Patrick T. McCormick
Over 47 million Americans find themselves without health insurance in the richest and most Christian nation in the world. Catholic Social Teaching views this situation as an unjust violation of a basic human right to medical care, arguing that all persons have the right to those goods and services necessary for the proper development of life. In making this claim, Catholic Social Teaching advances three biblical principles: (1) that all persons are sacred and social, (2) that God hears the cries of the poor, and (3) that believers are directed to make a preferential option for the poor. In addition, Catholic Social thought argues that the right to health care finds support in the philosophical principles of subsidiarity, distributive justice, and the universal purpose of created goods.
Imagine, if you will, that every person in the state of Washington is without health insurance of any kind. Then imagine that the same thing is true of every person alive in Idaho, Montana, Wyoming, Oregon, Nevada, Utah, Colorado, Arizona, New Mexico, Alaska, Hawaii, North Dakota, South Dakota, Nebraska, Kansas, Oklahoma, and Arkansas. In fact, imagine that, except for California and Texas, every person in every state north and west of the state where Bill Clinton was governor is without health coverage. Imagine in the richest nation in the world, in the land of billion dollar tax cuts, trillion dollar wars, and a defense budget larger than the next two dozen nations combined that the people of 18 of these 50 United States have no health coverage.
Then imagine that four out five of these uninsured Americans are members of working families, where people are employed fulltime at jobs without any health care coverage. And imagine that one sixth of America’s uninsured are children. Finally, imagine that 18,000 Americans will die unnecessarily this year because they lack insurance (Chandler, 2006, pp. 23-4). That is over five times as many U.S. casualties as those of 9/11 or more than four times the U.S. dead from five years of war in Iraq.
"For more than 40 years the Catholic Church has repeatedly called for universal health care ..."
Of course you don’t have to imagine. Today more than 47 million people in America lack health insurance, and another 80 million people will discover, if they experience a serious illness or accident, that they have inadequate insurance (“Laboring without Health,” 2007; Johnson, 2007, pp.1-10). Every year 1 million more Americans are added to the rolls of the uninsured, and those lucky enough to have insurance saw their costs grow 87% between 2000 and 2006, while their earnings went up only 20%, barely above the 18% inflation rate. No wonder that even tens of millions of America’s insured cannot pay medical bills and go without needed care.
Catholic Social Teaching argues that these numbers do not represent a tragedy, but an injustice. For more than 40 years the Catholic Church has repeatedly called for universal health care, largely relying upon the argument that access to health care is a fundamental and inalienable human right (Himes, 2007). As Pope John XXIII wrote in the 1963 social encyclical, Pacem in Terris, “every human being has the right to life, to bodily integrity, and to the means suitable for the proper development of life; these (include) food, clothing, shelter, rest, (and) medical care” (Obrien & Shannon, 1992, p. 132).
With these words Pope John XXIII reaffirmed the position of the United Nation’s 1948 Universal Declaration of Human Rights, which affirmed in Article 25 that “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.” And with these words Pope John XXIII reaffirmed the practice of every industrialized nation in the world – except the United States – for all these nations, and many developing countries as well, had already instituted a national health care policy to secure and protect this right for all its people.
Since 1963 the Catholic Church in the United States has repeatedly reaffirmed that access to health care is a basic human right. In their pastoral letter Health and Health Care the United States Conference of Catholic Bishops (1981, p. 26) argued that:
"...access to health care is a fundamental human right ..."
Every person has a basic right to adequate health care. This right flows from the sanctity of human life and the dignity that belongs to all human persons, who are made in the image of God. It implies that access to that health care which is necessary and suitable for the proper development and maintenance of life must be provided for all people, regardless of economic, social, or legal status.
In their 1986 letter Economic Justice for All (Obrien & Shannon, 1992, p. 598) these same bishops reaffirmed Pope John XXIII’s assertion, noting that some “human rights concern human welfare and are of a specifically economic nature. First among these are the rights to life, food, clothing, shelter, rest, (and) medical care. These are indispensable to the protection of human dignity (and) any denial of these rights harms persons and wounds the human community.”
