Health care: getting clear on the premises

For the past several days, I've watched the debate at What's Wrong with the World about Obamacare in particular, and the economics of health care in general, with growing frustration. I am frustrated because, to my mind, there's little use in debating such questions without achieving some clarity about what the pertinent moral premises ought to be. So much is, or ought to be, obvious; and many of the participants have indeed expressed their moral premises. But I see no agreement on what it would take to resolve the disagreements at that level, or even an awareness that reaching such an agreement is important. Since I believe it is important, I shall suggest a way of reaching, or attempting to reach, such an agreement.

To that end, the point of departure is the question is how we would reach agreement about formulating the goal of a national health-care policy. Personally, I see the goal as ensuring quality health-care for everyone at a cost the nation can both afford and accept. But making that our goal makes sense only if some level of health care must be treated as a politically enforceable right, not just as a market-priced commodity. Libertarians would not agree that health care should be treated as such a right at all, and non-libertarians do not agree on the extent to which health care should be treated as such a right. So the next question to be addressed is how resolve such disagreements.

I believe that question can and ought to be resolved in contemporary America. To that end, there are two points to consider: what citizens in general actually believe, and how their beliefs need to be modified in order to make possible a political resolution.

Americans in general believe that nobody should be forced, just by their inability to pay, to go without the health care they need for living life with a modicum of human dignity. Both our political policies and our private practices reflect that belief. It follows that Americans in general agree that health care should be treated as a right to some extent. So the libertarians have already lost the debate. The main point of contention is just how that extent can be defined and respected in a manner consistent with what I claimed is the goal: "quality health-care for everyone at a cost the nation can both afford and accept." That is largely a question of politics and economics: specifically, what politically feasible means of delivery would best attain the stated goal. Like most conservatives, I believe that Obamacare would fail miserably on that score, even aside from such intractable moral issues as abortion and euthanasia. But more importantly, not even conservatives can answer the main question without first gaining more clarity about our moral premises.

To that end, the chief moral question is what it means to "live life with a modicum of human dignity." That in turn requires that we get clear about our philosophical anthropology; for we cannot resolve major disagreements about what "a modicum of human dignity" entails without a clear, self-consistent answer to two other questions: what is the human person, and what is the human person for? In a blog post, of course, nobody can answer such questions to the satisfaction of all. What I suggest for general consideration, however, is the proposition that the principles of solidarity and subsidiarity, as expounded in Catholic social teaching, are those best suited to addressing the health-care debate in contemporary America as well as many other domestic-policy debates.

I say so because most Americans would agree that both principles are valid and mutually compatible. I say "would" agree because most Americans are unfamiliar with the terms, and still fewer know the philosophical and theological background for the corresponding concepts, but nonetheless hold beliefs that are fairly close to each. Accordingly, I suggest that the empirical debate about the economics of health care be conducted as a debate about how to balance solidarity and subsidiarity in heath-care provision. What I propose thus far is of course a framework for the debate, not a particular resolution of the debate.

I also propose clarifying that framework in one crucial respect: the morality of rationing. In a world of finite resources, any system of health-care delivery—be it purely market-oriented, socialized, or some hybrid of the two—is going to allocate health-care resources in such a way that some people get less care than they believe they need for living life with a modicum of human dignity. So the rationing question boils down to the question on what basis some people will have to get what they believe to be "the shaft." This seems to be the most morally and politically contentious question in the health-care debate.

Consider the fact that, under the current system, Medicare is variously estimated to spend 40-60%—i.e., roughly half—of its budget on care for people in their last three months of life. No doubt some of that expense is justified; but there should also be no doubt that some of it is not. Much of it is driven by the unwillingness of elderly patients and/or their families to accept the impending fact of death. Unless and until that attitude changes, no large-scale reform of our national health-care system will be both attainable and affordable. People who can afford to buy a bit of time for themselves or their loved ones, however wretched that time may be, should of course have every right to do so. But should their fellow citizens be forced to subsidize such choices? If we're going to achieve national health-care reform at all, the answer has to be no. That is not only a self-consistent but an inevitable way of balancing solidarity and subsidiarity.

