It's hard to believe it has been almost three years since the Patient Protection and Affordable Care Act (ACA) passed. Health care reform was long overdue in the U.S. Unfortunately, politics -- and polarization -- stood in the way far too long. But the polarization is still there, as we all know. And one party has placed itself smack dab in the middle, and I would like to call it out: the Catholic church. Back to this after some background.
At long last, the ACA is starting a process to bring the United States into line with countries that provide better health care at lower costs. We are so far behind that curve, particularly in terms of cost, it is frightening. But quality of care is pretty scary, too, in a relative sense. I'm sure you've seen the statistics.
According to a report  from the Commonwealth Fund, "Americans spend twice as much as residents of other developed countries on healthcare, but get lower quality, less efficiency and have the least equitable system." When compared to six other countries -- Canada, Germany, the Netherlands, Australia, New Zealand and the United Kingdom -- the U.S. came in dead last. This is one of dozens of similar reports.
Recent data from UNICEF  shows the United States to be the second worst among 35 developed countries on child poverty, beating Romania. The World Health Organization reports  that the U.S. ranks 50th in the world in maternal mortality. There are 49 countries that do a better job of keeping women alive during childbirth than we do. Doesn't that shock you?
These arguments have been proven over and over and have been among the drivers of health care reform. Thank God it passed, was upheld by the Supreme Court and is being implemented. But we have a long way to go. And yet this enormous overhaul is inextricably tied to the challenges we face in reducing our deficit. One major factor in deficit reduction is reducing long-term health care costs, especially with an increasingly aging population. According to  the Center on Budget and Policy Priorities (CBPP), among many other cost savers, we still need new and innovative practices to figure out how to save health care costs in the long run.
We also need to continue to care for the most vulnerable individuals through safety net programs like Medicaid, Medicare, SNAP (food stamps), child care, Head Start, WIC (Women, Infants and Children nutrition program) and others. Yet these programs are exceedingly vulnerable in a political environment where many policymakers are urging the president to support an additional $4 trillion in deficit reduction. CBPP argues that an additional $4 trillion is not necessary to stabilize our debt over the next decade because of two things. First, measures taken by the administration in 2011 with discretionary spending and caps on spending result in a $1.7 trillion deficit reduction over the next decade. Second, the Congressional Budget Office issued revised economic and budgetary projections last August with a lot of CBO speak that says, in effect, that deficit reduction is much easier to reach over the next decade than they thought before. In other words, according to CBPP (and they are almost always right), we only need about $2 trillion in additional cuts, not the "mythical" $4 billion number that's been floating around since the Simpson-Bowles Commission in December 2010.
So what is the point of all this? It's a long but necessary lead-up to the complexity of the problems we face right now with our economy and the hugely significant role health care reform plays in solving these problems, and the hugely polarizing role the Catholic church has chosen to play in these events, all of which have enormous consequences for the most vulnerable among us.
With all these complexities and the prospect of caring for 30 million uninsured Americans, including 8 million children, the drastic need for revenue in addition to spending cuts to vulnerable populations, the U.S. Conference of Catholic Bishops has focused in on one major issue after the passage of the ACA: the contraception mandate included within the ACA provision that provides free preventive care. Not the Medicaid expansion. Not the increase in care for low-income children. Not increasing the number of pediatricians and primary care providers. Not keeping insurance affordable for low-income families. Not ensuring that insurance companies abide by the law as written. Not reining in long-term system costs so our economy can function better for everyone and provide a more just and stable society.
The church and other religious institutions have argued that a mandate regarding free contraception is the equivalent of an infringement upon the religious freedom of religious institutions. It has used its bully pulpit to push this issue and this issue alone. The Obama administration worked with church leaders and others to fashion a remedy so employers would neither pay nor contract for contraception coverage themselves. This has taken considerable negotiation, resulting in yet another proposed regulation issued Friday . Initial analysis indicates that this time it may be resolved, but that remains to be seen. Owners of businesses who personally oppose contraception say they, too, should not be subject to the mandate. This seems to carry the whole freedom of religion argument a bit too far. As in over a cliff.
That said, I've watched this kind of process unfold between the church and the government, both legislative and the administration, so many times and been involved with it myself as a Senate staffer so many times that I really want to say to the church: What gives? Are you guys for everything? Or just focused on abortion and same-sex marriage? Because this is starting to get ridiculous and downright alienating to those of us who believe in the whole smorgasbord of social justice.
I think it's time for the church to go all in. Or all out.
