Over the past three weeks, we have seen a firestorm concerning the question of whether not contraceptive methods approved by the FDA are or are not properly a matter of healthcare. Over the past three weeks, we have seen amazing unity within the Catholic community in response to a clear over-reach by the Administration. (A few months ago, I wrote on this disconnect between the administration’s understanding of religious groups and religious identity and the understanding of Catholic identity behind all Catholic social services.) Over the past few weeks, we have seen an escalation in rhetoric from left and right (so prevalent that I would not even know where to begin singling out particular examples). In all of this, the debates have largely centered on religious freedom and reproductive rights – and at the center of the debate on the compromise: MONEY. What has been largely missing from the conversation? Health, Preventative Healthcare, and Health Equity for Women (as well as children and men)
Now I wish to be crystal clear – this is not a post about Contraception or whether or not contraception is properly “healthcare.” I am a Catholic moral theologian whose specialty is social ethics (including social aspects of medical ethics) and I wish to make a case for preventative healthcare and the provision of preventative care without co-pays.
While some plans already covered these services, millions of Americans were previously in health plans that did not. According to the Kaiser Family Foundation’s Employer Health Benefits Survey in 2011, 31% of all workers were covered by plans that expanded their list of covered preventive services due to the Affordable Care Act. The most recent data from the Census Bureau show that 173 million Americans ages 0 to 64 currently have private coverage. Putting these facts together, we estimate that approximately 54 million Americans received expanded coverage of at least some preventive services due to the Affordable Care Act in 2011.
And according to today’s Health Financial Times:
The report on private health insurance coverage also examined the expansion of free preventive services in minority populations. The results showed that an estimated 6.1 million Latinos, 5.5 million Blacks, 2.7 million Asian Americans and 300,000 Native Americans with private insurance received expanded preventive benefits coverage in 2011 as a result of the new healthcare law.
Unlike other forms of insurance, health insurance involves a basic human need. Where auto, home, and life insurance are chosen to protect individuals (and families) from possible catastrophes, accidents, etc (a risk/benefit analysis); health insurance involves a known and certain reality – every human person will need and use healthcare in their lifetime. Will I need surgery? Perhaps but I may not. But it is a certainty that I will need forms of healthcare in my lifetime. Since we are dealing with basic human needs, human dignity and the interdependence of the human family, it is my contention that preventative care is essential to a public health approach that takes seriously that access to medical care and an adequate standard of living is a basic human right
The Universal Declaration of Human Rights (1948) states:
Article 25.(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
In Pacem in terris (often considered the Catholic declaration of human rights), Pope John XXIII echoes this commitment
Beginning our discussion of the rights of the human person, we see that everyone has the right to life, to bodily integrity, and to the means which are suitable for the proper development of life; these are primarily food, clothing, shelter, rest, medical care, and finally the necessary social services.
Therefore a human being also has the right to security in cases of sickness, inability to work, widowhood, old age, unemployment, or in any other case in which one is deprived of the means of subsistence through no fault of one’s own.
Both Catholic social teaching and the international human rights tradition recognize that access to medical care and an adequate standard of living is crucial to the protection of human dignity.
For some time now, the medical community, public health workers and human rights workers have recognized that accomplishing this requires more than treatment of diseases once they occur – it requires preventative healthcare.
So what is preventative health? According to healthcare.gov:
For example, depending on your age, you may have access — at no cost — to preventive services such as:
- Blood pressure, diabetes, and cholesterol tests
- Many cancer screenings, including mammograms and colonoscopies
- Counseling on such topics as quitting smoking, losing weight, eating healthfully, treating depression, and reducing alcohol use
- Routine vaccinations against diseases such as measles, polio, or meningitis
- Flu and pneumonia shots
- Counseling, screening, and vaccines to ensure healthy pregnancies
- Regular well-baby and well-child visits, from birth to age 21
Nowhere is preventative care more essential than in the child health. In particular, well-baby and well-child visits as well as specific care: vaccines, developmental screenings, observations of physical development are all necessary for the well being of individual children, public health and early detection for treatable conditions. These are all a matter of basic human needs, they are guaranteed (not a matter of catastrophic illness) and for low income families with insurance copayments can be excessively burdensome. (without insurance, all non-emergent healthcare is basically out of reach) Quite simply, it is a matter of human dignity and the common good that preventative healthcare for all children be available. (This is integral to the unquestionable commitment of Catholic social teaching and the United States Conference of Catholic Bishops to universal access. –and in order for access to be real – it must be realizable and usable).
Now I began with children because it is easier to clearly see the role of preventative healthcare and a quick glance at a well-baby/well-child schedule will demonstrate that it is regular and frequent not a rare occurrence. So – we turn to the situation of women’s health. Just as it is important that the debate over contraception does not become an attack on the preventative health care provisions as a whole (a slippery reality creeping in as the focus turns to money and “free services” ) We also must not lose sight of women’s health equity and preventative care. Thus, it is important to remember that well-woman visits, mammograms, domestic violence counseling, breastfeeding counseling, gestational diabetes screening are all examples of preventative care for women as well. (A point reiterated by Michael Sean Winter’s recent article “The Politics of the Accommodation”)
A debate about whether or not contraception is properly preventative healthcare is a debate about contraception – it is not a debate about preventative health care, as such. The issue concerning who counts as a religious group for religious exemptions within US laws is an issue concerning religious freedom and the Constitution – it is not a debate about preventative healthcare. Preventative healthcare is geared to the overall well being and dignity of persons. We have long rejected the idea that healthcare is simply a matter of treating existing diseases; it is a matter of caring for persons and communities. As this debate continues, we must be very careful and make sure that significant achievements in access to preventative care and overall public health are not lost in heated rhetoric on all sides.