Susan Stabile, a law professor at St. John’s University and a contributor to Mirror of Justice, analyzes the current state of health coverage in the United States in light of Catholic social teaching in this article. I have quibbles here and there along the way, but on the whole the approach and the conclusions are sound. She is probably right that Health Savings Accounts (HSAs) have limited value, though my reasoning would be a little different. I would say that, in principle, they represent a helpful idea—increase the operation of the market within health care—but they are such a small foray into a vast and complicated world beset with market distortions on every side, that they end up exhibiting the deficiencies that Stabile identifies.
The verdict is obviously still out on the Massachusetts plan but I am willing, with Stabile, to give it the benefit of the doubt as a generally well-conceived step to try to solve a difficult problem.
One issue that Stabile and so many others writing on this subject fail to take into account is distinguishing between necessary and elective health care. This is a critical issue that simply must be a part of our ongoing debate about health coverage. She rightly insists that Catholic social teaching views health care as a right. But does that right imply a monthly medical check-up? An annual one? Plastic surgery to make wounds less noticeable? Botox treatments to take the lines out of one’s aging countenance?
Probably we could come to consensus that the last item in that list is not a right. But what about the others? It’s not an easy distinction and there will be a lot of different views about where to draw the line. As soon as we take health care out of the realm of the market (where every person gets just what he is willing to pay for personally), it seems to me that we have to answer not only the question, How is the community going to ensure that everyone receives health care?, but also the question, Which forms of health care will the community pay for? To think that everyone can have every bit of medical treatment he or she wishes is pie-in-the-sky utopianism. Health care is a scarce commodity like anything else, and its distribution at some level must somehow be tied to market pricing.
I think we need to stop thinking about health care as a special case and think about it more as just another basic good necessary for human wellbeing. Take nourishment as an example. No one (or nearly no one) advocates that any person be left to starve to death. And no (or nearly no one) argues that everyone must have access to five-star restaurants. Instead, people take up positions along a spectrum. Some argue that private charity can provide the needed safety net; some insist that government programs are necessary; some say that a mixture of the two is best. But with health care, it seems that many people believe that everyone must be able to afford the equivalent of the five-star restaurant; otherwise there is unconscionable inequity. It’s an impossible goal.