Still, the repeated claim that access to health care is a fundamental human right is but one argument Catholic Social Teaching offers in making its case for universal health care. Within the rich and organic tradition of Catholic Social thought we find a series of religious and philosophical arguments pressing us to provide basic health care for all people. Some of these arguments are grounded in revelation and direct us to pay special attention to the weak and marginalized, while others are founded in shared philosophical beliefs about the dignity and rights of persons and our duties to protect the common good.
"Every human being, Scripture informs us, is sacred."
This essay will review briefly a set of underlying biblical notions that shape Catholic Social Teaching and direct us to work for health care for all. And then we will lay out a set of philosophical arguments accessible to a wider audience of women and men of good will. The biblical arguments underscore the sacred and social character of persons and invoke a preferential option for the poor. The philosophical arguments explore the nature of our rights to basic goods and services, as well as a fair share of creation and the common good. Together, these arguments support and unpack the claim of Catholic Social Teaching that access to health care is a basic human right.
Catholic Social Teaching is grounded in a set of moral principles embodied in central biblical narratives. From reading Scripture we discover (1) that all human beings are sacred and social, (2) that God hears the cries of the poor, and (3) that God demands a “preferential option for the poor.” These three underlying biblical principles of Catholic Social Teaching direct believers to provide healing and health to the sick and wounded bodies of all their neighbors – especially the poor.
The two creation accounts in the first and second chapter of Genesis differ in a variety of ways. But both accounts agree that all humans have been made and blessed by God, and that every human is fashioned in the image and likeness of God. Every human being, Scripture informs us, is sacred. As Paul notes in 1 Corinthians 3:16, each of us is the temple of God, and as Jesus notes in Matthew 25, whatever we do to the least of our neighbors we do to God. Each human is an embodiment of the holy, which means we are to treat every human being as an image of God.
The creation narratives also report that humans are social. We read in Genesis 1:27 that God created humans in the divine image as “male and female,” suggesting that we are made in the likeness of God because we are fashioned as a community. And in the second chapter of Genesis God complains that “it is not good for the man to be alone,” so the Lord fashions a “partner” for the creature. And when this partner has been created, Adam recognizes his connection to this and every other human, crying out “here at last is bone of my bone and flesh of my flesh.”
"We are divine because we are capable of love, justice, and mercy..."
The message here is that being made in the image of a relational triune God means being fashioned as social creatures. We are divine because we are capable of love, justice, and mercy, because we are capable of recognizing and responding to the needs of our neighbor, and we become inhuman when we retreat from this solidarity. We – as a community – are made in the image and likeness of the God who is love.
The God of Scripture hears the cries of the poor. The God who comes to Moses in Exodus 3 is unlike any of the gods kept on retainer by the Pharaoh, Emperor and Caesar. For this God is not pleased with the worship and sacrifices of the rulers, or with the oppression and enslavement of the poor. Speaking from the burning bush, Yahweh tells Moses:
I have witnessed the affliction of my people in Egypt and have heard their cry of complaint against their slave drivers, so I know well what they are suffering. Therefore I have come down to rescue them from the hands of the Egyptians and lead them out of that land into a good and spacious land, a land flowing with milk and honey (Exodus 3:7-10).
And throughout the Bible the Lord continues to hear the cries of the poor, oppressed and suffering, demanding that the Hebrews show hospitality to the stranger (Pohl, 1999, pp. 16-35), provide justice for the widow, orphan and alien, and give liberty to the slave. Forty-six times in Deuteronomy God commands the Hebrews to “remember” those in the margins. Over and over the Prophets warn wealthy and powerful Hebrews that God despises the worship and sacrifices of those who forget and cheat the poor, that the Lord God will not accept fatted calves and first born lambs from those who oppress and rob their poor neighbor (Amos 5:21-4; Hosea 2:11, 19).
"...Jesus reaches out to touch, bless, and heal the crippled, blind, sick and possessed who flock to him."
“Is this not the fast I choose,” The Lord asks Israel in Isaiah 58:6-7, “to loose the bonds of wickedness, to undo the thongs of the yoke, to let the oppressed go free and to break every yoke? Is it not to share your bread with the hungry and bring the homeless poor into your house; when you see the naked, to cover him, and not to hide yourself from your own flesh?”
In the New Testament Jesus too is haunted by the cries of those in pain. In Luke 4:18-19 Christ announces that he has come to “preach the good news to the poor, to set the prisoner and captive free, to announce a year of liberation for all peoples.” Like Yahweh in the burning bush, Jesus has heard the cries of the suffering and come to set them free.
