Catholic pain in health-care fight

In Catholic debates, it always helps to be able to quote the official Catechism of the Catholic Church. Consider, for example, this reference to health care in its chapter on the biblical instruction, "You shall love your neighbor as yourself."

"Life and physical health are precious gifts entrusted to us by God," notes the catechism. "Concern for the health of its citizens requires that society help in the attainment of living-conditions that allow them to grow and reach maturity: food and clothing, housing, health care, basic education, employment and social assistance."

The implication is that governments -- as a matter of social justice -- should help citizens obtain basic health care, according to a letter sent to Congress and the White House by the Domestic Justice and Human Development Committee of the U.S. Conference of Catholic Bishops.

Health care is a human right, not a privilege, argued Bishop William F. Murphy.

"All people need and should have access to comprehensive, quality health care that they can afford, and it should not depend on their stage of life, where or whether they or their parents work, how much they earn, where they live, or where they were born," wrote Murphy.

But there's a problem. The letter stresses that the church will support accessible, affordable, universal health-care reform if it "protects and respects the life and dignity of all people from conception until natural death."

Try telling that to Health and Human Services Secretary Kathleen Sibelius, Speaker of the House Nancy Pelosi, surgeon general nominee Regina Benjamin, Vice President Joe Biden and other Catholics who play strategic roles in Washington, D.C., right now -- while rejecting Catholic teachings on many critical health-care issues.

That's the political reality that the bishops are facing, said Leonard J. Nelson III, a health-care law specialist at the Cumberland School of Law at Samford University.

For the bishops, Catholic teachings on the sanctity of human life are crystal clear, from birth to death, from abortion to euthanasia. Yet the bishops also support health-care for all -- rich and poor. It's getting harder and harder to keep these issues woven together.

"The bishops have been talking about social justice and health care for years and years and now the political climate has changed around them," said Nelson, author of the new book, "Diagnosis Critical: The Urgent Threats Confronting Catholic Health Care."

"The politicians who are in command are ready to pass some kind of health-care reform and they have all kinds of reasons to include abortion in that package. ... That's the fix that the bishops are in."

Meanwhile, he said, leaders of Catholic hospitals and health-care systems will almost certainly face challenges in the near future.

For starters, they could be pressured to join networks and cooperatives that have no reason to follow the bioethical guidelines detailed in the "Ethical and Religious Directives for Catholic Health Care Services" adopted by the U.S. Catholic bishops. It will be hard for Catholic leaders to cooperate with government approved health-care programs and receive government funds while declining to offer services such as contraception, sterilizations and referrals for abortions.

Catholic leaders also know that another life-and-death issue looms in the background. As President Barack Obama noted in a recent New York Times interview, it's impossible to cut or control costs without government efforts to shape health care in the final years of life.

"That's where I think you just get into some very difficult moral issues," said Obama. "But that's also a huge driver of cost, right? I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here."

The Catholic bishops, noted Nelson, have not addressed these end-of-life scenarios -- yet. Will government agencies or advisory boards be given the power to decide whether patients facing Alzheimer's or Parkinson's disease receive expensive medications? Who will decide whether elderly patients have a high enough "quality of life" to continue receiving medical care?

"Productive people in the middle years of life are always going to get the health care they need," said Nelson. "The big threats to the sanctity of life come at the very beginning and at the end. If you're going to defend the church's teachings on health care, you have to focus on those threats. The bishops have to find a way to do that."

That Salvation Army brand

'Tis the season for Salvation Army bells, which means that Major George Hood's telephone has started ringing and it isn't going to stop until Christmas.

People want to know how many dollars are coming in and where they are going and why. Hood is the man with the numbers, since he is the Salvation Army's community relations officer. In the past year, about 3.5 million Army volunteers and about 70,000 employees have helped more than 34 million needy people.

"If you look at those numbers, we're in good shape and it certainly seems like we're going to keep getting stronger," said Hood, hours before being buried in kick-off events for the 2005 red-kettle campaign. "We're thankful for that."

But there is another side of the equation, admitted Hood. As a charity, the Salvation Army is rolling with the punches -- political, cultural and, in recent years, meteorological. But as a church, and as an evangelistic movement, the recent numbers are sobering.

The Army has about 3,500 ordained officers and 113,000 soldiers who have signed the statement of faith called "A Soldier's Covenant," with roughly 35,000 of those being "junior soldiers" under the age of 14.

On a typical Sunday, about 130,000 people attend services in 1316 corps community centers. Three decades ago the Army's four seminaries were full. Today, there are active attempts to find more adults who are willing to serve and the average age of officers -- old and new -- is rising.

"Those numbers have been flat for a number of years and, frankly, that has people talking about our future," said Hood. "Of course, it's still a mystery to a lot of people that we are a church, so we have to keep reminding people of that. People say, 'I had no idea that you're a church, too.' ...

"Are we a church or are we a charity? People have been asking that for ages. The answer, of course, is that we're both."

Meanwhile, the Salvation Army's status as a church has been linked to some nasty headlines in recent years. According to the conservative National Clergy Council, a boycott of the red kettles by gay-rights groups may have contributed to the decision by Target executives to enforce their ban on solicitations outside their stores. Army leaders have insisted that, as a church, they have a right to let their traditional Christian doctrines on sex and marriage shape some employee policies and benefits.

Of course, it's also newsworthy that those bell-ringing volunteers keep greeting shoppers with the controversial words, "Merry Christmas!"

This year, stressed Hood, the Salvation Army has worked out a compromise with Target in which online customers can make some holiday purchases for the needy. However, a few conservative religious groups are targeting Target by reminding their members that the red kettles are alive and well at many other stores.

Hood confirmed that the two-year controversy has not hurt donations. The kettles took in $93 million in 2003, including $9 million at Target stores. After the 2004 Target ban, the kettles took in $103 million, including $17 million at Wal-Mart and Sam's Club locations.

It does appear, said Hood, that the Salvation Army is maintaining its niche in the American imagination. The public has responded well to its pledge to keep "doing the most good to the most people in the most need." The question is whether people understand why the Salvation Army is doing the work that it does. After all, the word "salvation" is still in the brand name.

Army officers are trying new things. Some are working with Harley-Davidson motorcycle clubs to reach out to bikers. Some corps centers are starting "church on wheels" programs with buses that take worship services directly to needy neighborhoods. Others are trying to make Sunday services "more charismatic and more contemporary."

Can the Salvation Army replace brass bands with rock bands?

"People admire what we do, but they would prefer to worship at a Baptist church or a Presbyterian church or that megachurch that's in their neighborhood," said Hood. "They'll donate money to us and volunteer to help, but they don't want to worship with us on Sunday mornings. ...

"We still have people who think that all of our soldiers are off living in a barracks somewhere. People don't understand who we are."