depriving them of their right (stressed by Pope John Paul II) to an intact family. By mandating that insurance plans cover these practices, it cannot help but to increase their incidence and to undermine the dignity of many more persons.
All this is even apart from the assault on human dignity by the HHS mandate that requires Catholics and other conscientious objectors to contribute by their insurance premiums to these immoral practices. The ACA, then, violates what John Paul II called two of the most basic human rights, to life and religious freedom (Sollicitudo Rei Socialis #33).
The continuing increase of the cost of Obamacare over time, as projected by the Congressional Budget Office and as experienced by virtually every entitlement program, is almost certain—especially in an anti-life culture—to result in the rationing of care. Indeed, the nature of the Independent Payment Advisory Board right in the law suggests this. So, the human dignity of the elderly and the chronically infirm will be imperiled. It is likely to accelerate demands for legalizing physician-assisted suicide, a right of health care institutions to withhold care irrespective of the wishes of patients’ families, and other forms of euthanasia.
While some scoffed at Sarah Palin’s comment about death panels, defenders of the law, like Paul Krugman, Steven Rattner, and Howard Dean, have admitted that it’s likely.
Human dignity can be offended in less obvious and dramatic ways, however. There doesn’t have to be an assault on basic human rights. Pacem in Terris says that human rights are rooted in the fact that man is a rational creature “endowed with intelligence and free will” (#9), and the Christian knows that freedom is at the heart of man’s dignity. The social encyclicals resound with the theme that insuring human dignity requires a condition of adequate temporal well-being. Man’s dignity also requires protecting his privacy, rightly understood. So, we have the seal of confession, the moral requirement of not divulging private information without a grave reason, and the need to respect the domain of personal and family privacy. Another part of human dignity involves telling people the truth, including in their role as citizens. Among the rights listed in Pacem in Terris is “to be informed truthfully about public events” (#12). Respect for human dignity means that a person must be treated justly. Charity and basic respect are also owed to people as part of respect for their dignity.
The early experience with the ACA shows disregard for human dignity in all these ways. In its very conception, it reduces freedom in an unprecedented way: by forcing people to purchase a product or face an increasingly steep financial penalty if they don’t. It refuses to allow them to choose how to go about taking care of one of the most personal of commodities: their bodily health. They may do it only by purchasing health insurance (which, by the way, is not synonymous with health care). Further, they may for the most part purchase only the kind of insurance coverage approved by the federal government. It is likely to reduce their health care choices further by limiting who can be their medical practitioners. In effect, the ACA tells people that they are unintelligent or ignorant; they cannot be trusted to make their own health care decisions.
Truthfulness has been in short supply all along in the push for Obamacare. We went from Nancy Pelosi telling us just to wait and see what was in the law to the recent admission by HHS that it wanted people to find out about their eligibility for government subsidies before telling them what the policies would cost. All the Democratic rhetoric leading up to the passage of the ACA said that it would make health insurance less costly. As mentioned, however, the reality is very different. In most states premiums will rise, often considerably and in some cases by over 100 percent. Premium costs will make it difficult for some individuals and families to meet their other expenses. They face a decline of their overall standard of living—their temporal well-being, a basis for a dignified life—because of the demands of Obamacare.
Obamacare was also supposed to make coverage available to everyone, but it looks like thirty million will still be without. Some are losing the plans they already have.
Some surveys are suggesting that the ACA could result in many physicians leaving the profession. That will obviously have implications for the state of people’s health, the very aspect of temporal well-being it was supposed to improve.
The favoritism shown to members of Congress and their staffs, the members of big labor unions, and various big companies hardly bespeaks just treatment; they are treated differently than the average citizen. This is a violation of commutative justice akin to the unequal bargaining position of employers and workers alluded to by Pope Leo XIII in Rerum Novarum (#43-45).
The ACA’s assault on privacy has been much commented on, from the stream of private medical information people must submit to sign up to the ready dangers posed by the ACA’s requirement of computerization of everyone’s medical records. If anyone believes that this is crying wolf, he should consider the leaks of confidential tax information by the IRS (the ACA’s enforcement agency) and the revelations of the near-universal NSA spying on citizen communications.
Then, there is the simple matter of the poor treatment and abject frustration faced by most people who try to sign up at the ACA websites—and the almost indifferent shrugs about it by officials. A government truly respecting its people would not have let such foreseeable systemic failure occur. We can recall John Paul II’s observation in Centesimus Annus that the welfare state is dominated more by “bureaucratic ways” than concern for serving its clients (#48).
The meaning of all this for the Church in the U.S. is to be cautious about supporting public policy initiatives just because they seem on the surface to address human needs and promote human rights. Often, how something is done is as important as what is done. About public policy, one must always take into account the details of the legislation, delivery schemes, counter-productivity, likely long-term developments, unintended consequences, and the political obsession with imagery over substance. Human dignity can be affronted in a myriad of ways, great and small, so that what seems to be an advance ends up as a serious retrogression.
(Photo credit: J. Scott Applewhite / AP)