EDITORIAL Catholic health care poised between mission
and money
Catholic health care is in the spotlight. The most recent evidence
is a front-page article in The Wall Street Journal on Jan. 7 with the
headline, Nuns zeal for profits shapes hospital chain, wins Wall
Street fans. Critics are raising questions about the practices of
hospitals owned by the Daughters of Charity, cynically nicknamed
Daughters of Currency.
Specific issues highlighted by the Journal include a $2
billion reserve accumulated by the Daughters of Charity National Health System,
a chain of 49 hospitals in 12 states that boasts $6 billion in annual
revenue.
No margin, no mission, says Sr. Irene Kraus, former
president of the Daughters system.
The Journal article comes at a time when interest in Catholic
health care is already high. Controversy over the sale of St. Louis University
Hospital to Tenet Health Care, a for-profit enterprise, has provoked discussion
nationally over whether Catholic health care is distinctively different.
Officials of the Catholic Health Association have answered with a resounding
yes (NCR, Nov. 17).
Yet, it would seem that if such a difference truly existed it
would be obvious. The Catholic Health Association has been unable to provide
NCR with data showing that care for indigent people at Catholic
institutions differs substantially from care offered by non-Catholic, or even
for-profit, institutions. The Wall Street Journal cites analysts who
note that key Daughters hospitals are located not in inner-city
areas but in more affluent suburbs and others who point out that the
amount of net patient revenue that Daughters facilities derive from
Medicaid is well below the national average -- 6 to 8 percent compared to 14
percent or more.
Institutions like those belonging to the Daughters need not
apologize for financial acumen. Three years ago, NCR published a special
report on the Catholic health care industry, noting that change and turmoil had
forced it to take on all the attributes of a competitive industry and to become
as cost conscious and dollar-driven as its secular counterparts.
In todays environment, hospitals can hardly care for paying
patients let alone the poor if they are bleeding red ink. But if Catholics are
going to put their names and resources behind health care and promote a healing
ministry as rooted in Jesus concern for the sick and the poor, then
isnt it reasonable to expect that the care they deliver be distinctively
different from that of other public and private institutions? Isnt it
reasonable to expect that the differences would be obvious to all?
Yet in many cases, distinctiveness is blurred. Even if gospel
values -- not least of which is a preferential option for the poor -- are
driving institutions from within, those values are obscured by the public face
of megasystems that rival the largest U.S. for-profit corporations in financial
scale.
We can hear predictable voices suggesting that The Wall Street
Journal article is just another example of the secular media
putting the church in a bad light. So its worth noting that questions
about Catholic health care are also being asked from within.
A radical call for a distinctive witness -- a national health care
network to deliver services in accordance with principles of Catholic
social justice -- came quietly last spring from a distinguished source:
Dr. Edmund D. Pellegrino, John Carroll Professor of Medicine and Medical Ethics
at Georgetown University and former director of its Center for Clinical
Bioethics.
Writing in the March 1997 issue of Christian Bioethics,
Pellegrino calls for thorough scrutiny of managed care -- managed care in one
form or another being all but synonymous with health care delivery today. He
asserts that, while the concept of managed care is morally neutral,
the current practice is nearly always morally deficient from a Christian point
of view.
The most fundamental of a variety of ethical issues driving that
assertion: Managed care stands to put cost containment or profit-taking ahead
of needs of patients. As antidote, he proposes uniting Catholic hospitals into
a single system, a national network that would operate from a gospel vision so
attractive, so morally compelling, that its distinctiveness would be
unquestioned.
Such a system, however unlikely, could turn formidable financial
power into formidable moral power, Pellegrino reasons. Care in such a system
would indeed be managed --- managed, however, with the focus on
making health care accessible to all in society as a fundamental human right
rather than on cost containment and the bottom line.
When Catholic officials decried the transfer of a Catholic
hospital in St. Louis to a for-profit group, they pointed to an inherent
conflict between serving the sick and pleasing investors. Yet, Pellegrino
notes, Catholic hospitals, though legally not for profit, are afflicted by
similar contradictions. At some point, a quest for margin and huge reserves
cripples the mission to serve the indigent and renders moot the debate over how
not-for-profit health care is morally superior to for-profit.
Even if no margin, no mission were an appropriate
slogan, more margin, more mission would be morally dubious at
best.
If we were given to slogans, we would suggest an alternative to
no margin, no mission. We would urge leaders of Catholic health
care, so given of late to laying up treasures: Seek prophets before profits.
Let more voices like Pellegrinos enter the debate.
At the very least, leaders of Catholic health care should strive
to create an environment in which no one, not even the secular media, would
dream of calling the Daughters of Charity by any other than their real name.
National Catholic Reporter, January 23,
1998
|