Saturday, December 5, 2009

Subsidiarity: The Latest Catholic Approach to Shaping "Moral" Health Care Reform.

On Thursday I noted an interview on Minnesota Public Radio with Minnesota Archbishop John Nienstedt. What I linked to and posted was a written article about the interview. Here you can find at least most of the interview.

The Archbishop states the church's five objectives for reform:

1. "Health care is an essential for the human life and dignity for every individual person."

2. Abortion has to be excluded, a Stupak-like amendment is necessary in the Senate version

3. Is skipped by the Archbishop but all sources assume that this point is: no funding for "euthanasia" or, absurdly, systematic killing of the elderly, disabled, comatose or otherwise infirm; the term euthanasia is stragegically used to conflate aid in dying with such killing.

4. Conscience clause that prevents persons of faith from performing services they morally object to

5. The Principle of Subsidiarity: the concept that health care should be "administered, determined, and coordinated at the lowest possible level in society. Government ought not be involved in the determining and application of health care. That should be left to the private sector."

In an August 17 article for TheCatholicSpirit, Nienstedt writes:

At present, the secretary of Health and Human Services is Kathleen Sebelius, allegedly a practicing Catholic, but an aggressively pro-choice politician. It is hard to imagine that her selection of candidates for membership on that council would be willing to restrict access to abortion services.

Of course, none of this should come as a surprise to anyone. Speaking to the Planned Parenthood organization during the presidential campaign, then Sen. Obama made clear his thinking on this matter, which was backed up by his voting record in the Senate.

He stated: “In my mind, reproductive care is essential care, basic care, so it is at the center, the heart of the plan that I propose.”

(In this context, “reproductive care” is a euphemism for “abortion.”)

Until now, federal agencies or programs (as well as state or local governments receiving federal funds) are forbidden under the Weldon amendment, approved by Congress each year since 2004, to discriminate against individual or institutional health care providers or insurers who decline to provide, pay for, provide coverage of, or refer for abortion.

The new health care program, as now proposed, would change all that. That is why an explicit statement in the bill is needed which asserts that government insurance would not cover abortion services.

In addition to Bishop Murphy’s four points, I would add a fifth. I believe that it should also be explicitly stated that euthanasia, either actively prescribed or passively encouraged, should not be permitted.

This quote confirms a number of things:

*point number 3 of his interview with MPR is indeed euthanasia (in the article, sounding like a more articulate Palin, Nienstedt goes on to describe that seniors are in danger of being killed or neglected, their care rationed)

*the church and Nienstedt assume that "reproductive care" means abortion, under which assumption they are able to group other services they oppose, like sterilization, fertilization, tubal ligations, contraceptive use and other non-controversial services with the highly contested issue of abortion, thus hamstringing any discussion of an array of reproductive services (smooth political move, archbishop!)

*then he lists, like other advocacy organizations, the numbers of senators (for democratic action) and the USCCB website (for the church's opinions about reform, all letters to the House and Senate).

In the interview, the Archbishop notes that the church is not attempting to flex political muscle (I'm in the midst of researching what exactly bishops are doing to pressure senators, though we know of RI Bishop Tobin's recent harassment of Kennedy) and that they speak out for moral reasons, assuming that Catholic morality is the only morality, asserting the moral argument that "pro-life" groups have made regarding abortion and reproductive rights for decades.

Patients' rights advocates have long since given away the morality argument (see Kathryn Joyce's pertinent article at therevealer). With the possible exception of disability rights, women's rights, LGBT, and end of life rights advocates have been unable to popularly assert that their advocacy is moral. Human rights, individual rights have not been enough of an assertion to take back from the church a claim to moral rectitude, nor has the government in effective ways stood up for patients' rights.

Nienstedt writes in another article for the TheCatholicSpirit, dated September 23:

Reading the commentaries of my brother bishops, I realized that I did not mention another essential Catholic principle that should have been included in my last column: subsidiarity, which posits that health care ought to be determined, administered and coordinated at the lowest level of society whenever possible.

In other words, those intermediary communities and associations that exist between the federal government and the individual must be strengthened and given greater control over policies and practices rather than being given less and less control.

To usurp this “hierarchy of communities” is terribly damaging in the long run, both to society as a whole and the individual citizen
(See Catechism of the Catholic Church, No. 1883,Compen dium of the Social Doctrine of the Church, No. 185 ff).

Papal insights

Two quotes from Pope John Paul II and Pope Benedict XVI are instructive in this regard:

Pope John Paul II has written:

“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,” No. 48).

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,” No. 28).

To neglect the principle of subsidiarity inevitably leads to the excessive centralization of human services, which leads to higher costs, less personal responsibility for the individual and a lower quality of care.

In a summer of 1996 article for Religion & Liberty (
posted at Catholic priest David A. Bosnich criticizes the USCCB for not more strongly adhering to the principle of subsidiarity regarding the Clinton health care plan. He writes:

One of the key principles of Catholic social thought is known as the principle of subsidiarity. This tenet holds that nothing should be done by a larger and more complex organization which can be done as well by a smaller and simpler organization. In other words, any activity which can be performed by a more decentralized entity should be. This principle is a bulwark of limited government and personal freedom. It conflicts with the passion for centralization and bureaucracy characteristic of the Welfare State.

This is why Pope John Paul II took the “social assistance state” to task in his 1991 encyclical Centesimus Annus. The Pontiff wrote that the Welfare State was contradicting the principle of subsidiarity by intervening directly and depriving society of its responsibility. This “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.”

