Can a Health Care Market Be Moral?

A Catholic Vision

Mary J. McDonough

"Her presentation is detailed, logical, and consistently approached with excellent documentation and a lengthy bibliography and index."
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Since the 1970s health care costs in the United States have doubled, insurance premiums have far outpaced inflation, and the numbers of the uninsured and underinsured are increasing at an alarming rate. At the same time the public expects better health care and access to the latest treatment technologies. Governments, desperate to contain ballooning costs, often see a market-based approach to health care as the solution; critics of market systems argue that government regulation is necessary to secure accessible care for all.

The Catholic Church generally questions the market's ability to satisfy the many human needs intrinsic to any care delivery system yet, although the Church views health care as a basic human right, it has yet to offer strategies for how such a right can be guaranteed. Mary J. McDonough, a former Legal Aid lawyer for medical cases, understands the advantages and disadvantages of market-based care and offers insight and solutions in Can a Health Care Market Be Moral?

Drawing on Catholic social teachings from St. Augustine to Pope John Paul II, McDonough reviews health system successes and failures from around the world and assesses market approaches to health care as proposed by leading economists such as Milton Friedman, Regina Herzlinger, Mark Pauly, and Alain Enthoven. Balancing aspects of these proposals with Daniel Callahan's value-dimension approach, McDonough offers a Catholic vision of health care in the United States that allows for some market mechanisms while promoting justice and concern for the least advantaged.

Table of Contents

Justice and the Catholic Church
Capitalism, Health Care, and Catholic Social Thought
Economic Theory, Market Mechanisms, and Health Care
Two Approaches to Health Care
Catholic Values and Health Care
Plan of the Book

Chapter 1
Justice in Catholic Social Thought
Augustine and Aquinas
The Influence of Rerum novarum
The Contribution of Quadragesimo anno
Pius XII and Human Dignity
Encyclicals of John XXIII
The Second Vatican Council and Gaudium et spes
The Catholic Social Teaching of Paul VI
The U.S. Catholic Bishops and Economic Justice for All
John Paul II: Culture and Mercy
Conclusion: What is Justice?

Chapter 2
Catholic Social Thought on Capitalism and Health Care
Capitalism and the Catholic Church
Catholic Social Thought and Health Care
Conclusion: Justice, Capitalism, and Health Care

Chapter 3
Health Care Economic Theory, Market Mechanisms, and Health Outcomes
A Short History of Medicine and the Market
Traditional Market Economic Theory
Health Care Economics: The Debate
Market Mechanisms
Various Countries' Responses to Market Mechanisms and Health Outcomes

Chapter 4
The Market Organization Approach to Health Care
Milton Friedman: A Market Purist's Cure for Health Care
Regina Herzlinger: Consumer-Driven Health Care
Mark Pauly: Responsible National Health Insurance
Alain Enthoven: Managed Competition
Summary: The Market Organization Approach

Chapter 5
The Value Dimension Approach to Health Care
Daniel Callahan's Critique of the Health Care System
Callahan's Finite Model of Medicine
Catholic Social Thought and Callahan's Finite Medicine

Chapter 6
A Catholic Vision of Health Care
Towards Universal Health Care
The Underlying Values of Health Care
Integrating Market Mechanisms
Conclusion: Can A Health Care Market Be Moral?



"Her presentation is detailed, logical, and consistently approached with excellent documentation and a lengthy bibliography and index."—Catholic Library World

"This book is a valuable steppingstone from moral calls for health care reform to concrete policy proposals. It will help those informed by Catholic social teaching to think more clearly about this complex and challenging issue."—Lisa Cahill, Boston College

"In an admirably comprehensive and in-depth book, Mary J. McDonough shows how the Catholic insistence on a right to basic health care can be put into practice in a system that is universal, affordable, and sustainable. McDonough convincingly argues that such a system requires both a systematic organization involving the role of government together with some market mechanisms to control costs and a value approach to the meaning of health that sees it as a means and not an end."—Charles E. Curran, Elizabeth Scurlock University Professor of Human Values, Southern Methodist University

"McDonough's Can A Health Care Market Be Moral? is a very helpful and critical contribution to the growing analysis of justice and fairness in health care ethics. She provides an excellent review of perspectives of Roman Catholic social justice in relation to understandings of various market models and models of health and health care. McDonough provides an excellent proposal for thinking through how a health care market can be moral. Her book is a welcome addition to a developing field and will help set the direction for future discussions."—Thomas A. Shannon, professor emeritus of religion and social ethics, Worcester Polytechnic Institute

"Catholic social teaching on capitalism and healthcare is the point of departure for this philosophical and theological analysis of models for funding and distributing health care. In clear and accessible writing, McDonough walks us through complex economic theories and models of health care distribution as she tests how well the market organization approaches of Friedman, Herzlinger, Pauly, and Enthoven and the value dimension approach of Callahan satisfy the ethical criteria found in Catholic social teaching. This will be a welcomed book for anyone who believes that the Catholic theological tradition can make a significant contribution to this major issue at the intersection of social ethics, economics, and health care."—Richard M. Gula, SS, professor of moral theology, Franciscan School of Theology/Graduate Theological Union


Supplemental Materials


About the Author

Mary J. McDonough has worked as an advocate for Montana Legal Services and served as a member of the Montana State House of Representatives. She received her PhD from the Graduate Theological Union and has taught as an adjunct professor of ethics at Rocky Mountain College.

272 pp., 6 x 9

Jun 2007

272 pp., 6 x 9

ISBN: 978-1-58901-157-1
Jun 2007

272 pp.

ISBN: 978-1-58901-287-5
Jun 2007

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