Kansas City Bishops Issue Joint Health Care Reform Pastoral Statement
is a joint pastoral statement by Kansas City, Kansas Archbishop Joseph F.
Naumann and Kansas City St. Joseph Bishop Robert W. Finn:
Principles of Catholic Social Teaching and Health Care
Reform: A Joint Pastoral Statement of Archbishop Joseph F. Naumann and
Bishop Robert W. Finn
September 1, 2009
Dear Faithful of the Archdiocese of Kansas City in Kansas and of the
Diocese of Kansas City-St. Joseph,
To his credit, President Barack Obama has made it a major priority for
his administration to address the current flaws in our nations health care
policies. In fairness, members of both political parties for some time have
recognized significant problems in the current methods of providing health
As Catholics, we are proud of the Church's healthcare contribution to the
world. Indeed, the hospital was originally an innovation of the Catholic
faithful responding to our Lords call to care for the sick, For I was...ill
and you cared for me. (Matthew 25, v. 35-36). This tradition continues today
in America, where currently one in four hospitals is run by a Catholic
agency. We have listened to current debate with great attention and write
now to contribute our part to ensure that this reform be an authentic reform
taking full consideration of the dignity of the human person.
Some symptoms of the inadequacy of our present health care polices are:
1) There are many people typically cited as 47 million without medical
2) The cost of health insurance continues to rise, with medical spending
in the U.S. at $2.2 trillion in 2007, constituting 17% of the Gross Domestic
Product, and predicted to double within 10 years. (Source: Office of
Public Affairs, 2008:
3) The Medicare Trust Fund is predicted to be insolvent by 2019.
4) Mandated health insurance benefits for full-time workers have created
an incentive for companies to hire part-time rather than full-time
5) Similarly, the much higher cost to employers for family health
coverage, as compared to individual coverage, places job candidates with
many dependents at a disadvantage in a competitive market.
6) Individuals with pre-existing conditions who most need medical care
are often denied the means to acquire it.
There are also perceived strengths of our current system:
1) Most Americans like the medical care services available to them. Our
country, in some ways, is the envy of people from countries with socialized
systems of medical care.
2) It is important to remember that 85% of citizens in the U.S. do have
insurance. Forty percent of the uninsured are between 19-34 years old.
(Source: Current Population Survey 2008 Annual Social and Economic
Supplement) A 2007 study by the Kaiser Commission on Medicaid and
Uninsured found that 11 million of those without insurance were eligible for
Medicaid or SCHIP but were not enrolled. Those eligible but not enrolled
include 74 percent of children who are uninsured. (Source:
Characteristics of the Uninsured: Who Is Eligible for Public Coverage and
Who Needs Help Affording Coverage?)
3) The competitive nature of our private sector system is an incentive to
positive innovation and the development of advanced technology. Medical
doctors and research scientists are esteemed. Doctors and other scientists
immigrate to our country because of the better compensation given to those
who provide quality medical care or produce successful research.
4) Medicare and Medicaid, while they have their limitations, provide an
important safety net for many of the elderly, the poor and the disabled.
What Must We Do?
The justified reaction to the significant defects in our current health
care policies is to say, Something must be done. Many believe: We have to
change health care in America. Despite the many flaws with our current
policies, change itself does not guarantee improvement. Many of the
proposals which have been promoted would diminish the protection of human
life and dignity and shift our health care costs and delivery to a
centralized government bureaucracy. Centralization carries the risk of a
loss of personal responsibility, reduction in personalized care for the sick
and an expanded bureaucracy that in the end leads to higher costs.
A Renewal Built on Principles
We claim no expertise in economics or the complexities of modern medical
science. However, effective health care policies must be built on a
foundation of proper moral principles. The needed change in health care must
therefore flow from certain principles that protect the fundamental life and
dignity of the human person and the societal principles of justice, which
are best safeguarded when such vital needs are provided for in a context of
human love and reason, and when the delivery of care is determined at the
lowest reasonable level. The rich tradition of Catholic social and moral
teaching should guide our evaluation of the many and varied proposals for
health care reform. It is our intention in this pastoral reflection to
identify and explain the most important principles for evaluating health
care reform proposals. No Catholic in good conscience can disregard these
fundamental moral principles, although there can and likely will be vigorous
debate about their proper application.
I. The Principle of Subsidiarity: Preamble to the Work of Reform
This notion that health care ought to be determined at the lowest level
rather than at the higher strata of society, has been promoted by the Church
as subsidiarity. 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. (See: Compendium
of the Social Doctrine of the Church, ## 185ff.; Catechism of the
Catholic Church, # 1883) 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.
Pope John Paul II wrote:
By intervening directly and depriving society of its responsibility, the
Social Assistance State leads to a loss of human energies and an inordinate
increase of public agencies, which are dominated more by bureaucratic ways
of thinking than by concern for serving their clients, and which are
accompanied by an enormous increase in spending. (Pope John Paul II,
Centesimus Annus #48)
And Pope Benedict writes:
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. & In the end, the claim that just social structures would make
works of charity superfluous masks a materialist conception of man: the
mistaken notion that man can live by bread alone (Mt 4:4; cf. Dt 8:3)a
conviction that demeans man and ultimately disregards all that is
specifically human. (Pope Benedict XVI, Deus Caritas Est #28)
While subsidiarity is vital to the structure of justice, we can see from
what the Popes say that it rests on a more fundamental principal, the
unchanging dignity of the person. The belief in the innate value of human
life and the transcendent dignity of the human person must be the primordial
driving force of reform efforts.
