Frequently Asked Questions – with CatholicWatch editor Monica Harrington
What’s the crux of the issue?
The Catholic Bishops think it’s their right to impose their moral values on others in health care institutions that are heavily supported with public tax dollars and that serve Catholics and nonCatholics alike, most of whom do not share the bishops’ values or beliefs. This is unacceptable.
The bishops are smart, focused, absolutely certain that they are in the moral right, and in it for the long haul. They have a very deliberate strategy to control health care policy by leveraging their control over Catholic health care institutions, especially in areas of the country where they cannot impose their conservative social agenda through legislative action or at the ballot box.
The Founding Fathers were very wise to separate State functions from the Church. They did this because they knew how divisive and cripping fights over religion had been in many parts of the world.
Americans have a Constitutional right to worship or not worship as we choose, free of government interference. In health care, we’ve quietly drifted into a situation where the Catholic Church, with government support, now runs health care “ministries” across the country. In Washington State, the American Civil Liberties Union estimates that 45% of acute care hospital beds (a proxy for the health system more broadly) are already subject to the control of religious authorities. In some areas, property owners provide a direct tax subsidy to “Catholic health care ministries,” even as these “ministries” run huge surpluses. PeaceHealth, for example, a Washington-based Catholic health ministry, had a $112 million surplus in 2010 on revenues of $1.6 billion.
We’ve got a “boiling frog” issue; no one objected when the heat was first turned on because medically, Catholic health care wasn’t different from nonCatholic health care. When Catholic hospitals first started in many areas of the U.S., it was largely because nuns were compassionate and wanted to serve (they didn’t have children they needed to take care) and most of what they offered was palliative care.
Now, health care is sophisticated and expensive and the people who run Catholic hospitals, most of whom are lay people making very high salaries (the CEO of Providence, John Koster, made $6.4 million in 2011), are implementing medical policies that are in line with the Catholic bishops, but that are opposed by the vast majority of Americans, and which run counter to the advice and recommendations of physicians and other health experts. The American Congress of Obstetricians and Gynecologists, for example, says that women should have easy access to contraception and to the “best available, scientifically-based health care.”
How did the Catholic bishops get so much power?
A constellation of factors have brought us to a crisis point in states like Washington where a very large percentage of the hospitals and medical systems are overseen by Catholic bishops with extremist views not shared by the general public:
1) The Nuns are Dying Out and the Vatican Has Ordered a Crackdown on the Nuns that Remain to Get Them into Line – The Catholic bishops are cracking down and asserting their will over more progressive nuns. Traditionally, most hospitals were run by the nuns, and there’s long been a schism between most nuns and the Catholic bishops. The nuns, many of whom were encouraged to seek higher education as part of the reforms of Vatican II, set out to become members of the community, and it’s because of their compassion and sense of social justice that they have often quietly supported contraception and have not spoken out on “social issues” like whether or not people of the same sex should have the right to marry. But that has changed. The Catholic bishops view the imposition of the Ethical and Religious Directives as a strategic tool to ensure that as hospitals pass from the control of more progressive nuns to highly compensated lay professionals who ultimately report to the bishops on ethics issues, the hospitals will operate under an ultraconservative “moral” code.
2) Changing social mores. Few people, including Catholics, identify with conservative Catholic doctrine. Only seven per cent of adult Americans self identified in 2012 as “strong Catholics.” Most Americans strongly believe that they should have the right to decide whether or when to have a family. Most Americans believe that same sex couples should have the right to marry. Most Americans believe that health care directives should be honored.
As Catholics themselves acknowledge, the bishops are out of touch and don’t understand the real lives of everyday people. As social attitudes continue to evolve, the delta between the views of everyday Americans and the Catholic bishops continues to widen.
3) Rising costs and consolidation. Because of rising costs and the need for better technology and reporting systems, hospitals and medical systems are consolidating. This has plusses and minuses – but a clear minus is that in places where Catholic hospitals had a stronghold, they are expanding in ways that completely crowd out other options for people who don’t share conservative Catholic values, and they’re doing it with taxpayer dollars. In December, 2013, a lay CEO in a Catholic system who oversees more than 80 hospitals, said that 60-65% if their funding comes from “government payers,” including Medicare and Medicaid. Ironically, the better reporting and tracking also makes it easier for ensuring compliance with the Bishops’ Ethical and Religious Directives.
4) The Bishops saw an opportunity to leverage government spending. Because of the government’s increasing role in health care (including Medicare, Medicaid, and health-related research), by 2012, almost half the funds spent on health care flowed from government programs. The next largest share is from private payers, including insurance companies on behalf of privately-insured patients. In many cases, hospitals are becoming an important source of revenue, which can be seen on the net-positive 990 returns of many Catholic systems, including the two major Catholic health systems in Washington State. (The largest of these, Providence, reported a surplus of $363 million for 2011.) When you combine a net positive revenue stream, which can be used for ongoing expansion, with the legal strategies the Catholic bishops have been working on for decades, the bishops are on a path to control a majority of hospitals and medical systems in several states, and the irony is that some of the first states where they’ll gain majority control first are much less religious than the rest of the country as a whole.
5) The Bishops’ push to expand the scope of the “conscience” exemption. The Catholic bishops have been very effective in exploiting the “Conscience exemption,” which was originally passed at the time abortion was made legal to protect individual providers (doctors) from having to actually do abortions or perform sterilization procedures if it violated their beliefs. The bishops have since been working to expand the definition of the conscience exemption so that it covers any situation in which a person feels uncomfortable with health care decisions, policies, medicines, or procedures that conflict with Catholic doctrine. In the Catholic bishops’ worldview, if there is anyone in the chain of people who need to be involved in order for a woman to actually get birth control (doctor, nurse, health care institution, pharmacist, employer, insurer, educational institution), then birth control should be denied. And because the bishops oversee the ethics decisions at all Catholic hospitals, it means that they believe they have an absolute right to forbid birth control or any other forbidden medical intervention at all Catholic hospitals, which for too many people means that although they are paying the bills (as taxpayers or patients), the Catholic bishops are calling the shots.
Is this about being anti-Catholic? Not at all. Most Catholics in the United States don’t agree with the Catholic bishops when it comes to key health issues like contraception or abortion or vascectomies or tubal ligation. Ninety-eight percent of Catholic women use birth control at some time in their lives, and 74% of Catholics want abortion kept legal.
The issue is that the Catholic bishops want to impose their version of morality on everyone who comes into contact with Catholic hospitals, even though Catholic hospitals receive a great deal of their funding from taxpayers and from private pay patients who don’t support the Catholic bishops’ conservative agenda. Of course, the irony is that the bishops’ extreme position against birth control gets in the way of dramatically reducing teen pregnancy and abortion rates.
The Catholic bishops can’t have it both ways. If Catholic hospitals are religious organizations, and the bishops assert they are, as religious institutions they should not be supported with tax dollars.
Using tax dollars to advance a specific religious agenda is not only unfair, it’s unconstitutional.
In 1782, Thomas Jefferson wrote:
“But it does me no injury for my neighbor to say there are twenty gods or no God. It neither picks my pocket nor breaks my leg.”
Jefferson’s point was that government needs to intercede when religious belief turns into oppression or injury to another. When a pregnant woman cannot go to a publicly financed hospital without having her health or life endangered because of someone else’s religious beliefs, that metaphorically “breaks her leg.” When a woman gives birth in a publicly financed hospital and is refused a tubal ligation because of someone else’s religious beliefs, thus requiring her to undergo an additional surgery somewhere else at far greater expense, that “picks her pocket AND breaks her leg.”