Catholic Health Care Advocates Papers

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A Catholic Vision for Health Insurance

Chris Kahlenborn, MD

The Proposal:

To form an international non-profit insurance company which would be charitable and yet efficient and would reflect the values inherent in the teachings of the Catholic Church. We arbitrarily call it the Natural Law Insurance Company (NLIC).

Traditional Catholics and other Christians often complain about our insurance companies? We become rightfully angry when our carrier pays for contraception and/or abortion, but what can we do? Many dioceses buy the "best plan for them." In effect, they simply give their money to a large commercial organization that offers little support for the ethical positions that are advocated by the Church, which are indeed the principles from God.

Could organizations such as the Knights of Columbus (KOC), the St. Vincent de Paul Society, the lay Franciscans or other international Catholic lay groups come together to organize a national health insurance company? The KOC already sells life insurance. With a little faith, patience and persistence, they and others should be able to build up an international health insurance company, especially since the base of Catholic lay groups is so vast. Such an endeavor would not be easy and a number of items must be considered: Specific Considerations: In order to provide ethical, equitable and efficient health care, the Natural Law Insurance Company would need to:

1. Remain loyal to the Church's teachings. Merely "contracting out" to a larger insurance company would be self-defeating in the long run as that "larger company" could easily abandon its principles by delegating coverage for such things as contraception, in vitro fertilization etc.
2. Be highly efficient. It would do little to start up an insurance company that cannot compete. Catholics and other Christians will likely choose the most economical plan, so if the Natural Law Insurance Company can't compete, it isn't worth starting.
3. Be international, that is, truly catholic. This would give it a large base with which to work, and should therefore be able to offer rates that would be as low as other companies, or lower. In addition, because of the true catholicity of the Church, if such an insurance company obtained world-wide availability, it would make it very convenient for foreign travelers who get sick to check enter a hospital without wondering if their insurance will cover them.
4. Offer medical savings account plans as one of their options. [Here the individual receives back a large portion of his or her annual premium {if he or she has not endured a significant health problem that year}, and the money is place into a type of retirement account]. Few companies do this (eg, the Golden Rule Insurance Company) and it would seem wise to be one of the few who offer this important option.
5. Make as one of the NLIC by-laws that it would invest its assets only in companies that do not violate the Church's teachings, especially on birth control, in vitro fertilization, and abortion, nor invest in any drug company that is using aborted baby parts in its drug development process. In this way the Natural Law Insurance Company would help to "shape" the thinking of companies who seek to sell stock to insurance companies. [A Catholic mutual fund advisor group that advocates ethical investment is called Pro-Vita Advisors, located in Dayton, OH].

There are two important corollaries that need to be enacted in order for a Catholic Insurance Plan to be a viable option, namely universal accessibility and acceptability.

1. Universal Accessibility: Even if the Natural Law Insurance Company were formed, there is no guarentee that employers would offer it to their employees. That is why we propose the following first corollary: The Business Anti-Monopoly Health Insurance Law.

   Each corporation which provides health insurance to its employees, must allow each respective employee to apply an equally designated health care expenditure to the health insurance plan of his or her choice.

   This type of law could have an enormous effect. Why?

   Many companies offer their employees a limited range of insurance choices. An employee must often choose from one of two or three plans, each of which might pay for contraception and/or abortion. Obviously, if the employee could choose the insurance company of his or her choice, he or she would choose a different plan. This is important, because insurance companies rely on "monopoly power" in the sense that large insurance companies limit the capacity of small businesses to choose other health plans. Small or even large businesses try to economize and often get a "good deal" from one or two health insurance companies. Who can blame them for selecting the most economical plan? But this is nothing more than a subtle form of "monopoly power" on the part of the corporation and leaves the employees without a real choice. An ethical employee is left with no opportunity to choose an insurance plan that supports his or her moral convictions. If the Anti-Monopoly Health Insurance Law were in place, the employee could now buy insurance from NLIC or any other insurance company they chose. Thus the monopoly power of both the insurance companies and business corporations would be countered.

   Interestingly, this law would also have consequences for the various institutions of the Church since they are often large employers and would have to accept this law as it pertains to them. The lay groups of the Church could therefore lobby for such a law with less partiality noting that even Church institutions would be asked to comply with it. This would have many benefits for example it is good for doctors. Many specialists who are both ethical and competent have been "cut out" of the major insurance company's plans. Even if a patient wishes to see his or her doctor, he or she may not be able to because of the type of insurance plan that they have. The Anti-Monopoly Health Insurance Law would give the patient the freedom to choose the health plan of their choice and could therefore go choose a health plan that allowed the patient to see the doctor of his or her choice. The Anti-Monopoly Health Insurance Law is good for doctors, good for patients and good for the Church. The latter is important since the Church could advocate that its people opt for ethical health plans that allow them to see ethical doctors under ethical settings.

2. Universal Acceptability: Even if the above noted measures were in place, individual doctors, medical practices or hospitals could still refuse to accept patients who belonged to the Natural Law Insurance Company. Therefore we propose corollary number 2.

   The Health Provider Anti-Monopoly Insurance LawnnAny health care provider (ie, doctor(s), medical group(s), hospital(s) etc.) must accept the insurance of any patient, so long as the fees paid by the insurance company to the health-care provider are in a competitive range with the average fee paid by the other insurance companies.

   Why is this corollary important? It is important because if the business anti-monopoly law were in effect without this corollary, one might be able to purchase the insurance policy of one's choice from one's company, but that would matter little if the hospital or doctor that you wished to see refused to accept your insurance. For example, if a hospital or particular doctor chooses to accept only two or three types of insurance and you don't have either of those, you are "out of luck" and would have to go to another hospital. Having the option to choose the type of insurance of your choice would do little if you could not use it. Thus the corollary would in effect prevent "monopoly power" on the provider end, and would theoretically keep things open and competitive.

Special Implications: It is the contention of this author that were such a Natural Law Insurance Company to become a reality it could profoundly affect the debate in a number of different areas:

1. Abortion: Could be reduced in as much as it would not be covered by the insurance and there would be less economic incentive in this area.

2. Contraception: Could be reduced in as much as it would not be covered by the insurance and there would be less economic incentive in this area. This would likely result in less sterilizations, less oral contraceptive use etc, which in the long run would likely lead to stronger families.
3. Natural Family Planning: In as much as contraception is not covered, positive pressure will occur for people to use NFP. The NLIC could event give lower rates for couples who have been documented to have completed a reputable NFP course.
4. In-Vitro Fertilization: Will not be covered by plan.

5. Unethical testing would not be covered. For example performing an amniocentesis to find out the genetic type of a child would not be covered unless there was a clear indication that the procedure could help the unborn child. Similarly giving sperm samples in a doctor's office for infertility testing would not be covered in as much as it requires patients to engage in an unethical practice (masturbation) and there are more ethical means to obtain sperm samples.
6. New Drug Development: By ethically investing their funds and by telling drug companies that drugs made by unethical means would be covered as a "last choice" the NLIC would create a moral pressure against both of these items.
7. The use of Embryo Research: Any drug or product whose development included the use of embryo research would not be covered by the plan
8. The Cloning debate: Any drug or product whose development included the use of human cloning research would not be covered by the plan.
9. World Health Care: An international health care plan would be truly catholic and could do much to help improve conditions around the world. The richer countries could use any "profits" to help the people from poorer countries obtain reasonable health care especially if a Catholic hospital exits in that particular third world country.

Chris Kahlenborn, MD kahlenborn@aol.com