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Reforming Health Care, Faithfully
published in Woodstock Report No. 92, January 2009
During the recent election season, voters frequently heard a word or two from presidential candidates about how they’d fix the healthcare system, whether the key phrases were “tax credits” or “universal coverage” or some other term of policy art. Chances are that few people, however, heard words like these from political leaders: “Do we have an obligation to the sick, the disabled, and those on the margins of society? That is the first question of any healthcare reform.”
And that was the question posed by Edmund Pellegrino, a physician and chairman of the President’s Council on Bioethics, while speaking at the Woodstock Forum, in a program titled “Values Inside the Issues: Religious Voices on Health Care Reform,” held at Georgetown University Law Center on April 23, 2008. Other voices from other faiths (Pellegrino is Catholic) included Rabbi David Saperstein, a lawyer and director of the Washington-based Religious Action Center of Reformed Judaism, and Zubair Saeed, a physician and health director of the All Dulles Area Muslim Society in Sterling, Virginia. Each spoke the language of moral and theological reflection using the dialects of their own traditions and drawing on their own histories of faith and service; each offered values and perspectives that, as the moderator, Father John P. Langan, S.J., said, might well “shape our response to the ongoing challenges of healthcare reform.”
The commonalities that surfaced at the forum, cosponsored by Woodstock with three Georgetown entities—the O’Neill Institute for National and Global Health Law, the Berkley Center for Religion, Peace, and World Affairs, and Georgetown University Medical Center—were palpable. To begin with, all three of these monotheistic faiths have foundational teachings that lead them to assert individual and social obligations to meet the bodily needs of God’s children. All three make the claim that property and resources are entrusted to humans and communities by God, with the stipulation that they be used for the benefit of God’s family. Most vivid were the convergences between the two faiths perhaps most often depicted as aligned against each other on the geopolitical stage: Judaism and Islam.
Both Saperstein and Saeed cited teachings that seemed cut from the same textual cloth. For example, Saeed pointed to the traditional Muslim teaching that if a person saves a single life, “it’s as if he saved ... the whole nation,” while Saperstein pointed to the traditional Jewish teaching that if someone saves a life, “it’s as if he saved the world.” Both faiths have specific traditions of commentary that underline an individual’s responsibility to look after her own health. “Your body has a right over you” is an exhortation from the Muslim tradition, sounding altogether like the Jewish admonition against “damaging your body” directly or through inattention. And, these obligations to care for one’s health extend from the individual to communities and entire nations, according to Jewish and Muslim commentaries (as well as Catholic and other Christian social teachings).
A professor of law at Georgetown as well as a leading practitioner of Jewish social action, Saperstein pointed out that during the medieval period and through much of Jewish history, rabbis were unpaid and had other professions. Roughly half of them were physicians, he pointed out, and they benefited from the patronage of Muslims and from scientific discoveries of the Muslim world. “Jews had far more opportunity to participate in Muslim society” than in Christian society, Saperstein said, noting that the 12th century rabbi-philosopher Maimonides served as a personal physician to an Egyptian caliph. “Muslim medical tradition and Jewish medical tradition developed for nearly half a millennia side by side, interacting with each other.”
There was a particularly moving moment during the discussion when Saeed, after hearing presentations by Pellegrino and Saperstein, became briefly choked up and paused before saying—“I’m sorry. It’s really heartwarming to see the commonalities that our three faiths share. There is a lot more that binds us than separates us.”
Not just historical, these commonalities pour into the present and have brick-and-mortar manifestations that can be glimpsed in any city graced by a Catholic long-term care facility, a Jewish hospital, and a Muslim clinic. Religions have an unmistakable presence as deliverers of healthcare in the United States, and in recent times they have been offering their experiences and imageries of faith, service, community, healing, and justice, as guidance for those shaping social policy on this exceedingly urgent matter. Signs of this expanded religious role include the recent formation of Faithful Reform in Healthcare, an interfaith coalition that seeks to imbue the public dialogue with religious and ethical perspectives; and the Massachusetts healthcare reform plan adopted in 2006 after pivotal lobbying by faith-based community organizations.
Heard and Seen, in the Public Square
For each of the speakers, one of the first orders of business was to simply argue the case that religious faiths should not only be seen—as healthcare providers—but also heard in public discourse on this and other policy issues. Pellegrino, an emeritus professor of medicine and medical ethics at Georgetown, pointed to one school of thought that says religious beliefs should normally be kept private, at a safe distance from political issues that can be inflamed by sectarian arguments. He countered that it’s not easy to dislodge political opinions from moral convictions, and these, in turn, often spring from religious faith.
"There's a very good reason for getting this [religious perspectives] out in the open-because it's there. When we neglect it, we neglect an important source of morality for a majority of persons," Pellegrino submitted. While many are familiar with the assertion that religious claims to moral truth can fuel political division, both he and Langan explained how faith-based intervention can, and often does, have the opposite effect. "For one thing," Pellegrino said, "it's an antidote to partisan politics. You don't take a position because you belong to a particular party. You have [larger] reasons for it, and those reasons ought to be put in the open." During his introduction, Langan, a Georgetown professor of Catholic social thought, had suggested that political differences over healthcare policy can be "relativized and softened somewhat" by the leavening presence of religious faith in policy discussions. That is, especially if those differences are limned on a larger canvass of agreement on moral principles kindred to all three of the great monotheistic traditions.