II. Principle of the Life and Dignity of the Human Person: Driving
Force for Care, and Constitutive Ground of Human Justice
A. Exclusion of Abortion and Protection of Conscience Rights
Recent cautionary notes have been sounded by Cardinal Justin Rigali,
Chair of the U.S. Bishops Secretariat for Pro-Life Activities, and Bishop
William Murphy of the U.S. Bishops Committee on Domestic Justice and Social
Development, against the inclusion of abortion in a revised health care
plan. At the same time, they have warned against the endangerment or loss of
conscience rights protection for individual health care workers or private
health care institutions. A huge resource of professionals and institutions
dedicated to care of the sick could find themselves excluded, by
legislation, after health care reform, if they failed to provide services
which are destructive of human life, and which are radically counter to
their conscience and institutional mission. The loss of Catholic hospitals
and health care providers, which currently do more to provide pro bono
services to the poor and the marginalized than their for-profit
counterparts, would be a tremendous blow to the already strained health care
system in our country.
It is imperative that any health care reform package must keep intact our
current public polices protecting taxpayers from being coerced to fund
abortions. It is inadequate to propose legislation that is silent on this
morally crucial matter. Given the penchant of our courts over the past 35
years to claim unarticulated rights in our Constitution, the explicit
exclusion of so-called abortion services from coverage is essential.
Similarly, health care reform legislation must clearly articulate the rights
of conscience for individuals and institutions.
B. Exclude Mandated End of Life Counseling for Elderly and Disabled
Some proposals for government reform have referenced end of life
counseling for the elderly or disabled.
An August 3, 2009 Statement of the National Association of Pro-Life
Nurses on Health Care Legislation, in addition to calling for the
exclusion of mandates for abortion, the protection of abortion funding
prohibitions, and the assurance of conscience rights, insists that the
mandating of end of life consultation for anyone regardless of age or
condition would place undue pressure on the individual or guardian to opt
for measures to end life, and would send the message that they are no longer
of value to society.
The nurses statement concludes, We believe those lives and all lives are
valuable and to be respected and cared for to the best of our abilities.
Care must be provided for any human being in need of care regardless of
disability or level of function or dependence on others in accordance with
the 1999 Supreme Court Decision in Olmstead v. L.C. (www.nursesforlife.org/napnstatement.pdf)
Recently, Bishop Walker Nickless of the Catholic Diocese of Sioux City,
Iowa, commented on the dangers inherent in the establishment of a health
care monopoly, drawing a comparison to the experience of HMO plans in our
country, where individuals entrusted with keeping the cost of health care at
a minimum may refuse to authorize helpful or necessary treatment for their
clients. (See Bishop Walker Nickless, Column in The Catholic Globe,
August 13, 2009)
C. The Right to Acquisition of Health Care in the Teaching of the
The Right to Health Care as taught by the Church is a companion to the
fundamental right to life, and rights to other necessities, among them food,
clothing, and shelter. It may be best understood as a Right to Acquire
the Means of Procuring for Ones Self and Ones Family these goods,
and concomitantly, a duty to exercise virtue (diligence,
thrift, charity) in every aspect of their acquisition and discharge.
This language of rights, coupled with duties toward those who through no
fault of their own are unable to work, is present throughout papal teaching,
and only reinforces the idea that, in its proper perspective, the goal is to
live and to work and to be looked after only in the event of real necessity.
(Source: Catholic Medical Association, 2004 document, Health Care in
America. bold and italics our own)
The right of every individual to access health care does not necessarily
suppose an obligation on the part of the government to provide it. Yet in
our American culture, Catholic teaching about the right to healthcare is
sometimes confused with the structures of entitlement. The teaching of the
Universal Church has never been to suggest a government socialization of
medical services. Rather, the Church has asserted the rights of every
individual to have access to those things most necessary for sustaining and
caring for human life, while at the same time insisting on the personal
responsibility of each individual to care properly for his or her own
Indeed part of the crisis in today's system stems from various
misappropriations within health care insurance systems of exorbitant
elective treatments, or the tendencies to regard health care services paid
for by insurance as free, and to take advantage of services that happen to
be available under the insurance plan. Such practices may arguably cripple
the ability of small companies to provide necessary opportunities to their
employees and significantly increase the cost of health care for everyone.
