“Medicare for All” has become a focal point of controversy during the 2020 election season. What does Catholic social teaching have to say?
What about “Medicare for Some,” which is what I and millions of others now enjoy? Does Catholic teaching favor “Medicare for All” or “Medicare for Some”? Or neither?
Of course, this is the wrong question. In the first place, Catholic social teaching rarely points to a specific public policy position. Policy positions must be discerned by Catholic voters and the people they elect. In the second place, health care policy is too complex for a political slogan, whether it’s “Medicare for All” or “Repeal and Replace Obamacare.”
Here’s the good news for Catholics. We have principles of Catholic social teaching to help us, and we Catholics are good at complexity. If we can handle “Three persons in one God” and “Transubstantiation” and “Two natures in one person,” we can discuss health policy with more depth than policy slogans.
Catholic social teaching relies on faith and reason in dialogue with human experience (the Second Vatican Council’s “signs of the times”). Its fundamental principles, articulated in papal encyclicals, other magisterial documents and episcopal statements in the United States include: the irrevocable equal human dignity of all persons; the fundamental responsibility of government to promote social justice and the common good; and the preferential option for the poor as the measure of social health. The virtue of solidarity, linking each of us to the fate of all, motivates us to act on these principles in the political realm.
For half a century, Catholic teaching has drawn the conclusion that all people deserve access to health care based on their need for prevention or treatment of injury or illness. (For example, read the U.S. bishops’ 1993 “Framework for Comprehensive Health Care Reform.”) The vast technical and human resources available in the U.S. health care system support this conclusion.
We know from experience that the U.S. falls well short of this goal: 27.5 million people (8.5 percent of the population) lack any health insurance, and an additional 23 percent of all adults are underinsured.
Our faith requires that any health care reform proposal guarantee to every person the means to care for their health. That in turn entails health insurance for all that covers all necessary treatments. The United States possesses the means to achieve universal health care. We have simply lacked the political will.
Human reason counsels that medical care should be the highest quality possible, provided in the most efficient manner possible (lowest cost compatible with access and quality). Experience again demonstrates that the United States falls short on both these dimensions. We have too many preventable medical errors in a system that is the most expensive and least efficient in the modern, democratic world.
What’s the conclusion? Our dysfunctional health care system is a long way from the Catholic principle of universal access with high quality and acceptable costs. Any health care reform proposal acceptable to Catholic voters must move appreciably toward this goal. There is, however, no uniquely Catholic way to move from where we are to where we need to be. (There are other Catholic considerations related to coverage of abortion and contraception, but I have space here for only the most general policy outlines.)
Only four approaches on the political agenda fulfill our Catholic principles. However, there are many possible variations of each. Here I will clarify what’s behind the campaign slogans. (I will not attempt to evaluate the conflicting claims made by proponents or opponents of each option.) {The Henry J. Kaiser Family Foundation published an overview of the main proposals at (https://www.kff.org/health-reform/issue-brief/medicare-for-all-and-public-plan-buy-in-proposals-overview-and-key-issues/).
1. “Medicare for All Right Now”
This alternative would immediately eliminate all private insurance, and most public insurance (Medicare, Medicaid, and the state Children’s Health Insurance Program) and enroll all people in a new federally-funded insurance program patterned on Medicare. It would cover all medically necessary services, including vision and dental and long-term care. Households, families, employers and states would no longer pay directly for health care. Instead, federal tax dollars would fund the new program.
2. “Medicare for All Soon”
This alternative would end up at the same place as the option above, but would phase out existing insurance and phase in the new program over three to five years.
3. “Expanded Medicare” (or “Medicare for Some+”)
This alternative, as the name implies, would keep the existing Medicare program (currently limited to disabled persons and those 65 and older), but would allow older working adults (aged 50-64) to “buy in” to Medicare when they have difficulty affording individual or employment-based insurance. Low-income older adults would be eligible for subsidies to help them afford Medicare premiums. In some versions, Medicare could be opened gradually to all for buy-in if they prefer it to their current insurance. This option retains the existing system of public and private health insurance.
4. Reforming the Affordable Care Act (ACA)
This alternative would establish a federal public insurance plan to be offered on the Affordable Care Act market, so that people dissatisfied with current ACA options would have another and more affordable insurance option. Existing Medicare, Medicaid and private insurance would remain in place. These proposals also expand the income eligibility for ACA premium subsidies, enabling more individuals and families to afford policies. This proposal also includes multiple technical “fixes” to the ACA to help it run more efficiently.
These policy options differ primarily on two questions: first, what is the most effective means to enroll people into health insurance (private companies, public insurance, or a combination); and second, how to pay for the insurance (what combination of taxes, premiums, co-pays, and employer contributions). They do not include significant change to the delivery of health care by private physicians or private hospitals. None proposes government ownership or operation of health care delivery. Additionally, none has any unique plan to improve quality of health care. All adopt and build on already-existing quality improvement initiatives.
Each alternative does address the unsustainable cost of health care. Options 1 and 2 above aim to achieve lower costs by reducing the number of health care dollars flowing to administration (insurance advertising, claims processing, hospital and physician office billing and claims operations, and such). These costs, related to competitive insurance markets, make American bureaucratic costs very high but contribute little or nothing to the quality of care provided by doctors and nurses. If there were a single payer for health care, most of these dollars could be saved or redirected toward better care.
Options 3 and 4 would retain private insurance, so they cannot claim extensive administrative cost savings. Instead, they would achieve savings by using Medicare or a new public insurance plan to negotiate lower payment rates to hospitals, physicians, pharmaceutical companies and other providers.
There is no fifth option that Catholic social teaching could support, because there is no other way currently proposed by either of the major political parties or by any Republican or Democratic presidential candidate to realize the goals of universal coverage with high quality and efficient cost.
Apart from Catholic principles directly applicable to health care, our faith and our experience tell us also that many other social problems directly affect people’s health and well-being. We recognize that poverty and severe economic inequality influence health; thus, we support laws designed to reduce poverty and inequality. We recognize that unaffordable and unsafe housing affects health; thus, we advocate for preserving and building affordable housing. We recognize that racial and ethnic discrimination impinge on well-being; thus, we fight against racial and ethnic discrimination. We recognize that crime and violence affect health; thus, we support policies to reduce violence and improve law-enforcement and courts. We recognize that lack of education affects health; thus, we endorse education improvement.
We’re Catholics. We can handle complexity.
Deacon Clarke E. Cochran, PhD, serves at St. Peter Church in Charlotte.