So, St. Blog’s leading light from the Most Catholic Kingdom of Spain pointed me to an interesting comment by the Holy Father on Catholic healthcare that’s found here. In short, the Holy Father wants Catholic healthcare to be more Catholic – to help people who are in need and to minister to the whole person, rather than just to their medical conditions. I saw another article that seems to have disappeared in which mention is made of emphasizing authentic teaching on redemptive suffering.

I’ve worked in the healthcare industry in the US for almost 9 years, first at a secular non-profit, then in for-profit, then in a Catholic organization and now, again, in the for-profit role. I hope to return to Catholic healthcare after finishing my MBA next year. (And, in case you thought you had a grip on just how odd of a duck I am, the USCCB’s Ethical and Religious Directives for Healthcare Facilities – a document that is to be binding on all Catholic healthcare facilities in the US – played a role in my conversion to Catholicism.) There are some serious problems facing Catholic healthcare in the US. (While I’m not qualified to address Catholic healthcare elsewhere, I wouldn’t be surprised if some of the same concerns apply.)

Many of the problems facing Catholic healthcare probably tie in quite strongly with problems facing church governance as a whole as described in Amy Welborn’s latest
tour-de-force. They aren’t easy to describe concisely.

One thing I’ve noticed in Catholic healthcare is a much lower turnover of management, coupled with a trend of very slow career advancement. Many would hail this as a good thing, and it can have some advantanges. It does not reward innovation, as the potential reward for innovation is very small.

The high premium placed on consensus (or what is misunderstood to be “consensus”) as the preferred form of decision-making compounds this problem and introduces the heightened risk in proposing innovations in Catholic healthcare. The following example, hard as it is to believe, is factual. I am grateful that it isn’t the norm, but am alarmed that it ever could have happened. One day in early 2000, about two dozen rather senior managers for a Catholic healthcare entity were to have a day-long meeting on an issue that was both important to the long-term position of the organization and that had a somewhat high degree of time-sensitivity. The first 45 minutes of the meeting were spent on one issue: when to break for lunch. None of the two dozen managers dared to be enough of a grown-up to say something like “We have bigger issues in front of us. Let’s start on them now and break for lunch when we get to a good pause in the discussion.” So eighteen hours (45 minutes times 24 managers) went into the decision of when to have lunch. So not only is there little reward for innovation, with this type of decision-making structure, there’s a high cost to proposing new ideas.

The reluctance to make waves extends beyond the boundaries of the organization. Most Catholic healthcare facilities in the US receive operating income from (in descending order):
Government-funded programs (medicare and Medicaid, the latter program using distinctive brand names in some states);
Private insurance (usually health insurance, but also auto insurance and, for most practical purposes, workers’ compensation – though that is a governmental program in some states);
Charitable contributions; and
Patient out-of-pocket payments.

Capital funds are usually obtained by some combination of
Federal grants and loans;
issuing bonds; or
charitable contributions (yet again!).

There’s considerable interaction between the various funding sources too. For example, most contracts with private health insurance require a provider to be an active provider in good standing with medicare.

Many Catholic healthcare institutions now have permanent relationships based on “formal and material cooperation” with non-Catholic entities, as was anticipated by the Directives. Some of these are structured as joint ventures, others as entirely new non-profit corporations. Here in Denver, one major Catholic hospital system works jointly with Lutheran Hospital and the other with a few Seventh-Day Adventist hospitals --- despite the SDA’s well-publicized local leaflet campaign just 9 years ago accusing the Holy Father of being the antichrist! They two Catholic hospital systems, though, don’t work with each other.

The desire to please the funding sources and outside “cooperators” often leads Catholic healthcare institutions to water down their Catholicism. We’ve all seen horrific examples like this, even though it doesn’t involve an outside “cooperator”, the push to this type of behavior becomes even stronger when “cooperators” are involved.

Propaganda campaigns like this (trying to scare people into believing that, if Catholic hospitals aren’t forced to perform abortions, then the entire pro-abortion cause is destroyed) also seem to be effective in making Catholic hospitals reluctant to uphold Catholic principles in a clear public fashion.

The secularization of society in general also plays a part. When I worked for a Catholic organization there was little, other than the crucifixes in meeting rooms, to remind one that this wasn’t just any non-profit healthcare business. People were reluctant to discuss patently Catholic themes since discussion of religion has become more taboo than discussion of sex. IIRC, the organization’s stated values (that were posted everywhere) were: Collaboration, Compassion, Dignity, Justice and Stewardship. Of those only “stewardship” usually carries an exclusively religious connotation, but even there the concept isn’t specifically Christian. While the words used can represent aspects of Faith, they aren’t particularly explicit. (How about using words like “Ministry” or “Sacraments” in the core values?)

So the first thing that Catholic healthcare needs is the confidence to be openly Catholic. We need to stand up with the Apostle and say, “I am not ashamed of the Gospel”. That doesn’t mean a long procession of professed religious in habits chanting Latin antiphons up and down the corridors (though I’d rather like that!), it means discussing and living healthcare as “the continuation of the healing ministry of Jesus” as the Directives charge us. It means emphasizing pastoral care – even when that pastoral care of necessity can’t come directly from a priest. (I was delighted that in my September hospitalization, I heard prayers over the loudspeaker system a few minutes before going into surgery. That sort of thing doesn’t happen quite often enough.)

It also means being willing to face the consequences of being a Christian. For example, if a state were to require all of its medicaid hospitals to perform abortions, that hospital would have to be willing to forego medicaid patients.

The next necessary thing is the combination of greater flexibility (in changing the organization) and stronger leadership. The ideal of collaboration is appealing, but its reality is too often enormously dysfunctional. Take a medical example: if there’s one surgeon with a couple of assistants in the operating room, the operation is conducted quickly and efficiently. Things could go wrong, but the process is as simple as possible. If, though, there are multiple surgeons, the operation takes more time, there are more chances for things to go wrong. The surgeons can focus more on their disagreements than on the patient. There’s something to be said for being decisive – even at the expense of “collaboration”.

A group of smart and dedicated people need to find a way to increase Catholic hospitals’ charity care participation. There are many complicating factors in terms of medicaid regulations (in many states), Hill-Burton grants and loans and bond indentures. Working with your local Catholic hospital to resolve those issues is a great opportunity for Catholic attorneys to do something to help the neediest in our society.

Most challenging is long-term care of the incapacitated elderly. This is unimaginably expensive. It’s difficult physically and emotionally. The need is immense. We bear responsibility to care for those who can’t care for themselves. Too often the care that commercial providers give is simply custodial care of the body. These people have spiritual needs too! As the years roll on, there are more and more people who, thanks to modern medicine, continue life yet lack the ability to do much of anything for themselves. Perhaps some shuttered educational institutions can become nursing homes. Perhaps there are other solutions that haven’t been imagined yet. We must work on meeting this need.

Despite all the problems I catalog above, there’s still great potential in Catholic healthcare. It is, after all, a continuation of Jesus’ own work. It’s animated by the Holy Spirit. It combines the strongest aspirations and exertions of our hearts, minds and souls. It’s commended at the last judgment.

Duc in altum!