This suggests that our national health-care policy should be a hybrid: socialized care for those who cannot pay for what they truly need "for living life with a modicum of human dignity," and free-market solutions for those who can. It is at that point, and only at that point, that debating economics becomes central. But we will not be able to reach that point unless the reality and necessity of rationing is generally accepted. And no such acceptance will become general unless we get our philosophical anthropology—i.e., the basis for solidarity and subsidiarity—straighter than we've got it.

Cross-posted at What's Wrong with the World.

Bad arguments against the Magisterium: Part I

Much has been going on in the Vatican lately, and I plan a series of posts on those events. The one which most interests me is the publication of the Pope's new encyclical Caritas in Veritate. Both Left and Right have, unsurprisingly, been spinning it to suit themselves. I've already given my preliminary take on CV at What's Wrong with the World, and will have more to say after I've pondered CV more carefully than the spin doctors have. To me, though, the most interesting questions raised by any doctrinally significant Roman document concern how they affect the credibility of the claims the Catholic Magisterium makes for itself. I've often discussed those claims before, and I shall resume doing so here.

First, two caveats. I shall not attempt here to produce a good argument for the aforesaid claims. One can only do so much at once; and in any case I do not believe that any article of faith, precisely as such, can be established by an intellectually compelling argument—by which I mean an argument that, in addition to being (deductively or inductively) valid, contains only premises it would be irrational to reject. The best one can do is construct a cumulative-case argument showing that a given article of faith, including and especially one concerning the Magisterium, is logically consistent with the rest, coheres with the larger, pertinent body of received data, and illuminates both. Some have undertaken that project, but it is way beyond the scope of a blog—and given my need to earn a living, way beyond my book-writing capacity at the moment. More within my scope are the bad arguments against the claims the Magisterium makes for itself. There are plenty of those; but in my experience, the most challenging ones boil down to three types. In this post, I shall state and rebut the first type, as I understand it.

The other caveat is that, when I speak of 'the Magisterium', I do not mean only or even primarily the papal magisterium. In Catholic doctrine, certainly, at least the free consent of the pope is indispensable for the purpose of certifying conciliar definitions of dogma as binding on the whole Church; and if he sees fit, the pope can issue a dogmatic definition, and make it binding on the whole Church, unilaterally. But the latter is rare, and rightly so. The more common case is that of "general" councils defining dogmas; and more common still is the case of the episcopal college as a whole, in communion with the papacy, teaching a given doctrine with diachronic consensus from the beginning. According to Lumen Gentium §25, those too are instances of binding and irreformable teaching inasmuch as, when a given teaching is a case of either sort, it is infallibly set forth. So my account is meant to cover the "ordinary and universal" magisterium as well as the "extraordinary" magisterium of councils and popes.

With that caveat understood, I move on to the first of the standard argument-types.

"Those who exercise the Magisterium are men. As such and thus to a man, they are fallible. Many have held and taught propositions which the Magisterium itself has later given up. And some have behaved abominably. Therefore, it is just common sense to insist they be held accountable in making their doctrinal judgments. But if the claims the Magisterium makes for itself are true, no such accountability is needed or called for. Therefore, said claims are incompatible with common sense."

Let's dispose of the easy points first. Since infallibility has never been said to entail impeccability, the fact that some bishops and popes have been quite peccable indeed is irrelevant as an objection to the doctrine that they are infallible under certain conditions. By the same token, infallibility is not a prerogative that men enjoy as men. Since only God is infallible by nature, infallibility is a divine gift to the Church that nobody deserves or can attain by their own efforts. Such a gift is also negative rather than positive: it does not entail that the irreformable pronouncements of the Magisterium are divinely inspired, or opportune, or even particularly well-formulated; it entails only that the Magisterium will never bind the Church definitively to a statement that is false.

