Two Catholic

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Two Catholic Moral Agendas for Healthcare
Reform September 29, 2008
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Two Moral Agendas

• Advocacy Agenda
• Public Conscience Work Agenda

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• 3 new tools of social theology
• Continuum of social sin
• Chronic social sin
• public conscience work

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Personal sin Deliberate, conscious acts of
individuals that harm persons/society
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Social Sin Systemic structural harm to persons/
society
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Continuum of social injustice/sin
Simple Thin Shallow
Complex Dense Deep
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Continuum of Social Reform
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Continuum of Social Injustice

• Episodic Social Injustice
• BBA relief
• SCHIP reauthorization
• Medicare rate reduction

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Continuum of Social Injustice
Episodic Social Injustice
moral pathologies that can be reformed without
reforming culture major structures of society
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Continuum of Social Injustice

• slavery
• suppression of women
• child labor
• Jim Crow
• U.S. health care

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Continuum of Social Injustice
Moral pathology that so saturates structures of
society that it is beyond the realm of routine
political process It involves social movements
resulting from public conscience work.
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Continuum of Social Sin
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U. S. Health Care
Chronic social injustice/sin
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• Historically cobbled-together social structures
  
• incoherent,
• dysfunctional,
• abusive

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widespread and deep human and social suffering

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Despite broad dissatisfaction, it remains deeply
anchored
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U.S. health care belongs to the family of
Chronic Social Injustice
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This injustice is vastly more than the problem of
the uninsured
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A quick reminder
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Colossal human enterprise without vision, goals,
or accountable leadership
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• Fragmentation
• 6 million employers/2000 insurers
• 800 programs for poor children
• 800-page eligibility manual for MediCal

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• Implicit, hence, perverse rationing
• elaborate federal system to treat every failing
  kidney
• LA County jail is U.S. largest mental health
  facility

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Tolerates/invites profiteering at the expense of
the most vulnerable
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Explosive Inflation Disrupts U.S. Health Care
and Economy
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This injustice is vastly more than the problem of
the uninsured
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• I believe that a major reason we have failed for
  a century to reform U.S. health care is because
  we have
• failed to see social sin as a continuum
• we have collapsed social change to the left
  half.

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Continuum of Social Injustice
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Polling Questions
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• It makes sense to see social injustice/sin as a
  continuum.
• strongly disagree 2. disagree
• 3. not sure 4. agree 5. strongly agree

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This continuum helps clarify that there are two
different moral agendas for healthcare reform.
1. strongly disagree 2. disagree 3. not sure
4. agree 5. strongly agree
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The chronic social injustice of child labor
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Concerning reform of U.S. healthcare, I believe
that we are in 2008, where U.S. was with child
labor in late 1800s.
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This stretches over five generations
Milestones of Child Labor Reform
1904 National Child Labor Committeecampaign for
child labor law reform
1876 Working Mens Party proposes banning
employment lt14
1832 New England Unions Condemn child labor
1914 Declaration of Dependence by NCLC
1836 Unions propose state minimum age laws
1881 AFL resolution calling states to ban
lt14 gainful employment
1916 First federal law prohibits goods crossing
state lines if manufacture violates min age laws.
1918 declared unconstitutional by Supreme Court
1836 Mass. Child labor law lt15 attend 3 months
school
1883 NY labor movement successful in prohibiting
cigar making in tenements
1842 Mass. Limits childrens work day to 10 hours
1924 Failed constitutional amendment to give
federal government authority to regulate child
labor
1892 Democratic party adopts plank to ban lt15
factory employment
1938 Federal law regulates ages and
hours for childrens work
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Milestones of Child Labor Reform
1904 National Child Labor Committeecampaign for
child labor law reform
1876 Working Mens Party proposes banning
employment lt14
1832 New England Unions Condemn child labor
1914 Declaration of Dependence by NCLC
1836 Unions propose state minimum age laws
1881 AFL resolution calling states to ban
lt14 gainful employment
1916 First federal law prohibits goods crossing
state lines if manufacture violates min age laws.
1918 declared unconstitutional by Supreme Court
1836 Mass. Child labor law lt15 attend 3 months
school
1883 NY labor movement successful in prohibiting
cigar making in tenements
1842 Mass. Limits childrens work day to 10 hours
1924 Failed constitutional amendment to give
federal government authority to regulate child
labor
1892 Democratic party adopts plank to ban lt15
factory employment
1938 Federal law regulates ages and
hours for childrens work
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Richard Arkwright's employees worked from 6 am to
7 pm Many were as young as six years old. 1,300
of Arkwright's 1,900 workers were children.
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Chronic Social Injustice
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Chronic Social Injustice

• deep, sustained social pathology
• inherited
• no single villain
• no single accountable reformer
• saturates and contains
• mind, heart, imagination of public
• language, symbols of culture
• social institutionslaw, policy, business,
  religion

