Health care access and the common good: What should Americans expect?

(OSV News) -- When alleged would-be assassin Luigi Mangione stalked into view on a surveillance camera outside Manhattan's Hilton Midtown hotel on Dec. 4, 2024, he was apparently seconds away from killing insurance giant UnitedHealthcare's CEO Brian Thompson -- and igniting a national reaction that teetered uncomfortably between horrified shock and celebratory glee.

UnitedHealthcare's reputation for postponement and denial of medical procedures seemed related to Mangione's alleged vigilante motives; but sources maintained that while Mangione had spine issues -- including a significant back surgery involving screws and rods in 2023 -- he never held a UnitedHealthcare policy.

In the crime's aftermath, figures quickly circulated asserting UnitedHealthcare has the highest industry claim rejection rate -- 32% -- while the company maintained it approves and pays 90% of all claims.

Mangione remains in a New York City jail, awaiting trial -- elevated to a kind of cult figure folk hero for whom a sympathetic public has, since his arrest, raised $700,000 in legal defense funds. A scion of a wealthy Baltimore Catholic family known for its philanthropy, Mangione faces the death penalty if convicted in his federal trial.

In a system not impervious to market forces, the health outcomes Americans expect and what they actually receive may seem like two different things -- and may also lead Catholics to wonder what's morally required from networks forced to consider both care delivery and the bottom line.

"Catholic social teaching gives us guidelines or principles, to go by -- but of course, it doesn't give us exactly how a health system ought to be structured," said Jesuit Father Michael Rozier, an associate professor at St. Louis University's College for Public Health and Social Justice in St. Louis. He also chairs the school's Department of Health Management and Policy.

Father Rozier said Catholic social teaching should not be looked to "for an answer as to how things should be structured -- but to maybe evaluate the current system, and to see how it might be modifiable to be more in line with the kind of elements that Catholic social teaching teaches as important about the human person and the human community."

What might such a system look like?

"We would hopefully try to look at how we create a system that of course serves everyone -- but is particularly responsive to those who are in the greatest need of health care," said Father Rozier. "Which is exactly the opposite of the system that we have."

A 2021 report by Families USA, a non-profit advocacy group, claimed that between the start of the pandemic and Aug. 31, 2020, roughly one in three COVID-19 deaths, or 56,000 deaths at the time, were linked to health insurance gaps; it also said 40% of COVID-19 infections, or 2.6 million cases at the time, were linked to such gaps.

Johns Hopkins researchers estimate almost 800,000 Americans die or become permanently disabled each year because diseases they suffer from are unrecognized or misdiagnosed.

For those who are insured, almost 1 in 5 in-network claims (19%) and 37% of claims for out-of-network services are denied, according to a 2023 analysis by KFF, an independent online source for health policy research and news.

Catholic social teaching -- and popes -- have said health care is a human right, not a privilege.
In his 1963 encyclical "Pacem in Terris" ("Peace on Earth"), St. John XXIII declared humans have "the right to bodily integrity and to the means necessary for the proper development of life, particularly food, clothing, shelter, medical care, rest, and, finally, the necessary social services."

Pope Benedict XVI also observed in 2010, "In the health-care sector too, which is an integral part of everyone's life and of the common good, it is important to establish a real distributive justice which, on the basis of objective needs, guarantees adequate care to all."

In 2022, Pope Francis warned, "A world that rejects the sick, that does not assist those who cannot afford care, is a cynical world with no future. Let us always remember this: health care is not a luxury, it is for everyone."

"I think we can all agree that each human being -- whether it's in this country, or throughout the globe -- is owed at least a certain level of medical care," said Daniel Daly, founding executive director of Boston College's Center for Theology and Ethics in Catholic Health. The center was established in 2024 as a collaboration between Boston College and the Catholic Health Association of the United States.

"The operative word there is 'certain' -- and that's very much undefined, and it changes through history," Daly told OSV News. "So what we would consider to be required 50 years ago is different than what it is today, or 100 years ago."

Nonetheless, public furor is frequently stoked by incidents that seem to emphasize insurers' concern for costs rather than care.

In November, Anthem Blue Cross Blue Shield plans representing Connecticut, New York and Missouri unilaterally declared anesthesia care would no longer be paid for if a surgery or procedure exceeded an arbitrary time limit, regardless of how long the surgical procedure took. Anthem announced the decision's reversal Dec. 4, hours after Thompson's brutal killing drew renewed and widespread scrutiny to the anesthesia policy.

A December 2024 investigation by advocacy group ProPublica claimed UnitedHealth Group, the parent company of UnitedHealthcare and Optum, was attempting to strategically limit access to critical treatment for children with autism.

Just a month after Mangione is alleged to have shot Thompson, an Austin, Texas, doctor received a call from UnitedHealthcare during surgery; she claimed she was asked to assure the necessity of the procedure she was performing.

Also in January, UnitedHealthcare was accused of denying the claim of a patient in a coma, because her doctor hadn't proven the medical necessity of caring for her in a hospital. "Tear it all down," the New York-based physician tweeted on X.

A 2024 Gallup poll found 79% of Americans were dissatisfied with the cost of U.S. health care, while 62% thought the federal government should be responsible for making sure all Americans have health care coverage.

According to a 2022 KFF Healthcare Debt Survey, more than half of Americans say it's difficult to afford health care costs. The survey also indicated the expense of health care leads some to put off needed attention, while the price of drugs prevents others from filling prescriptions.

Added to that, the leading cause of personal bankruptcy in America is medical debt.

"There's a moral outrage to the system, which I think is warranted -- but we shouldn't then make (UnitedHealthcare CEO) Thompson an avatar for that," said Daly. "We live in a terribly unequal and increasingly unequal society -- and I think some of this moral energy is a response to that. I think when you see deep inequality, we see this kind of backlash."

Daly urged discussion -- but not simply in academic terms or circles.

"We need a national conversation about what is a basic level of health care we owe every man, woman, and child in this country," he said. "We need that conversation to be a public conversation."

But again, the critical question is the definition of a "right to health care" within America's for-profit medical system.

"When the Catholic Church keeps talking about a 'right,' it's actually saying that if we are truly to be a community, we will do what we can to ensure the flourishing of every person within that community," explained Franciscan Father Thomas Nairn, who has served as a medical ethics consultant to several Chicago hospitals, as well as senior director of ethics and theology at the Catholic Health Association.

"When the Catholic social tradition is talking about a right," Father Nairn said, "it presupposes things that have not been, sadly, part of the American system -- that we are a community of friends; a community of sisters and brothers, rather than actually strangers."

The proper equilibrium between commerce and care is, Father Nairn said, a delicate topic.

"The question always is, how can we make a system which is based on profit more beneficial to all -- closer to what the Catholic Church would call the common good?" he said. "And that is going to take some sort of government oversight."

It also poses a thorny dilemma for those who hope to encourage reform.

"The issue is going to be how do we ensure that we create the sort of checks and balances that allow a system -- which is going to be based on profit -- also to be there for the good of all; what the Catholic Church would call the common good," Father Nairn said. "How's that going to happen? I wish I knew."