With that out of the way, consider the objector's premise that "many have held and taught propositions which the Magisterium itself has later given up." That is true. But its relevance is too limited to serve the objectors' purpose. For the Magisterium has never claimed to be protected from error in everything it teaches; it claims infallibility only under certain conditions. The question the critics need to consider is whether the Magisterium has ever revoked or contradicted any doctrine which it understood to be irreformable because it met the conditions for having been infallibly taught; if there is even one such a case, that would be a decisive counterexample to the claims the Magisterium makes for itself.

Now by tradition, irreformability is said to apply only to what certain doctrines actually say, to what logically follows therefrom, and to the received understanding coextensive with those. As a Catholic, I am committed to holding that there is no case in which the Magisterium has repudiated such a doctrine. So I do—and I usually find that people concede that point. One can only generate a counter-example if one supposes that all doctrines must be interpreted to mean not merely what they say, and what logically follows therefrom, and how they are received as such, but also what some who exercise the Magisterium have meant beyond all that. For some such "interpretations" have indeed been revoked or contradicted; a good example is the historical development of the dogma extra ecclesiam nulla salus. But interpretations of doctrines which are not logically equivalent to what the doctrines actually say have never been said to be irreformable. Hence the cases in which such interpretations have been revoked or contradicted are not counterexamples to what the Magisterium claims.

But that's hardly the end of the objection. The most common reply to the defense just offered is to say that it renders the Catholic system plausible only as a self-enclosed "hermeneutical circle" without giving one a cogent reason to enter into the circle. That statement is true. But it has force as an objection only if the defense in question be offered as sufficient reason to accept the claims the Magisterium makes for itself: so offered, the "defense" would patently beg the question. But the aim of such a defense is more modest. It indicates that the Magisterium meets one condition it must meet if it is to be credible: that of self-consistency. It is surely necessary and worthwhile to show, for the sake of defending a given body of propositions, that it is internally consistent.

A bigger problem with the objection is how its advocates are supposed to answer two questions which, taken together, are by no means easy to answer: how is such "accountability" to be satisfactorily manifested, and in whose estimation?

Take the latter question first. If it be claimed that the Magisterium must be accountable to "the whole Church's" estimation of its claims, who relevantly counts as members of such a collectivity? All the baptized? Notoriously, that large group agrees on very little theologically, never mind the Magisterium; hardly anybody suggests that the sure reception of the deposit of faith rest on such a thin reed. The pastors of the faithful? Very well: the pastors of which church(es) other than the Catholic—and how can one answer that without begging the question? The consensus of scholars? Such a thing exists only concerning the question what, in many cases, the data are; but there is no consensus about the theological significance of such data, or at least none secure and perduring enough to make such a consensus a criterion of scholarly orthodoxy to which the Magisterium can, let alone should, be held "accountable." Nor, given the nature of scholars, is such a consensus likely to develop.

Which brings me to the first question. The most common and rhetorically convenient way of insisting that the Magisterium be accountable is to cite Scripture and Tradition as "sources" of divine revelation to which the Magisterium must be subordinate. Of course the Magisterium insists that it is subordinate to Scripture and Tradition (cf. Dei Verbum §8-§10); but it also claims that it is the sole "authentic" interpreter thereof. This does not mean that others cannot correctly interpret Scripture and/or Tradition; others often do, and the Magisterium often considers that. It means that only the Magisterium is divinely authorized to make any particular interpretation binding on all the faithful, and thus an article of faith as distinct from a sound opinion. To this, the objectors typically reply that Catholicism's rule of faith is, in effect, solum Magisterium rather than Scripture alone or in combination with Tradition: for the orthodox Catholic, Scripture and/or Tradition mean only what the Magisterium says they mean. And that in turn is supposed to mean that the Magisterium is unaccountable. But that objection is rather easily answered.

