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.”

21 thoughts on “faq

  1. Lauren Winn

    Monica, your rhetoric certainly reads anti-Catholic.
    Catholic ministries exist to carry out the mission of Christ in the world. It is the responsibility of the bishops to promulgate the truth of Christ as the Church articulates it and hold Catholic ministries accountable to live out that truth authentically.
    If you value freedom, you should be concerned with the idea you are promoting: that individuals and institutions should be coerced by the state to act in ways they believe immoral in order to accommodate prevailing public opinion.
    Your primary focus seems to be on access to contraception and abortion. I would recommend that you listen to Catholic Answers radio (available at catholic.com) to develop an understanding of Catholic teaching, particularly on those subjects.

    1. catholicwatcher

      Hi Lauren, thanks for writing. I know many fine Catholics and in fact, live with one of them. I was raised Catholic and am steeped in Catholic tradition and teachings. (My father taught at a Catholic university and my mother was head of the Altar Society.) I’m also the last of eight.

      What you and the bishops believe is up to you. I object to the bishops (or anyone else) forcing their religious views on others, especially when it compromises people’s health. I object to paying taxes that support a Catholic health care ministry. I object to multi-billion dollar enterprises getting tax exemptions when they compete aggressively against other nonprofits and businesses that don’t get the same advantages.

      Most Catholics in the U.S. disagree with the Catholic bishops when it comes to the issues I’m focused on, which includes contraception, same-sex marriage, abortion, and stem cell research. I wouldn’t care what the bishops believe except that they are intent on forcing their views on others, using our tax dollars in the process.

      Best, Monica

      1. diane

        Monica–Thank you for your good work. I am not against the Catholic church. I am against any church creating a monopoly on healthcare, and only the Catholic church is doing that here. Our attorney General should use anti trust laws to stop this. And our citizens should be writing letters to our governor and legislators. People have to take action or they will just be steamrollered.

        1. Karl

          I think that todays healthcare system is a mess. The Affordable Care Act addresses this to some extent but did not go far enough. In the current system, hospitals, even nonprofits, have to work in a money driven system providing negotiated reimbursement that often does not cover costs. Hospital systems are better situated to deal with the way healthcare is financed and can negotiate with insurance companies and with suppliers of equipment and drugs for better prices. Hospital systems are more efficient and provide the basis of consistent care and a standardized medical record shared through out the system. And in the process provide better services and care. It is just a fact of life in the USA,

          In my opinion, it is not the hospital systems that are a problem, it is our healthcare system. Many would like to see a single payer system and take healthcare out of the “for profit” competitive economy. And with that perhaps we need even larger hospital systems in which patient health records are shared and the system is centered on low cost quality patient care, not competition and profit.

          I believe for now, hospital systems provide some of the benefits that we want in healthcare. It is the healthcare system that needs change and that is where we need to focus our efforts.

          Interested in your thoughts. It is important that we all understand where we are and work in a constructive way to improve the system while supporting our current institutions in the interest of patient care.

  2. Matt

    Dear Monica,

    As a young pro-life student, I just want to remind you that you will lose this battle. My generation is coming to terms with what you and the rest of the baby boomers have done to our nation. The legalization of abortion and the onset of the sexual revolution has led to a bioethical catastrophe. Thankfully, we are here to clean up your mess.


    A future doctor

    1. catholicwatcher

      Dear Matt,

      I hope your studies open your eyes. My very Catholic mother, who was pregnant ten times in 12 years, knew women who died from botched abortions, and it’s a key reason she was prochoice.

      Thankfully, I spend time with young doctors in training who respect the rights of women and who understand the need for safe, legal abortions. But, it’s a good reminder to all of us that young people like you are out there, secure in the knowledge that you deserve the right to impose your will on everyone else.

