It was inevitable that religious groups would be drawn into the fight over health care reform. Any proposal to restructure one-sixth of the U.S. economy is bound to affect almost every social institution, including religious institutions. In fact, these have a significant stake. The Catholic Church alone delivers $5.7 billion in health care annually through 600 affiliates.
Health care is an area that particularly touches upon religious values. Catholic hospitals can trace their lineage back to the Middle Ages, when religious orders took the lead in caring for the sick. They were trying to imitate a Savior who first made his reputation as a healer.
But what constitutes healing? Is abortion an act of healing? Is contraception? What about euthanasia? For many Americans, these questions cannot be considered apart from theological notions about the sacredness of the human body and the uses for which God intended it.
The moral questions about the boundaries of health care become more acute as health care is centralized. When health care is provided through local markets with a multiplicity of players offering disparate services, individuals have freedom to choose the options that best fit their moral convictions.
But to the extent that health care reform concentrates decisions in the federal government, it raises the stakes. With the Department of Health and Human Services (HHS) defining essential benefits under private insurance while also bringing more people directly under federal programs, HHS will increasingly be making moral decisions for everyone. Either it will respect religious consciences and limit some of the standard services, or it will force numbers of religious believers to participate in a health care system that violates their consciences. This is the nub of the current dispute about abortion coverage.
The debates about abortion and health care reform are not between religion and secularism. They are between different sets of religious values.
A superficial reading of church statements on health care would suggest considerable consensus on goals such as universal access, affordability, and cost control. There is a parting of ways, however, when it comes to the legislative specifics.
The Southern Baptist Ethics and Religious Liberty Commission, representing America's largest Protestant denomination, is encouraging a filibuster of the current Senate bill. The commission's foremost objection is the failure to exclude abortion coverage from any government-run or government-subsidized insurance plan.
But the Southern Baptists would oppose the bill in any case. Suspicious of concentrated state power, they predicted that an earlier version would "lead to diminished health care for most Americans, less choice, higher taxes, and unprecedented government intrusion into every level and aspect of society."
Diametrically opposed are the oldline Protestant leaders, who habitually look to the state to fulfill biblical promises of "good news to the poor." Agencies of the United Methodist Church, Presbyterian Church (U.S.A.), Episcopal Church, and United Church of Christ touted the health reform bill that passed the House in early November. They would have preferred a government-controlled "single payer" system; however, they saw the Democratic proposals as a step in that direction.
Oldline leaders' main qualm has been that the House bill contains the Stupak amendment barring abortion coverage in government-funded plans. A December 4 letter signed by offices of the four denominations exalted abortion as "critical health coverage [for] women." At a recent rally the head of the oldline-backed Religious Coalition for Reproductive Choice thundered: "You not only have a constitutional right for abortion, but you have a God-given right."
Caught in the middle are the Roman Catholic bishops. Their tradition has been to address social problems through partnerships between the state and private institutions, including churches. So, in principle, they are open to the approach being pursued by the Democrats.
The Catholic bishops would like to see an even more expansive health reform than the current bills provide. In a November 20 letter to senators, three U.S. Conference of Catholic Bishops (USCCB) committee chairs advocated stronger "provisions for adequate affordability and coverage standards" and better access for immigrants.
But abortion remains a sticking point for the bishops. "Failure to exclude abortion funding will turn allies into adversaries and require us and others to oppose this bill," warned USCCB president Cardinal Francis George recently.
A society that sees morality as merely subjective sentiment is ill equipped to resolve this kind of controversy. It's no wonder that the culture wars have been reignited in the health care debate. How could the Democratic leadership have expected otherwise when it proposed a more centralized health care system? Raw political power may enable the leadership to push through a decision; however, it will leave many embittered citizens feeling that their moral concerns have not been attended.