Having heard these cries, Jesus reaches out to touch, bless, and heal the crippled, blind, sick, and possessed who flock to him (Matthew 15:21-30; Mark 5:25-9). And he instructs his disciples to make room for the sick and suffering, to find food for the hungry, to offer hospitality to the poor (Matthew 14:13-18; 15:29-35; Mark 6:30-44; 8:1-13; Luke 9:10-17; John 6:1-15).
As a result of the biblical principles affirming the sacred and social character of persons and unveiling the compassion of a God who hears the cries of the poor, Catholic Social Teaching has, for at least four decades, argued that Christians are called upon to make a preferential option for the poor.
During his quarter century pontificate Pope John Paul II was often seen as disagreeing with Liberation Theologians working in the developing world, but in season and out of season this restorationist pope and these liberal theologians always agreed that middle class and wealthy Christians have a duty to stand in solidarity with and take effective action on behalf of the world’s hungry, poor, marginalized and oppressed (Dorr, 1992, pp. 260-351; Dorr, 1994, pp. 755-759). For both the conservative pope and the liberal theologians the God revealed in both the Hebrew Scriptures and the Christian Bible demanded that righteous believers hear the cries of the world’s poor and come to their aid – that Christians everywhere make a preferential option for the poor.
"The dignity and sanctity of each person argues in favor of a right to those goods necessary for a humane life ..."
As noted, this preferential option for the poor requires that Christians place themselves in solidarity with the world’s oppressed, marginalized, and disenfranchised; that social, political, and economic structures and systems be evaluated in light of their impact upon the poor, and that meeting the basic needs of the poor be made a priority over advancing the power, prestige and advantage of the wealthy.
Informed by a belief that all persons are sacred and social, that God hears the cries of the poor, and that Christians are obliged to make a preferential option for the poor, Catholic Social Teaching turns to the question of access to health care with a strong presumption in favor of universal health care. The dignity and sanctity of each person argues in favor of a right to those goods necessary for a humane life, while our social bonds to every neighbor and the special claim of the poor oblige all Christians to come to the aid of those who cannot care for their own health.
As we noted above, since the early 1960s Catholic Social Teaching has affirmed a basic right to health care, echoing the position of the United Nations and the practice of the developed world. But, as Pope John XXIII noted, this claim to a fundamental right to health care grows out of a deeper conviction that all persons have a basic right to life and to those goods and services required for a decent life.
"...Catholic Social Teaching has long argued that for each set of rights there is a matching set of duties or responsibilities..."
Long before Catholic Social Teaching asserted a specific right to health care, Pope Leo XXIII argued that all persons had a right to a private property and that all workers had a right to a just (or living) wage (Obrien & Shannon, 1992, p. 31). In 1891 Leo argued in the social encyclical On the Condition of Labor that all people had a right to private property because they had “the right to possess the things necessary for one’s personal development and the development of one's family” (Obrien & Shannon, 1992, p. 444). In the same document the pope also claimed that workers had a right to a just wage because “every individual has a natural right to procure what is required to live; and the poor can procure that in no other way than by what they can earn through their work” (Obrien & Shannon, 1992, p. 31).
The heart of Leo’s argument for both private property and a just wage was that persons had a basic right to those goods and services necessary to sustain a decent life. This is the same argument John XXIII and the U.S. Catholic Bishops employ when arguing for a person’s right to basic medical care.
At the same time Catholic Social Teaching has long argued that for each set of rights there is a matching set of duties or responsibilities; and in the normal course of events persons and their families would be responsible for securing their own right to life, food, clothing, shelter and education. Thus, healthy, competent adults have a responsibility to provide and pay for the basic goods needed for a decent life; and family members have a strong obligation to care for their weak, infirm, and dependent relatives. Within Catholic Social Teaching this notion of graduated rights and responsibilities is expressed in the principle of “subsidiarity,” which contends that small and local communities should take on as much responsibility and initiative as possible, and that larger and federal organizations should step in to address issues too complex or cumbersome for smaller groups (Obrien & Shannon, 1992, p. 60).
