By Mary J. McDonough
Georgetown University Press
Mary J. McDonough has served as a Legal Aid lawyer; she has also been a member of the Montana State House of Representatives. Her book, an outgrowth of her Ph.D. dissertation while at Graduate Theological University in Berkeley, California, presents a very comprehensive and in-depth view of the U.S. health care system as viewed through the lens of Catholic social thought. In the introductory pages, she presents an outline of the book’s six chapters which include: Justice in Catholic Social Thought; Catholic Social Thought on Capitalism and Health Care; Health Care Economic Theory, Market Mechanisms, and Health Outcomes; The Market Organization Approach to Health Care; The Value Dimension Approach to Health Care; and, finally, A Catholic Vision of Health Care.
The initial chapter examines the Catholic Church’s rich justice traditions starting with the works of Augustine and Aquinas. The author discusses several of the encyclicals and other writings of popes from Leo VIII through John Paul II. The first chapter concludes with a discussion of the six central themes that represent the Catholic justice tradition: human dignity, social interdependence, the common good, special obligation to the poor and vulnerable, stewardship, and a Christian interpretive framework of meaning.
In chapter two, McDonough provides the reader with a look at the Catholic Church’s position on capitalism and health care. The Church’s skeptical view on capitalism and its simultaneous advocacy of universal health care makes this chapter an interesting read. McDonough describes these issues (capitalism and universal health care) within the context of Catholic social teaching on justice. The conclusion of this discussion leads to an exploration of secular health care economic theory and market mechanisms found in chapters three and four.
An overview of the history of U.S. health care financing and the pros and cons of the present health care system are discussed in chapter three. McDonough provides arguments for and against several market mechanisms found in a free-market care system such as private insurance, managed care, user fees, copayments, deductibles, and physician incentives. The closing section of chapter three is an interesting overview of how various countries are considered as either “market acceptors” or “market rejectors” in terms of the use of market mechanisms. The U.S., of course, is the primary proponent of market mechanisms along with countries such as Brazil, Argentina, and Chile. Canada, Sweden, and the United Kingdom are countries that are considered as “market rejectors.” These countries are among those that provide universal health care for all of their residents.
The works of four secular economists, with their ideas and plans on how health care should be organized in the U.S., are the focus of chapter four. The economists are Milton Friedman, Regina Herzlinger, Mark Pauly, and Alain Enthoven. McDonough chose these four because their theories represent a continuum of thinking in terms of market practices. Milton Friedman is the most orthodox of the four. Alain Enthoven’s theory is the least market driven and the most compatible with Catholic social thought. He is a strong proponent of universal health care but within a managed-competition plan.
McDonough recognizes that none of the four plans of market organization have been totally successful nor have any plans, for that matter. As a strong believer in more than just an organizational approach to health care, McDonough discusses, in great depth, the value dimension of a health care market as proposed by her friend and supporter, Daniel Callahan.
Callahan, co-founder of the Hastings Center, argues several points in his criticism of the current health care system including: an overly broad view of health as defined by the World Health Organization; a view of death as a biological and moral evil; and the infinity model of medical progress. It is from these criticisms that Callahan has developed a “finite model of medicine.” In this model, he contends that different approaches to viewing the meaning of health, the meaning of aging, suffering and death, and the need for appropriate goals of medicine, medical research, and health care are imperative.
The last section of chapter five presents McDonough’s view of how Catholic social thought is reflected in Callahan’s “finite model of medicine.” She discusses several elements including human dignity, social interdependence, common good, stewardship, and obligation to the poor and vulnerable.
In the final chapter, the author, drawing upon Catholic social teaching, proposes that a Catholic vision of health care can be achieved. This would involve the acceptance of certain market mechanisms to contain health care costs as well as the adoption of elements of Callahan’s value based approach such as the meaning of life, health, illness, suffering and death.
Market mechanisms that she feels can be utilized are private insurance, aspects of managed care, user fees, copayments and deductibles. McDonough succinctly states: “when it comes to health care, the most fundamental requirement is that some basic level of health care must be accessible to all.” (p. 228)
This is a must read book for anyone in the health care arena who seeks answers, from a Catholic social justice perspective, to the problems of our broken health care system. The book does not furnish clear cut solutions but it does provide guidelines for improving the U.S. health care system.
Reviewed by Jean Deliganis
University of the Incarnate Word: Ministero de Salud Ministry
St. Philip of Jesus Catholic Church