      1. Matt

        The answer for those women who died from botched abortions isn’t legalized abortion. The answer is better and more accessible care for both the mother and child. If the culture can be changed to not stigmatize pregnant mothers, and instead provide an accepting community then we can reduce the number of abortions. There are thousands of women who have been pressured into having an abortion by their parents, friends, and relatives. But this isn’t the crux of the argument. The crux of the argument is that abortion destroys a human life, whether the Supreme Court recognizes this or not. You say that I am imposing on women’s rights? I would argue that you are imposing on the rights of a child.

        1. Cytherea

          “You say that I am imposing on women’s rights? I would argue that you are imposing on the rights of a child.”

          Fun fact: Forcing a pregnant woman to bear a child against her will accords her fewer rights than we accord dead bodies in this country.

          Even if we accept your postulate that a blastocyst or an embryo or even a fetus has the same worth as a fully mature human being, in no other instance can a person be compelled to sacrifice their own bodily autonomy for another person’s good. If Alex desperately needs a blood transfusion/kidney transplant/bone marrow transplant/what-have-you, and will, for certain, die without it — and Pat is the only person on the entire planet who is a match for Alex… Pat’s blood/kidney/bone marrow/etc cannot be procured for Alex against Pat’s will, even if Pat is dead. Except in the one instance wherein Pat is a pregnant woman and Alex is her blastocyst/embryo/fetus.

          Please, pro-lifer, explain to me why pregnant women should have fewer rights than corpses. Use small words, so I’ll be sure to understand.

  3. Karl

    Future Doctor, my niece just graduated from medical school along with 167 classmates. Everyone of the new Doctors I spoke with were committed to the best possible healthcare for all. As a doctor, you take an oath “That into whatsoever house I enter, it shall be for the good of the sick to the utmost of my power.” A doctor’s religions convictions must not and cannot supersede the good of the patient. If a religion says it is ok for a man to beat his wife in certain circumstances which is illegal in our country, then an individual cannot inflect this belief on others. Each of us can exercise his/her own religious convictions but none of us can impose our religious convictions on others. As you move toward your responsibilities as a doctor, it is critical that you understand this and will take that oath as an absolute duty, always for the good of your patient no matter what your religious convections might be.

    1. Matt

      My religious convictions are irrelevant. Science and reason can tell us that human life begins at conception. Wouldn’t it be common sense to err on the side of caution when a human life is at stake? For example, if you were hunting in the dark and there was a possibility, however small, that a person was walking in your line of fire, you wouldn’t shoot, right? In the same way, I would never perform or help procure an abortion (taken from the Hippocratic Oath), because it is certainly killing a human life and may kill a human person. I will do whatever it takes to care for the life of any patient, old or young, male or female, but I will never actively snuff out the life of a human being, just because half of the country believes it is just a clump of cells.

  4. Karl

    I have no problem with what you say. A dying mother might be a different issue. Things in medicine are not often as black and white as we might like. If a 15 year old girl wants birth control pills to keep her from becoming pregnant, what would you do? Giving her a lecture on abstinence might seem right to you but it may not work for your patient. Should your religious convictions override what is legal and what the patient feels is in their best interest? This is not about you or your convictions, it is about the rights of patients. And it is about the separation of church and state. You have a right to your convictions but do you have a right to force your convictions on a patient who does not share them?

    1. Matt

      What role does separation of Church and State play in the conversation between a doctor and his patient? If a fifteen year old girl asked me for birth control, I would politely tell her that it goes against my convictions and explain why, but then I would remind her that she can switch to a doctor who will prescribe them to her. Nobody’s rights are being violated in that scenario. She will be able to access her birth control pills, and I will be able to practice medicine in a way that does not violate my conscience.

      1. Cytherea

        “f a fifteen year old girl asked me for birth control, I would politely tell her that it goes against my convictions and explain why, but then I would remind her that she can switch to a doctor who will prescribe them to her.”

        You live in an interesting world, wherein 15 year old girls are allowed to select their own doctors, as opposed to having to go to whichever doctor their parent(s) choose.