In the case of health care this means that persons and families have the first duty to care for their sick, and that state and federal organizations serve as a backup or safety net for those who fall through the cracks. In this organic view of society the responsibility to provide health care falls first on individuals and their families, next upon a mixture of middle sized public and private organizations structured to deliver health care in a more efficient and equitable manner, and then upon the state and federal government. Thus, when individuals, families and an assortment of private and public groups are incapable of providing health care access to all persons in a society, Catholic Social Teaching’s principle of subsidiarity would mean that the state or federal government must step in to address this basic human right.
"In a wealthy nation where 47 million people lack health insurance..."
In addition to the principle of subsidiarity, Pope Leo XIII argues in On the Condition of Labor that the state had a special obligation to intervene on behalf of the poor and working class in order to secure and defend their right to the basic goods needed for a decent life (Obrien & Shannon, 1992, p. 28). Catholic popes from Leo XIII to John Paul II have strongly opposed the excesses of communism and socialism and warned against the dangers of totalitarian states that interfered in the lives of its citizens. Nonetheless, these same church leaders have argued again and again that the State has a duty to protect the rights of the poor and working class. As Leo wrote in 1891, “the richer class have many ways of shielding themselves, and stand less in need of help from the State; whereas the mass of the poor have no resources of their own to fall back upon, and must chiefly depend upon the assistance of the State. And it is for this reason that wage-earners, since they mostly belong in the mass of the needy, should be specially cared for and protected by the government” (Obrien & Shannon, 1992, p. 28).
In a wealthy nation where 47 million people lack health insurance far too many poor and working class persons are unable to secure their basic right to health care, even with the existence of different public and private organizations working to address this shortage. Both the principle of subsidiarity and Leo’s understanding of the state’s duty to the poor would direct us to call upon the federal government to assume a greater responsibility in meeting this basic need.
Catholic Social Teaching has long supported the basic notion of distributive justice, which demands that the bounty of a society be shared fairly among all its people. This does not mean every person has the right to access to the best and most expensive medical treatments, or that elective and/or experimental treatments should be equally available to all persons, but it does require that the basic needs of all the people must be met before the luxuries of others are provided for.
As the U.S. Catholic Bishops wrote in Economic Justice for All,
The fulfillment of the basic needs of the poor is of the highest priority. Personal decisions, policies of private and public bodies, and power relationships must all be evaluated by their effects on those who lack the minimum necessities of nutrition, housing, education, and health care. In particular, this principle recognizes that meeting fundamental human needs must come before the fulfillment of desires for luxury consumer goods, for profits not conducive to the common good, and for unnecessary military hardware (Obrien & Shannon, 1992, p. 600).
"Distributive justice demands that we share our resources fairly..."
In a nation saturated with conspicuous consumption and possessing a military budget that dwarfs all other nations, distributive justice demands that provision be made to secure basic health care for all our people.
Distributive justice demands that we share our resources fairly, and that we do not abandon our poorest and weakest members, leaving them behind to waste and die. For a very long time the notion of distributive justice was woven into the fabric of American culture, demanding that “we the people of these United States” behave as a people, recognizing our commitments and ties to one another. This notion of “one nation under God” led us to recognize and reject the evils of slavery and segregation, because these societal sins were an abandonment of large segments of our society, and in the end we chose emancipation and integration because simple justice demanded that we not leave any group behind in the quest for the American dream. And for the same reason we embraced the “New Deal” and the “war on poverty” because we were committed to providing basic justice and fairness to all Americans.
Today, however, we are in danger of abandoning a whole class of our people, leaving them behind as our wealthy and well to do pull away from the poor and working classes, leaving them behind and embracing a vision of two separate and unequal Americas – one rich and one poor, with a dwindling middles class standing between these two lands. Of all the industrial nations in the world, America has left its poor furthest behind. We now have the largest gap of any between our rich and poor, and this chasm continues to grow wider and deeper and more deadly.
Nobel Prize-winning economist Paul Krugman argues that “the concentration of income at the top is a key reason that the United States, for all its economic achievements, has more poverty and lower life expectancy than any other major advanced nation” (Krugman, 2002, p. 64). In America, the wealthiest one hundredth of one percent of our population (about 13,000 families) make more than our poorest 20 million households combined, and earn about 300 times as much as the average American family. And, unlike our parents and grandparents generations, poor children in America today will find it harder to escape from poverty than the children of any western European nation (Thompson, 2003, pp. 55-6; Crook, 2007, p. 23; Eckholm, 2008, p. A14). This is no longer the nation where the poor can dream of being rich – or it is the country where they can only dream of it.