Here's another thing that really confounds me. Why are the majority of Catholics who believe in free contraception, especially for women who cannot afford it, called the "cafeteria Catholics" when the evidence is overwhelming that no-cost birth control leads to dramatic reductions  in unplanned pregnancies and abortions? Why do we not call the USCCB the cafeteria Catholics because they are cherry-picking abortion and same-sex marriage while they ignore about 100 other issues with which they could incessantly threaten lawmakers for the good of vulnerable Americans?
I have the highest respect for organizations like the Catholic Health Association and members of Congress who have worked long and hard with the administration to fashion a genuine compromise that will allow religious organizations to protect their principles regarding the contraceptive mandate. The people looking for genuine solutions understand the inherent common good in ensuring people do not have to pay for preventive health care. Not to mention the enormous cost savings we achieve with prevention. They have worked extremely hard to work this out, and it looks like they may have succeeded.
But here's another thing. The mandate on contraception is not, as the USCCB and some extreme religious groups have called it, an "unprecedented" war on religion. In tossing out a federal lawsuit filed by attorneys general from seven states, a Nebraska federal district judge noted that large Catholic organizations like Georgetown University, DePaul University, and even the archdiocese of New York routinely provided contraceptive coverage  to employees before the mandate went into effect. This was not the basis for dismissal of the suit, but was an interesting highlight. While it doesn't legitimize a mandate that potentially affects the religious freedom of genuine religious organizations, it does call into question some of the politics of this particular debate.
The Catholic church is, at least for now, still a force to be reckoned with on Capitol Hill. But why so narrow a focus when its power is so potentially enormous?
Meanwhile, last week, tens of thousands of pages containing previously secret and hideous personnel records of priests who molested children for decades were released in Los Angeles . Can we please have some perspective? Aside from appearing utterly non-self-reflective and even grossly immune to the needs of its most vulnerable children, the church has become dangerously myopic when it comes to public policy for the poor and disenfranchised in the United States. And I am far from the only person who is extremely concerned about and even alienated by this.
And as a member of this church, I am asking the U.S. bishops: Since you are willing -- better yet, determined -- to involve yourselves intimately in influencing public policy and the votes of individual members of Congress, can you please explain why you are not using your bully pulpit and considerable influence and power for the following, just a few, examples from health care reform?
- Criticizing states that are refusing to expand Medicaid coverage for vulnerable adults as provided under the ACA. This refusal, almost exclusively by Republican governors, is estimated to cost more than $53 billion, according to findings  by the National Association of Public Hospitals and Health Systems;
- Calling out the administration  for a final decision on health care reform that will leave hundreds of thousands of children without affordable health coverage;
- Supporting, overwhelmingly and loudly and regularly, the principle that every human being has a fundamental right to health care, either affordable or free, as circumstances dictate.
And since your voice is so persuasive and present on Capitol Hill on some issues, why is it not being heard loud and clear on:
- the utterly shameful rate of child poverty in the United States? Nearly a quarter (23.1 percent) of U.S. children living in poverty in the richest country on earth?
- guns, assault weapons, 7-year-old children being massacred at their desks? My God. After Newtown, there was a renewed sense that finally something would be done about the obscene number of guns in this country, with corresponding gun fatalities. But even now, political courage on the Hill is fading. The president is out taking the case for common-sense gun legislation to the people. Where is the church's voice on this human tragedy that is beyond all proportions?
- preserving every single component of the safety net for vulnerable individuals from birth to death, all of which are at risk of dramatic cuts? The threatened discretionary spending cuts (non-mandatory programs) would be a drop in the bucket for deficit reduction, but would decimate the lives of poor people.
- the ongoing fight for revenue sources by cutting tax breaks for the wealthiest Americans? Even a majority of them are calling for higher rates on themselves to help curb the deficit, but where is the church's call for a return to this cornerstone of sensible fiscal policy that will help protect the most vulnerable among us?
OK, I'm going to be corny and quote President Andrew Shepherd (Michael Douglas) in what some readers may know is my favorite movie, "The American President," when he says, "We have serious problems to solve, and we need serious people to solve them."
Well, we do have serious problems to solve, and the church could go a long way toward helping us solve them instead of focusing on two issues to the exclusion of some of the most significant life-threatening issues of our time. The contraceptive mandate is an issue, yes. The administration and the church and other leaders have worked to resolve it. The proposed exemption is not meant to apply to secular employers and it should not. This is not some secret ploy to secularize America. It is not an unprecedented attack upon religion. In short, the adversity, distraction, rhetoric and polarization created by this issue has dramatically outweighed its importance in the overall effort to implement health care reform and improve the quality and access to affordable health care in this country.
That is not the Catholic church I came to know and love as I grew up. But I was taught by IHM nuns and Jesuit priests. I'm not sure if that makes a difference.
In any case, I suggest it's time for the USCCB to decide: all in or all out. As one member of the church, I think it's time to choose.