Religion & Law

Over at PrawfsBlawg, Rick Esenberg responds to my question about Bishop Nickless's statement regarding the importance of defending the private sector in health care.  Rick comments:

Rob asks whether Catholic Social Thought actually claims that "a flourishing private sector" is the predominant concern when it comes to a society's provision of health care? "

If the question is put in that way, the answer is "no.' It is not the "predominant concern" although, in fairness to Bishop Nickless, I am not sure that he claimed it to be. He did say that it was the only way to prevent a "top down" rationing of care and CST does suggest that we be skeptical of that type of decision making. This, I think, is what may cause him to say that any bill that undermines the viability of the private sector is suspect.

As I suggested last week, subsidiarity is premised, at least in part, on the subjectivity of individuals and the associations that they form. The state is to empower and facilitate - rather than stifle - human agency and creativity. While this is cannot be read as an uncritical endorsement of markets or a rejection of the need for state regulation and even intervention in their operation (there is much criticism of unbridled markets in CST and robust support for assistance to the poor and to the weak), flourishing private markets are a way in which human creativity is expressed. There are, it seems to me, an almost infinite numbers of ways to control costs and to socialize (or insure) the cost of care. Choosing among them will almost certainly affect incentives to innovate. The notions that the state can choose the "best" form of insurance (mandating coverages and setting limits) or specify the conditions for optimal innovation seem rather dubious and, beyond that, restrict the subjectivity that is at the heart of subsidiarity (and, I would argue, solidarity).

This doesn't mean that the Obama health care plan (whatever it turns out to be) is inconsistent with CST or that current arrangements are not, by its lights, in need of reform. Large numbers of uninsured rests very uneasily with the premises of the Church's social encyclicals. But I think it does suggest why a "flourishing private market" is, if not the predominant concern, an important one.

Rick's insights are sensible, but I still wonder whether we are too quick to assume that CST embraces a market approach to health care.  (Has the Church criticized any other countries for their state-run health care systems?) Obviously, CST opposes a market in the sale of human organs, as the commodification of such goods defies human dignity.  I don't think the sale of health care is equivalent to the sale of human organs, but it's also not exactly like the sale of tires.  The American tendency is to take a very narrow view of the category of "needs and common goods that cannot be satisfied by the market system." (Centesimus annus)  To be clear, I'm not rejecting the practical importance of the market when it comes to health care; I'm just hesitant to claim CST's imprimatur.