Managed care: an ethical reflection

Christian Century, August 12, 1998 by Edmund D. Pellegrino

Helping, healing, caring and curing were so much a part of the life of Jesus that no Christians can absolve themselves of responsibility for the health care system their nation adopts. All Christians share responsibility for working toward a societal ethic of care that is imbued with the spirit of Christ's love for the sick. Without the support of the entire Christian community, it will be ever more difficult for Christian health professionals to resist the injustices of commercialization.

In the end, the kind of health care we tolerate reflects the kind of society we are or want to be. The bedside reflects back to all of us where our treasure lies. While physicians, nurses and administrators have the immediate responsibility, they can only operate within the parameters society sets for them. If our system of "care" denies care, none of us can deny complicity. If the health care system Christians tolerate is itself a violation of Christian teaching on care of the sick, Christians cannot avoid complicity.

Managed care and its commercialization are part of the larger question of a national health care system replete with ethical incongruities. On the one hand, American medicine is, for those who can afford it, the most proficient care available; the U.S. economy at the moment is better than it has been for a very long time; U.S. institutions and health care personnel are in sufficient supply. On the other hand, these resources are denied to the poor and the underinsured, and resources are increasingly more difficult for the middle class to get without harassment. In the face of plenty, U.S. medicine is frantically cutting costs and downsizing in imitation of American business and the ideology of markets and profits. How does all of this measure against the Christian ethic of concern for the sick and the poor?

Christians of all denominations must ask themselves some very serious questions--especially those Christians who have accommodated to managed care as "inevitable" or excused themselves by blaming "the system," or profiting periodically by cost-shaving. This is not the place to outline how Christians, joined to others of good will and social conscience, can mobilize to fashion a just and humane health care apparatus. Tough resource allocation decisions may be necessary, but before accepting rationing as inevitable there are questions those of us living in the U.S. must ask ourselves:

Are we practicing rational, effective medicine that reduces unnecessary care to a minimum? Have we counted the administrative costs of our complicated, multi-insurer system? What are the nondollar costs in harassment, in delays of care, in grievance and appeal procedures, in confusion and misleading advertisements? Have we exhausted all measures short of rationing? Have we examined our enormous discretionary expenditures on amusement, spectator sports, etc? Have we considered the obligation of Christians to make sacrifices of some of their excess to provide for the needs of the less fortunate? Have all Christians, and especially Roman Catholics who have the largest system of health care institutions in the U.S., asked how they can cooperate and merge their resources to provide care that is not profit-oriented but, rather, based on Christian ethical principles?