In spite of this clear warning, the United States Catholic Bishops remain staunch defenders of a statist approach to social problems. They have publicly criticized recent congressional efforts to reform the welfare system by decentralizing it and removing its perverse incentives. Their opposition to the Clinton Administration’s health care plan was based solely upon its inclusion of abortion funding. They had no fundamental objection to a takeover of the health care industry by the federal government.


As our founding fathers made clear in The Federalist Papers, the U.S. Constitution was designed to leave many issues of great importance in the hands of the states. The federal government was to do only those things which the individual states could not effectively do for themselves. The subsidiarity principle was at work in the foundation of our nation. But from the New Deal era onwards, there has been a steady growth in federal power at the expense of the states. This has sparked a renewed interest in the Tenth Amendment, which reserves all powers not delegated to the federal government to the states.

But there is another area of Alexis de Tocqueville’s thought which runs directly counter to Monsignor Higgins’s argument. Higgins is defending the Welfare State, the prospect of which Tocqueville dreaded. Tocqueville described the system which he foresaw in terms which are chillingly similar to modern society. He predicted that modern democratic government would degenerate into a huge, paternalistic state which would guide the individual in all of his affairs and insure that all of his needs were met. “For their happiness such a government willingly labors, but it chooses to be the sole agent and the only arbiter of their necessities, facilitates their pleasures, manages their principal concerns, directs their industry, regulates the descent of property, and subdivides their inheritances; what remains, but to spare them all the care of thinking and all the trouble of living?”

Tocqueville strongly opposed this system because it kept the citizens in perpetual childhood. Pope John Paul II criticized the Welfare State in Centesimus Annus for the same reason. However, Monsignor Higgins does not even address the Pope’s critique. He makes one passing reference to it before directing the attention of his hearers elsewhere. Higgins cites Gregory Baum’s argument that the principle of subsidiarity has been complemented by the principle of socialization, first elaborated by Pope John XXIII. Baum defines subsidiarity as “de-centralization” and socialization as “centralization”. In other words, in this view, Catholicism teaches the principle of de-centralization and the principle of centralization simultaneously!

The absurdity of this argument is clearly revealed by taking a closer look at the meaning of socialization. In reviewing John XXIII’s encyclical Mater et Magistra, Father Robert Sirico observes that the Pontiff’s desire was to strengthen mediating institutions in order to protect the primacy of the human person. Far from advancing any form of collectivism, Pope John wanted to “multiply social relationships” so that the individual would be free to pursue the common good. Socialization does not mean centralization. Rather, it refers to the voluntary associations which Alexis de Tocqueville praised as being a vital part of American freedom in the 1830s.

The principle of subsidiarity is both thoroughly Catholic and thoroughly American. The U.S. Catholic Bishops should be leading defenders of it. That they are not is due to intellectual currents which go beyond the partisanship of scholars such as Monsignor Higgins. The Bishops have not learned the key lessons of the 1980s: the success of free market economics and the failure of collectivism. The top-down, centralized planning of the Soviet system could not succeed because it contradicted the subsidiarity principle. When producers and consumers are not allowed to bargain freely, prices cease to reflect meaningful information and become arbitrary dictates of the bureaucracy. The Austrian economist Ludwig von Mises wrote, “Without the basis for calculation which Capitalism places at the disposal of Socialism, in the shape of market prices, socialist enterprises would never be carried on, even within single branches of production or individual countries.”

Apparently Nienstedt has since learned the lesson of Subsidiarity. The benefits of the free-market 80s have been clearly debunked. The Tea Party noise of the summer brought discussion of small government and federalism to the fore. Despite Nienstedt's argument that the church does not wish to be a political force, there are distinct reasons why he now brings up subsidiarity.

As Bosnich notes, "The federal government was to do only those things which the individual states could not effectively do for themselves." One of these things individual states cannot do for themselves is protect citizens rights. Again and again, states have proven ineffective at combatting slavery, poverty, poor education, disease and discrimination. Precisely because their regionality isolates them from viewing human rights as a whole, separate from local prejudice. Protecting rights is the role of federal government, law enforcement entities, world governing bodies, in short, large centralized organizations that can exert laws that protect individuals while viewing local cultures with relativity.

Morality is the imposition of segmented ideals over the broader community. The church has recognized, the current climate, that their assertion of Catholic morality is best done through their "grass roots" organizers, church congregations. Or in the case of health care, through the use of conscience clauses to allow workers within health care to impose morality on the rights of individual patients,; through institutional conscience protections such as those allowed all 620 Catholic hospitals in the US to determine what services are provided patients.

Beyond the fact that centralized enforcement of individual rights is grossly maligned by the church's efforts to control the morality of federal reform of health care - they rely on the government to assert moral code (laws) regarding abortion, for instance - they see a need to engage the recent noisy, motivated rump of the Republican party devoted vocally (though clearly not actually) to smaller government and federalism.

It's a two front approach to defeating any health care reform that does not include the moral teachings of the Catholic church: work subsidiarity to maintain the backing of anti-centralized government agents such as the Republican base and Catholic constituents, to continue moral imposition at hospitals in communities where states have failed to protect individual patients' rights, and motivate congregations; and work the Senators to legislate morality at the sake of individual patients' rights by pressuring them with visits, letters, calls and threats of excommunication.

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