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Chronic Social Injustice
despite broad discontent no shared
vision clear, specific and powerful enough to
overcome social forces that anchor the status quo
in place
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Polling Questions
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Child labor exemplifies how chronic social
injustice is imbedded in society and why it was
so hard to transform. 1. strongly disagree 2.
disagree 3. not sure 4. agree 5. strongly
agree
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Comparing U.S. health care to child labor as an
instance of social sin helps to clarify why it is
so difficult to reform. 1. strongly disagree
2. disagree 3. not sure 4. agree 5. strongly
agree
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There is Good News
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Reformers can enable and accelerate society
moving beyond Chronic Social Injustice
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1870
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The social movement from chronic social injustice
to reform involves
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Public Conscience Work is the process of
societythe general publicmoving from confused,
conflicted, and vacillating conscience
(mind, affections, imagination, energy of
will) to clear, convinced, purposeful conscience
on a given issue.
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Each of these reforms involved transformation of
the public. Its engine was public conscience
work.
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Every social movement has 2 dimensions, 2
agendas
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ADVOCACY
PCW
Both are essential

• Legislators
• Policy/legislation
• Feasible
• Lobbying
• 6-24 months

• Public
• Culture/conscience
• Not-now feasible
• Dialogue/education
• 6-24 years

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Two Kinds of Change
National Consumers League Labeling Initiative
Samuel Gompers Cigar-Makers Legislation
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Two Kinds of Change
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How do we do the moral work of PCW?
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There is a moral paradigm and method
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Too many reform conversations/ programs start at
the top
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Aaaagh!
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3. Specific programs
2. Necessary infrastructure
1. Foundation
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1. Enable communitys engagement with substance
and priorities of health health care
This is not survey data. This is engagement of
the public with hard, specific choices.
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http//www. Ourhealthcarefuture .org
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2. Enable communitys building a consensual
vision/credo concerning health care
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• Developing a credo is
• further step in clarifying the substance of
  health care
• seeing system as a whole
• identifying the essential elements
• seeing these as parts of a larger whole
• seeing them in relationship to one another

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• Having a credo
• allows us to share our vision with others
• gives us words for celebration and meditation
• reminds us of its scope and complexity
• stands between too little and too much detail
• gives a foundation for next steps, further tools
  

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Credos have been essential to past social
movements.
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Much still to be done.
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Healthcare reform is big, messy, difficult
change. It will move like this.
It will take a lot of work. It will take a lot
of time.
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If this seems too slow, too complex, too arduous
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There is no quick, easy, simple way to transform
culture and social morality.
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If you are planning --for a year, plant
rice --for 10 years, plant a tree --for 100
years, educate Chinese Proverb
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Polling Questions
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Generally in discussing healthcare reform no
distinction is made between advocacy work and a
longer-term reform agenda. 1. strongly
disagree 2. disagree 3. not sure 4. agree 5.
strongly agree
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It is helpful to distinguish between advocacy
work and public conscience work. 1. strongly
disagree 2. disagree 3. not sure 4. agree 5.
strongly agree
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Which of these figures is closest to the ratio of
PCW/advocacy in your institution/system at this
time?
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Which of these figures is closest to the ratio of
PCW/advocacy that you would eventually like to
see?
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Translating this into short-term goals
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Always think in terms of two horizons of reform
Always set advocacy in the context of long-term
transformation
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Long-term frame context Childrens health needs
a system that promotes future generations of
healthy children a system that includes all
children, is managed according to clear goals and
priorities with integrated services and
programs. As we pursue this long-term goal, we
will also rescue as many children as we can from
the current childrens health chaos and be
grateful for our victory and the children who
benefit from our efforts. One significant
success was the Senate vote (68-31) in favor of
SCHIP reauthorization. This followed approval
earlier this week of the House version of
reauthorization legislation, which passed
225-204. Etc.
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August 2009

• 50 of Catholic health executives will have
  taken priority exercise
• 50 of employees in all Catholic facilities will
  have taken priority exercise

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August 2010

• Have developed a one-page credo for U.S. health
  care
• Over 50 of Catholic systems/facilities formal
  adoption
• Over 50 of employees in Catholic health
  facilities

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Public Engagement Module 1 Identifying
Priorities for U.S. Health Care http//www.stjoec
hr.org/?p236  
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  Public Engagement Module 2 Creating a Shared
Vision for the Future of U.S. Health Care       
http//www.stjoechr.org/?p244  
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Public Engagement Module 3 Using a Vision to
Assess a Healthcare Proposal http//www.stjoechr.
org/?p270  
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Snapshot of this presentation
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Reforming U.S. Health Care demands both!
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Thank you
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• Declaration of Dependence by the Children of
  America in Mines and Factories and Workshops
  Assembled 1913
• childhood is
• endowed with certain inherent and inalienable
  rights, among which are
• freedom from toil for daily bread
• right to play and to dream
• right to the normal sleep of the night season
• right to an education,
• opportunity for developing all that there is in
  us of mind and heart.