Earlier this week, Francis Cardinal George of the archdiocese of Chicago sent a message to parishioners in Barack Obama’s home town that imposition of the HHS mandate to fund and facilitate contraception, abortifacients, and sterilization would force the Catholic Church to close its hospitals, clinics, schools, and all other organizations that would otherwise have to comply. “Two Lents from now,” Cardinal George warned, “unless something changes, the page [listing Catholic organizations] will be blank.” At the time, some commenters wrote that this has been Obama’s plan all along — to force religious charities out of business to make people more dependent on government. Others, including myself, figure that Obama just thinks the bishops are bluffing, and wants to engage in a high-stakes bout of brinksmanship to force them to kneel to secular authority over doctrine.
But how high are those stakes? In my column for The Fiscal Times today, I did a little research just on Catholic hospitals and their significance in American health care. As it turns out, this bet involved nearly $100 billion in annual costs and about one-seventh of all hospital beds in the US — and that’s not all:
The Catholic Church has perhaps the most extensive private health-care delivery system in the nation. It operates 12.6 percent of hospitals in the U.S., according to the Catholic Health Association of the U.S., accounting for 15.6 percent of all admissions and 14.5 percent of all hospital expenses, a total for Catholic hospitals in 2010 of $98.6 billion. Whom do these hospitals serve? Catholic hospitals handle more than their share of Medicare (16.6 percent) and Medicaid (13.65) discharges, meaning that more than one in six seniors and disabled patients get attention from these hospitals, and more than one in every eight low-income patients as well. Almost a third (32 percent) of these hospitals are located in rural areas, where patients usually have few other options for care.
Compared to their competition, Catholic hospitals take a leading role in providing less-profitable services to patients. They lead the sector in breast cancer screenings, nutrition programs, trauma, geriatric services, and social work. In most of these areas, other non-profits come close, but hospitals run by state and local governments fall significantly off the pace. Where patients have trouble paying for care, Catholic hospitals cover more of the costs. For instance, Catholic Health Services in Florida provides free care to families below 200 percent of federal poverty line, accepting Medicaid reimbursements as payment in full, and caps costs at 20 percent of household income for families that fall between 200 percent and 400 percent of the federal poverty line.
Imagine the impact if these hospitals shut down, discounting the other 400-plus health centers and 1,500 specialized homes that the Catholic Church operates as part of its mission that would also disappear. Thanks to the economic models of these hospitals, no one will rush to buy them. One in six patients in the current system would have to vie for service in the remaining system, which would have to absorb almost $100 billion in costs each year to treat them. Over 120,000 beds would disappear from an already-stressed system.
The poor and working class families that get assistance from Catholic benefactors would end up having to pay more for their care than they do under the current system. Rural patients would have to travel farther for medical care, and services like social work and breast-cancer screenings would fall to the less-efficient government-run institutions. That would not only impact the poor and working class patients, but would create much longer wait times for everyone else in the system. Finally, over a half-million people employed by Catholic hospitals now would lose their jobs almost overnight, which would have a big impact on the economy as well as on health care.
Of course, it’s not just hospitals. The Catholic Church runs over 7500 primary and secondary education schools in the US (where over a third of students are non-Catholics), educating more than 2.5 million students. Thanks to a near-blanket moratorium on vouchers, taxpayer money doesn’t get used in teaching these students in a system that has a 99% graduation rate and a 97% success rate at placing students in college. Based on an average student cost of $8000 in public schools, Catholic schools save taxpayers about $20 billion dollars a year.
Perhaps with schools, though, the notion that Obama wants to crowd out private enterprise in favor of the public sector makes more sense. How about charities? Catholic Charities would also have to close its doors if the bishops refuse to comply with the HHS mandate. In 2003, the latest data available, they provided emergency food services to 6.5 million people, temporary shelter to over 200,000 people, and a range of other assistance to another 1.5 million people, including assistance in clothing, finances, utilities, and even medication. Those efforts would disappear overnight, along with schools and hospitals.
Surely, some will think, the bishops are just bluffing, and won’t purposefully create such a social disaster. Perhaps, but consider the teachings of St. Ignatius of Loyola, the founder of the Jesuit order and a deeply influential figure in Catholic thinking:
Some may doubt that the bishops would create this kind of havoc and disruption, and perhaps President Obama believes Cardinal George and the U.S. Conference of Catholic Bishops to be bluffing. However, Obama may want to read St. Ignatius of Loyola, the founder of the Jesuits, and his Principle and Foundation of faith, which informs Catholics on the priority of salvation. The first task of mankind, according to St. Ignatius, is to serve God and “save his soul,” and “other things on the face of the earth” should be used only as long as they serve that purpose. When they become a hindrance to salvation, St. Ignatius warns to “rid himself of them.”
If the HHS mandate forces the Catholic Church to fund and facilitate access to products and services they believe imperil souls, they will apply Ignatius’ principle and stick with salvation — which is the entire raison d’être of any religious organization. The implications for public-sector spending and services is massive, and Obama may be pushing all in with only a pair of jacks. Don’t count on the bishops to blink first.