"Today ... we are in danger of abandoning a whole class of our people..."
In such a land of contrasts, in a nation that has grown increasingly “separate and unequal,” simple decency and the bare bones of distributive justice demands that those who stand outside our gated communities and resorts, whose incomes have not grown appreciably in nearly forty years, who do all our menial and difficult labor, and who live in our most blighted communities and go to our worst schools – should at least be able know that when they or their children get sick they can receive basic medical care without being driven deeper into debt and poverty. Distributive justice demands at least that much common decency.
Along with distributive justice and every person’s right of a fair share of the common good, Catholic Social Teaching embraces what Pope Paul VI (Obrien & Shannon, 1992, p. 245) called “the universal purpose of created goods.” This means that the goods and fruits of human labor belong to all humanity.
From its inception Catholic Social Teaching has defended the rights of private property – the Catholic Church is not Marxist or socialist. Indeed, seven hundred years before Pope Leo XIII St. Thomas Aquinas strongly defended the right to own private property in the Summa Theologica (II-II, q. 6, arts. 1,2 & 6).
But in the 13th, 19th or 21st centuries, the Catholic Church has not said that the right to private property was absolute – or that those who own property have no duties in justice to those who are without property (O’Neill, 1994, pp. 785-90). Instead, since long before Aquinas, Catholic thinkers have argued that the goods of the earth are held first and foremost by the human community and are meant to provide for the whole human community. To paraphrase Lincoln, Catholic Social Teaching argues that the Earth’s bounty belongs to the people and is for the people.
Since Aquinas, Catholic theology has argued that it is not theft for a starving poor man without any other recourse to take bread from a wealthy baker. For the food of the earth was made first and foremost for all God’s children, and we support private property because it is usually seen as the most efficient way to care for these goods and to ensure that they serves the common good.
The reasons for this belief in “the universal purpose of created goods” are twofold. First, it reflects the belief that God has created the world and its bounty for all humanity, and that no individual or group has a right to use these goods in a way that threatens the livelihood of the larger community (Obrien & Shannon, 1992, p. 52). Second, it recognizes the historical fact that most of the wealth and capital possessed by individuals or groups is actually the fruit of the labor of previous generations of poor and working class people; and that wealthy owners do not have an exclusive or unlimited right to benefit from this labor (Obrien & Shannon, 1992, p. 368).
The “universal purpose of created goods” means that the pharmaceuticals and medicines developed by countless generations are goods meant to serve all humanity, just as the skills and knowledge of the medical community belong in a very real sense to the larger society. As Pope John Paul II argues, our accumulated wisdom and technologies is the fruit of countless generations of laborers, an inheritance that does not truly belong to individual persons or companies, but is held in trust for all people everywhere (Obrien & Shannon, 1992, p. 368). And so the exclusion of 47 million Americans from this inheritance is a violation of simple justice.
For more than half a century Catholic Social teaching has argued for universal access to health care by asserting a basic human right to health care. This claim to a basic right to health care rests upon two sets of arguments – one religious and one philosophical – and grows out of a rich and organic tradition founded in both biblical and ethical principles. From a religious perspective, the belief that every person has a fundamental right to health care is founded in the biblical principles that all persons are sacred and social, that God hears the cries of the suffering bodies of the poor, and that believers are called upon to make a preferential option for the poor. From a philosophical perspective, the claim that persons have a specific right to health care is grounded in a larger notion of human rights as including those goods and services necessary for a decent life, and is supported by a belief in the principles of subsidiarity, distributive justice and the universal purpose of created goods.
"Since the earliest days of Christianity believers have felt an obligation to come to the aid of the poor and the sick."
Since the earliest days of Christianity believers have felt an obligation to come to the aid of the poor and sick. In a nation where over 80 percent of the population claims to be Christian, the scandal of 47 million people without health insurance demands a commitment to action. Tapping into religious and philosophical arguments, Catholic Social Teaching makes a strong case that every person has a right to health care, and that this nation should take up the responsibility of securing this right for all of its people.
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