During this forum the speakers focused almost entirely on such precepts rather than on the merits of particular proposals for curing systemic ills of healthcare (proposal addressed, often in detail, by religious activist groups). One of the clearest principles defended at the forum—though not without a cautionary word from the moderator—was that healthcare shouldn’t be treated as a commodity. It shouldn’t be seen, in other words, as a business driven solely by market forces.
Such principles usually provoke arguments over government’s role in the economy and the wisdom of market-based solutions. But Pellegrino said that while those discussions are important, there is a prior question: “Is there a moral obligation on the part of a good society to those who are sick, disabled, not able to function, and even to our brothers and sisters who are not taking care of themselves and are not being responsible, but who have the same dignity that you and I have?” That question, he said, ought to be the starting point of debate.
Later, during the discussion period, he continued pressing this case, saying, “I don’t think it [healthcare] could ever be a commodity. The only way I could make this clear is to ask you to put yourself on the gurney, get on the [hospital] bed. Stop thinking about policies. You are a sick person. You’re vulnerable. You’re anxious. You’re dependent. Do you want market forces, which have no heart to them, to determine” what kind of care you receive? Illustrating the difference between healthcare and other things that might well be left to the marketplace, he added: “When you’re on that gurney, you’re not buying beer, panty-hose, or band-aids.”
In a way, Pellegrino was echoing what great figures such Pope John Paul II and even Adam Smith have taught—that some things escape the logic of the marketplace, and those are fundamental human needs. Modern Catholic social teaching has contended that human beings have a basic right to the things that make life more human, and which are necessary for leading a dignified life in community. (Pellegrino himself shies away from the nomenclature of rights and prefers to speak instead of obligations, partly because, as he sees it, there’s no legal framework for economic rights in the United States.)
Similar sentiments were expressed by the other two panelists, and Saperstein made a more particular point as well. Alluding to the argument of some that universal healthcare would inevitably drive down the quality of care, he stated, “In a choice between healthcare that provided better quality but left a sixth of the population out, and a universal system in which the quality of care was less for everyone, the Jewish tradition is clear that you’d opt for the universal system.” Saperstein wasn’t saying these are the only choices; he was making an argument (in not so many words) about the kinds of decisions that are made when healthcare is understood as a right rather than a commodity.
At that moment during the exchange, Langan—a Woodstock board member and senior research fellow at Georgetown’s Kennedy Institute of Ethics—added his word of caution, noting the size of the healthcare sector in the United States. “I’d like to remind our panelists that we are talking about one-sixth of the economy,” Langan said, questioning what he described as the idea that powerful economic pressures (including the trend toward making healthcare a commodity) could be wrested from the healthcare system. Such a notion “stretches my capacity for belief,” Langan said.
In response, Pellegrino said he didn’t think the size of the healthcare system should matter when advancing a moral critique: “The fact that we’re spending so much on healthcare does not eliminate the need for the kind of ethical analysis that is often left out [in the policy debate].” For his part, Saperstein added that nobody is suggesting “we wrest out” the economic realities of healthcare, but he said that even while working within those realities, public leaders can seek reforms more in keeping with the common good.
Limits of Religious Advocacy
During the question-and-answer period there was some discussion of whether religion is speaking boldly enough when it comes to social and political change. As put by one questioner (a young man with an indeterminate accent), the “establishment trembled” whenever Moses, Jesus, and Mohammed spoke, and he asked why people of faith aren’t taking a more “dynamic, revolutionary stance on healthcare in the United States.”
Saperstein gave the first reply, assuring the young man that religious activists have been “speaking truth to power” on this issue and doing so together, through ecumenical and interfaith channels. “I don’t think it’s a lack of courage” on their part, he said, explaining why faith-based groups haven’t been more successful. “Almost all of us would like to see a single-payer system. That’s a revolutionary step. But we remain the quintessential multi-issue entity,” he said, speaking primarily of coalitions that bring together mainline Protestant, Jewish, and Catholic organizations.
In other words, the impact of mainstream religious advocacy is inevitably spread across the public-policy landscape. Still, Saperstein pointed out that largely because of faith-based community activism in Massachusetts, “millions” of people now have better access to healthcare. “I think we can do that nationally,” he said.
Pellegrino seconded Saperstein’s analysis, but he also said specifically in regard to the Catholic Church that “the hierarchy is ahead of the populace” on such issues as universal healthcare (the same is often said of liberal Protestant denominations and Jewish organizations). “I think there’s been courage, but we haven’t convinced our own conferees,” he explained.
In closing remarks, Kevin Fitzgerald, S.J., an ethicist and molecular geneticist at Georgetown University Medical Center, said the forum was the first in a series of dialogues focusing on healthcare ethics and policy at Georgetown. He said the panelists that evening had taken a worthy stride toward the eventual goal—“a truly healthy future for each and for all.”