A significant consideration in assessing possible responses to these questions should be the application of subsidiarity. Subsidiarity is a fundamental tenet of the Catholic Church’s social doctrine. As Pius XI wrote in Quadragesimo Anno:
Just as it is gravely wrong to take from individuals what they can accomplish by their own initiative and industry and give it to the community, so also it is an injustice and at the same time a grave evil and disturbance of right order to assign to a greater and higher association what lesser and subordinate organizations can do.
The Compendium of the Social Doctrine of the Church cautions that it “is impossible to promote the dignity of the person without showing concern for the family, groups, associations, local territorial realities.”
Then read Tony Blankley’s commentary in today’s Washington Times:
After first squeezing the private insurance policies by undercutting their offerings with subsidized federal health insurance, the government could then further undercut private insurance by denying the insurers tax deductibility unless they complied with federal health service regulations. As only the wealthiest could afford to buy private health insurance if the cost was not deductible, private health insurance companies would be compelled to follow federal benefits and cost regulations.
At that point, almost all Americans would get their health care pursuant to federally regulated systems. Then the president would be able to begin to deliver on his twin pledges to reduce the cost of entitlements and make health care overall contribute to lower deficits.
The federal regulators could merely do what the British regulators do:
• Constantly reduce the compensation of doctors and all other skilled health care providers. (As domestically trained American doctors would become scarcer, more not-as-well-trained foreign doctors would be needed).
• Limit the availability of medical technology. (in Canada, patients have to wait months for MRIs, so those who can do so come to America for immediate diagnostic services.)
• Ration available treatment to fit the federal budget requirements. The universal digitalized health data could be used to justify non-treatment on a cost-benefit basis. For example, hip replacement for older people could be denied because they would be unlikely to live long enough to justify the expense.
Catholic social teaching requires us to consider both solidarity and subsidiarity. We cannot be oblivious to the needs of our neighbors. That is solidarity. However, the problems must be addressed at the lowest effective level. That is subsidiarity. When the federal government is making health decisions from on high, the individual patients are not in focus. It seems reasonable from that distance to ration care based on arbitrary factors like age, mental capacity or disabilities. However, when you are on the ground in the trenches of health care, each individual patient is clearly in focus. Broad regulations that deny care based on age, mental capacity, disabilities or other arbitrary factors deny the dignity to which each individual human is entitled.