D. The Right to Make Health Care Decisions for Self and Family
Following both the notions of subsidiarity mentioned above and the sense
of the life and dignity of every human person, it is vital to preserve, on
the part of individuals and their families, the right to make well-informed
decisions concerning their care. This is why some system of vouchers at
least on a theoretical level is worthy of consideration. Allowing persons
who through no fault of their own are unable to work, to have some means to
acquire health care brings with it a greater sense of responsibility and
ownership which, in a more centralized system, may be more vulnerable to
When the individual has a personal, monetary stake or a financial
obligation to pay even a portion of the cost of medical care, prudence comes
to bear - with greater consistency on such decisions, and unnecessary costs
are minimized. Valuing the right of individuals to have a direct say in
their care favors a reform which, reflecting subsidiarity, places
responsibility at the lowest level.
E. Obligation of Prudent Preventative Care
All individuals, including those who receive assistance for health care,
might be given incentives for good preventative practices: proper diet,
moderate exercise, and moderation of tobacco and alcohol use. As Bishop
Nickless reminds us in his statement, The gift of life comes only from God,
and to spurn that gift by seriously mistreating our own health is morally
Some categories of positive preventative health care, however, may not
easily be procured apart from medical intervention. Pre-natal and neo-natal
care are particularly crucial and should be given priority in any reform.
Because of the unique vulnerability of the unborn and newly born child, such
services ought to be provided regardless of ability to pay.
In addition to the primordial Principle of the Life and Dignity of the
Human Person delivered in a way which respects subsidiarity, we might look
briefly at two other principles which promote justice in the consideration
of health care.
II. Principle of the Obligation to the Common Good: Why We Must Act
The Catechism of the Catholic Church speaks of the obligation to promote
the common good as the sum total of social conditions which allow people,
either as groups or individuals, to reach their fulfillment more fully and
easily. (CCC #1906)
It is very clear that, respectful of this principle, we must find some
way to provide a safety net for people in need without diminishing personal
responsibility or creating an inordinately bureaucratic structure which will
be vulnerable to financial abuse, be crippling to our national economy, and
remove the sense of humanity from the work of healing and helping the sick.
The Church clearly advocates authentic reform which addresses this
obligation, while respecting the fundamental dignity of persons and not
undermining the stability of future generations.
Both of us in our family histories have had experiences that make us
keenly aware of the necessity for society to provide a safety net to
families who suffer catastrophic losses. Yet, these safety nets are not
intended to create permanent dependency for individuals or families upon the
State, but rather to provide them with the opportunity to regain control of
their own lives and their own destiny.
Closely tied to the Principle of the Obligation of the Common Good is the
Principle of Solidarity.
III. The Principle of Solidarity: The Way We Measure Our Love
The principle of human solidarity is a particular application on the
level of society of Christ's command to love your neighbor as yourself. It
might also be seen, in other terms, as the application of the Golden Rule,
Do unto others as you would have them do to you. Solidarity is our sense of
connectedness to each other person, and moves us to want for them what we
would want for ourselves and our most dear loved ones.
In regard to health care this might require us to examine any proposal in
terms of what it provides and how to the most vulnerable in our society. Dr.
Donald P. Condit in his helpful treatment of the principle of Solidarity in
Prescription for Health Care Reform reminds us of the proverb attributed
to Mahatma Gandhi: A nations greatness is measured by how it treats its
For example, legislation that excludes legal immigrants from receiving
health care benefits violates the principle of solidarity, is unjust and is
not prudent. In evaluating health care reform proposals perhaps we ought to
ask ourselves whether the poor would have access to the kind and quality of
health care that you and I would deem necessary for our families. Is there a
way by which the poor, too, can assume more responsibility for their own
health care decisions in such manner as reflects their innate human dignity
and is protective of their physical and spiritual well being?
Conclusion: We Can Not Be Passive
These last two principles: Solidarity and the Promotion of the Common
Good cause us to say that we cannot be passive concerning health care policy
in our country. There is important work to be done, but change for changes
sake; change which expands the reach of government beyond its competence
would do more harm than good. Change which loses sight of mans transcendent
dignity or the irreplaceable value of human life; change which could
diminish the role of those in need as agents of their own care is not truly
human progress at all.
A hasty or unprincipled change could cause us, in fact, to lose some of
the significant benefits that Americans now enjoy, while creating a future
tax burden which is both unjust and unsustainable.
We urge the President, Congress, and other elected and appointed leaders
to develop prescriptions for reforming health care which are built on
objective truths: that all people in every stage of human life count for
something; that if we violate our core beliefs we are not aiding people in
need, but instead devaluing their human integrity and that of us all.
We call upon our Catholic faithful, and all people of good will, to hold
our elected officials accountable in these important deliberations and let
them know clearly our support for those who, with prudence and wisdom, will
protect the right to life, maintain freedom of conscience, and nurture the
sense of solidarity that drives us to work hard, to pray, and to act
charitably for the good of all.
We place this effort under the maternal protection of our Blessed Mother,
Mary, who was entrusted, with Joseph in the home at Nazareth, with the care
of the child Jesus. We ask Our Lord Jesus Christ to extend His light and His
Mercy to our nations efforts, so that every person will come to know His
healing consolation as Divine Physician.
Most Reverend Joseph F. Naumann - Archbishop of Kansas
City in Kansas
Most Reverend Robert W. Finn - Bishop of Kansas City-St. Joseph
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