One of the tactics defenders of tax-supported Catholic health care like to use is to point to the history of Catholic institutions and the role of nuns in compassionately serving the poor. “How dare you criticize the nuns?” is the rallying cry.
Well, the point everyone should get is that the nuns have been dying out and highly paid lay professionals, ultimately accountable to the bishops, have been taking their place. Very recently, Sister Carol Keehan, who heads the Catholic Health Association, reported that there were only four religious CEOS left among more than 600 hospital CEOs. In 1968, there were 770 religious CEOs, and 26 lay CEOs running Catholic hospitals.
I grew up with nuns. I attended Catholic grade school, and because my parents were long-time volunteers who admired the work nuns did (Dad was a long-time pro bono legal advisor to nuns; Mom was head of the Altar Society), I spent a lot of time around them and hearing adults talk about their work.
Many of the nuns I knew seemed very feisty and independent compared to the mothers I grew up with, most of whom were too busy raising their many children to pursue advanced degrees or vocations. The nuns tended to be very well educated, a point my mother (who had eight children) often made in admiration.
But somewhere along the way, Catholic girls stopped becoming Catholic nuns. The peak year for women religious in the U.S. was 1966, with 181,421 nuns. By 1993, the LA Times reported the numbers had fallen to just over half, 94,022, and according to its statistical survey, just 3% of those nuns were 40 or under. By 2009, the Boston Globe reported that 91% of nuns were 60 or older. Today the average age is well into the 70s and postulants (women in the early stages of becoming a nun) have become an endangered species.
As control of Catholic hospitals passed from nuns to lay managment, the bishops saw and seized an opportunity. The nuns, with their hands-on experience working in poorer communities were more accepting of social mores and values that conflicted with Catholic doctrine. Quietly, many nuns supported contraception, disagreed with the bishops on the total abortion ban, and refused to fully implement the Ethical and Religious Directives for Catholic Health Care. (The reason a nun was excommunicated in Arizona years ago was that she thought a life-saving abortion made sense.)
With lay professionals, the lines of authority are more clearly drawn. An executive pulling down $6.4 million a year (as Providence’s CEO did in 2011) will do what his bosses want. Lay CEOs are praised and celebrated for their allegiance to the bishops. Kevin Lofton, the CEO of Catholic Health Initiatives, one of the largest health systems in the United States, runs an empire with more than 85,000 employees and $12 billion in revenue. At CHI, strict compliance to the ERDs is required.
We’ve gone from nun-started healthcare, with its compassionate emphasis on the poor and underserved, to bishop-controlled health care, with its emphasis on expansion, the bottom line and complete fidelity to the Ethical and Religious Directives.
Respect for the nuns and what they accomplished over more than a century shouldn’t blind us to the fact that Catholic health care has fundamentally changed, which means the underlying assumptions about Catholic health care need to change too. The nuns themselves are in conflict with the bishops, a key reason Archibishop Sartain of Seattle was tasked with bringing them into line. Given the age of the nuns and their declining power, it’s possible the crackdown on the nuns will quietly die out too. Why bring attention to a conflict if you can simply wait until the nuns are gone?
Meanwhile, the Catholic health care ministries (their preferred term) will continue to grow and expand, which means the bishops’ sphere of influence and ambitions for their ultraconservative agena will grow and expand as well. And the cry “How dare you attack the nuns?” will be used to dissuade and intimidate critics who believe in and advocate for the separation of Church and State.
The “boiling frog” situation we find ourselves in, where taxpayer-supported Catholic health care became part of our daily lives happened because of the charity and compassion of the nuns. But the bishops are not the nuns. They have a different agenda. Diocesan bishops take no vow of poverty, can live like princes, and are viewed as out of touch even by Catholics.
In a democracy, bishops deserve a public policy role no greater the influence they have on their own flock. And with Catholic support for everything from marriage equality to contraception use being so at odds with the bishops, it’s clear bishops have a lot of work to do before they can ever consider speaking as moral authorities to or for the rest of us.
“No man shall be compelled to frequent or support any religious worship, place, or ministry whatsoever -” Thomas Jefferson, Virginia Statute for Religious Freedom