On May 21, 2010, the United States Conference of Catholic Bishops released a media statement which sought to identify the way forward for Catholic engagement in the healthcare debate in light of the passage of healthcare legislation. The USCCB stresses that at the core of the bishops’ advocacy throughout the debate was a concern for three principles: (1) the protection of innocent life from the use of lethal force from conception to natural death; (2) the maintenance of conscience protections; and (3) the realization of universal access to healthcare for all, especially the poor and migrants. These, the USCCB stresses, will remain at the forefront of its contributions to the healthcare discussion. The USCCB consequently asks America’s munity e together in defense of human life, rights of conscience and fairness to immigrants so we will have a health care system that truly respects the life, dignity, health and consciences of all.”

All this is well and good. Unfortunately, there is no mention in this text of a concern voiced by a good number of Catholic bishops throughout the debate: an assessment of whether the recent healthcare legislation can truly be said to reflect adherence to the principle of subsidiarity. For anyone who needs a reminder of what this principle means, here’s what the Catechism of the Catholic Church says (CCC 1883):

Excessive intervention by the state can threaten personal freedom and initiative. The teaching of the Church has elaborated the principle of subsidiarity, according to which munity of a higher order should not interfere in the internal life of munity of a lower order, depriving the latter of its functions, but rather should support it in case of need and help to co- ordinate its activity with the activities of the rest of society, always with a view to mon good’.

It’s important to note that subsidiarity is not an “anti-government” or “anti-state” principle. Indeed it affirms that there is a role for government because (1) there are some things that only governments can and should do and (2) sometimes the state does need to intervene when munities are unable to cope temporarily with their particular responsibilities. Nor, it should be added, does subsidiarity always translate into the very same policy-positions, precisely because some elements of mon good are in a constant state of flux.

That said, it’s puzzling to say the least that the USCCB, both during and after the healthcare debate, is not in the habit of referencing subsidiarity as a vital principle for Catholics to reflect upon as they consider the implications of what few now question amounts to the massive expansion of Federal government control over healthcare in the United States. Contrary to what some Catholics imagine (especially the professional social justice activists who dissent from fundamental church dogmas and doctrines while casting anathemas against anyone who disagrees with their own prudential judgments on any number of economic issues), striving to widen access to healthcare need not automatically translate into the state assuming a dominant role.

In their important joint pastoral letter of August 22, 2009, Archbishop Joseph F. Naumann of Kansas City, Kansas, and Bishop Robert W. Finn of Kansas City-St. Joseph listed subsidiarity as a vital principle upon which Catholics should reflect when thinking about health care reform. They even described subsidiarity as “the preamble to the Work of Reform”. Elsewhere in the document the bishops spelt out what this means for healthcare reform:

The right of every individual to access health care does not necessarily suppose an obligation on the part of the government to provide it. Yet in our American culture, Catholic teaching about the ‘right’ to healthcare is sometimes confused with the structures of ‘entitlement.’ The teaching of the Universal Church has never been to suggest a government socialization of medical services. Rather, the Church has asserted the rights of every individual to have access to those things most necessary for sustaining and caring for human life, while at the same time insisting on the personal responsibility of each individual to care properly for his or her own health.

During the healthcare debate, a considerable number of Catholic bishops expressed similar views. Bishops Walker Nickless of Sioux City, for example, was very specific:

… the Catholic Church does not teach that ‘health care’ as such, without distinction, is a natural right. The ‘natural right’ of health care is the divine bounty of food, water, and air without which all of us quickly die. This es from God directly. None of us own it, and none of us can morally withhold it from others. The remainder of health care is a political, not a natural, right, because es from our human efforts, creativity, passion. As a political right, health care should be apportioned according to need, not ability to pay or to benefit from the care. We reject the rationing of care. Those who are sickest should get the most care, regardless of age, status, or wealth. But how to do this is not self-evident. The decisions that we must collectively make about how to administer health care therefore fall under ‘prudential judgment.’ [I]n that category of prudential judgment, the Catholic Church does not teach that government should directly provide health care. Unlike a prudential concern like national defense, for which government monopolization is objectively good – it both limits violence overall and prevents the obvious abuses to which private armies are susceptible – health care should not be subject to federal monopolization.

Preserving patient choice (through a flourishing private sector) is the only way to prevent a health care monopoly from denying care arbitrarily, as we learned from HMOs in the recent past. While a government monopoly would not be motivated by profit, it would be motivated by such bureaucratic standards as quotas and defined ‘best procedures,’ which are equally beyond the influence of most citizens. The proper role of the government is to regulate the private sector, in order to foster petition and to curtail abuses. Therefore any legislation that undermines the viability of the private sector is suspect. Private, religious hospitals and nursing homes, in particular, should be protected, because these are the ones most vigorously offering actual health care to the poorest of the poor.

These and similar views expressed by many bishops were dismissed as “libertarian” by whatever’s left these days of the Catholic left – as if only libertarians could possibly believe that limiting government power and encouraging private sector and civil society solutions to genuine social and economic problems are good things.

The truth, however, is that the USCCB’s professional social justice bureaucrats have a long history of playing down or even ignoring the implications of the principle of subsidiarity. Subsidiarity isn’t, for example, even listed as one of the “Themes of Catholic Teaching” on the Justice, Peace and Development section of the USCCB’s website. It is long past the time for that to change.