A Jesuit Expert on Managed Care Reflects on Pope Francis' Visit

Pope Francis’ 5-day visit to the United States last week brought calls to uplift the poor, to welcome immigrants, and, in less specific terms, to ensure that everyone has healthcare.

But what, exactly, does that directive mean in today’s rapidly changing healthcare landscape? The Affordable Care Act (ACA) has extended coverage to more people, but in some cases, it’s also limited choices. From the Pope’s point of view, is that acceptable?

For a perspective on Pope Francis’ healthcare message, The American Journal of Managed Care turned to a fellow Jesuit: The Rev. Kevin W. Wildes, SJ, PhD, is a bioethics expert and the president of Loyola University in New Orleans, Louisiana. An important lesson, Wildes said, is that while Catholic tradition calls for ensuring universal access to healthcare, “that system is going to vary from culture to culture, and from country to country.”

“What the Catholic tradition doesn’t do is say one system is better than another,” he said. “The church has always said, ‘How you figure things out is up to you.’ “ Even within the United States, Wildes said, implementation of the ACA has varied, “from state to state and from city to city, within the context of where you are.”

Before he became a university president, Wildes was a senior research scholar at the Kennedy Institute of Ethics at Georgetown University, where he became known for advancing a moral argument in support of managed care, as outlined in his 2001 essay in the Jesuit magazine, America. Among its many points, Wildes’ “Patient No More” compares an old-fashioned view of the physician-patient relationship, in which an all-knowing physician intervenes only when something goes wrong, to a modern model that demands accountability from patients for healthier lifestyles and preventive measures—exactly the strategies that accountable care organizations (ACOs) promote today.¹

In sum, the moral case for managed care argues that unlimited healthcare spending crowds out the ability of the system to provide universal access, and in fact ends up harming those with limited means.

From the church’s perspective, “The fundamental commitment is to make sure that people have access,” Wildes said in the interview. In the United States, “We’ve not done very well on this until the Affordable Care Act.”

Pope Francis’ most specific references to healthcare came during a visit to Catholic Charities in Washington, DC, when the Pope called on Catholic healthcare leaders to do more to help the poor, especially immigrants; and in Philadelphia, when he listed healthcare among a family’s basic needs. While the Pope did not specifically discuss issues like Medicaid expansion, some attendees at the Catholic Charities event told Modern Healthcare they can have a role in pressing lawmakers in states like Florida and Texas that have yet to extend coverage to those households earning 100% to 138% of the federal poverty level.²

In Philadelphia, the Pope said publicly, “How many problems would be solved if our societies protected families and provided households, especially those of recently married couples, with the possibility of dignified work, housing and healthcare services to accompany them throughout life?”³

Access, however, is not the same thing as unlimited healthcare spending, according to Wildes. When Wildes began writing about a moral argument for managed care, physicians resisted the thought that cost-containment should be part of the equation in healthcare decision-making. Not much has changed, he said.

“We still don’t train physicians to think enough about cost—that continues to be a challenge,” he said. “Part of our culture as Americans is that we want the newest, we want the best,” and this thinking finds its way into patients’ expectations. “There’s a hidden assumption that the best is defined by the most expensive.”

As soon as the discussion turns to cost-containment, “there’s an assumption they’re not going to get the best possible care.”

References

1. Wildes KW. Patient no more. America. 2001; 185(2):8-10.

2. Evans M. Catholic hospitals hear Pope Francis’ call to help the poor. Modern Healthcare. http://www.modernhealthcare.com/article/20150924/NEWS/150929924. Published September 24, 2015. Accessed September 29, 2015.

3. McElwee JJ. Francis: families should be given work, healthcare. National Catholic Reporter. http://ncronline.org/news/vatican/francis-families-should-be-given-work-healthcare. Published September 26, 2015. Accessed September 29, 2015.