The Magisterium is limited by, and thus "accountable to," Scripture and Tradition in several ways. First, the latter circumscribe the subject-matter of the Magisterium's competence. The Magisterium does not claim competence to pronounce on matters other than the deposit of faith and morals, and which thus are not already addressed by either Scripture or Tradition. The latter are understood to contain the entire deposit of faith given "once for all to the holy ones." Second, and accordingly, the Magisterium does not see its "authentic" interpretations of Scripture and Tradition as supplying any information that Scripture and Tradition do not somehow and already contain. What the Magisterium does claim is that it is the normative heir to Christ's promise to send the Holy Spirit to "lead you into all truth" (John 16:13). That indeed is why we have Scripture, understood as the Old and New Testament together. The writings comprising the New Testament are products of the Church: they rely on Tradition for their very composition and content, and it is by Tradition at later stages that the authorities of the Church determined that only such-and-such writings, not others, are to be regarded as divinely inspired and inerrant. Only the ignorant dispute that. Accordingly, and third, on the Catholic understanding there can be no separating Scripture, Tradition, and the definitive judgments of the Magisterium. Both historically and in principle, the three stand or fall together as means of transmitting divine revelation; for according to the Magisterium, Scripture and Tradition together present "the Church"—i.e., the authorities of the Church—as the authentic interpreter of the truth handed on from the Apostles. Finally, and in the way indicated above, the Magisterium is bound to what it has definitively taught in the past as binding interpretations of Scripture and/or Tradition. Taken together, the four considerations above leave us with much more than solum Magisterium. Even by its own criteria, the Magisterium is far from free to say whatever it likes; and much of what it does say, by way of adjudicating disputes about interpreting Scripture and Tradition, depends on discernment of the sensus fidelium manifest through a variety of means.

That ought to be the end of the objection, but alas it is not. In my long experience debating this matter with educated folk of all three major Christian traditions, as well as of none at all, I have generally found that they want the impossible. Thus they argue that the Catholic doctrine of the Magisterium is credible only if it can be established on the basis of a rationally compelling argument from authorities independent of itself. But of course, if there were such independent authorities, then the Magisterium's understanding of its own relation to Scripture and Tradition would be unjustifiable. So if the present form of the objection were sound, the Magisterium would be justifiable only if unnecessary—and if it's unnecessary, then its claims for itself are false. Nifty. To be sure, calling out such a "heads-I-win-tails-you-lose" argument for what it is does not establish the Magisterium's credibility; but it does show that what the objectors require in this case would logically entail its suicide. The polite way of characterizing that would be to say that it begs the question.

That said, I am far from done with bad types of argument against the Magisterium. Another common one is that the Catholic, as an adherent of the Magisterium, is in no better an epistemic position than even the Protestant adherent of sola scriptura. Rebutting that argument will be the topic of my next post.

Independence Day

Paul Cella and Lydia McGrew have posted excellent observations for today at W4. I have only one thing to add.

As Lydia implied, the United States remains the West's last best hope for preserving what makes Western civilization worth preserving. That would be recognizing, in Jefferson's phrase, "the laws of nature and of nature's God." What Peter Berger termed "ethical monotheism" is the basis for recognizing certain human rights as inherent and inalienable rather than bestowed by cultural evolution or political fiat. That recognition is essential for the preservation of liberty without sectarianism. We have struck a fine balance between ethical monotheism and sectarianism. As we confront the twin challenges of secular liberalism and jihad, let us not imperil our liberty by losing that balance.

That group thing again

Many of my readers know that I used to be a co-author of the blog Pontifications, founded and edited by Fr. Al Kimel, which shut down in the summer of 2007. I loved that role for many reasons, one of which was that writing for a well-trafficked group blog afforded me the kind of visibility I need if I am to regain the professional status I once had. Last October, I founded Philosophia Perennis as a group blog for Catholic philosophers; yet, for spiritual reasons, I found I had to reduce my blogging in general for the next several months, posting occasionally only here. For the last few months I've been able to pick up my pace, mainly here, while making a few major posts at PP. Now, by divine providence, I have been accepted to become a co-author at the conservative-Christian blog What's Wrong with the World, which gets several times the traffic of either this blog or PP. So, for the time being, my posting will be mostly there, with cross-posts here and at PP.

My first major post at W4 went up this evening and is entitled "ID, the God of the gaps, and Metaphysics." I will cross-post it at PP tomorrow.