  5. Karl

    I would say you are asking her to find another doctor, make an appointment which may take some time, undergo a physical usually required for new patients and then ask for her prescription. And all she needs is to prevent an unwanted pregnancy. I do not feel that is serving your patient. Most practices would not consider that to be serving your patient and would not hire you. And if you want to practice that way you need to give a written statement to any potential female patient of your policy before you take them on as a patient. I am very sorry to say this but perhaps you should consider another career. This is not personal, I am just being realistic about the practice of medicine and the expectation of patients.

    1. Matt

      As the son of two Catholic pediatricians who have both been employed for 20 years, I’m pretty sure that I’ll be ok.

      1. catholicwatcher

        Thanks for making the point that physicians and institutions should have to disclose their policies upfront, before patients become victims of religious beliefs which they do not share.

        1. Al

          I agree, thank you for making the point. I also believe A Church that discriminates openly in the United States should Not be able to receive Any Government money what so ever. If you are the doctor you say you are going to be, (which confuses me, is it required to become a doctor, to take the oath? The same as the military members joining the service? If so, you are knowingly lying when you take that oath – do you take 10 Hail Marys to be forgiven of that sin immediately after?) I would like to know the taxes I pay are not going to a Church (which it does when the Catholic Church purchases hospitals and local pharmacies – which is currently in motion.

  6. Karl

    Times are changing. It used to be that the patient and family were the center of healthcare. The doctor often came to the patient’s home. Then as time passed, the doctor became the center of healthcare. The patient would have to come to the doctor and the doctor had the first and last word. Perhaps “doctor centered” medicine was the world in which your parents practiced medicine. Well, there is now a strong movement to patient and family centered care. It is not what the doctor might think or believe, the patient and what is best for the patient is what is most important. It may be family planning, it may be how and when the patient chooses to die. If you want to be a good patient family centered doctor, it is not all about you, it is about the patient and the patient’s family. This is the new reality and it seems to be both logical and appropriate. I think you need to come to terms with this. And for those reading this blog, be not afraid, patients and their rights are going to prevail. And it is fully supported by doctors and is being taught in medical schools across the country. You and your families best interest will be served.

  7. Cytherea

    Monica —

    Thank you VERY much for this blog. I appreciate very much being able to be more fully informed about the healthcare options in the hospitals around me, and the influences on them that may affect their standard of care. I’ll be following your posts with interest!

  8. Kevin

    No one thinks abortion is a great idea or a wonderful thing, not even pro-choice advocates. At best, it’s the lesser of several evils. At worst– it’s a back-alley procedure that seriously risks the health or life of the woman. Keeping it legal helps to avert the worst-case scenarios for abortion.
    FACT: It’s been proven that banning abortion does not decrease abortion rates. Women still seek and obtain abortions when they need it.
    FACT: It’s been proven that the best way to reduce the rates of abortion is to teach good-quality comprehensive (not abstinence-only) sex-education, and provide easily accessible, low-cost contraception.
    So all those pro-lifers who want to reduce abortions, yet lobby against comprehensive sex-ed and contraception, we see your true colors. The life of the unborn fetuses and the women who bear them aren’t NEARLY as important to you as preventing people from having safe sex. It’s all about preventing sexual immorality to you… not about saving lives.
    You can twist it and turn it all you want, but banning abortions does not stop them from happening, any more than prohibition stopped people from drinking– it only drives it underground, into a black market, and causes more harm.

  9. Daniel Jereb

    I am an every Sunday Catholic. And I see the greatest scandal of Catholicism, not pedophilia, but the so called nonprofit Catholic hospital systems in the U.S.The Catholic Church is the main obstacle to universal healthcare in this country. A simple payroll tax for hospital bills is a simple first step. But the Church loves its money more than Jesus. Proof? Look how the hospitals fought the unions. See how willing they are to let the Good go undone for the sake of empire. The Church could lead, but it does the bidding of the Lightbearer. When the rank and file Catholics realize this, they will lose heart in a catastrophic way.


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