Thousands of you read, responded to and shared my August piece about the health care debate and Catholicism. We are now in the final phase of the Congressional process and some things are clearer than they were then. Catholic Church leaders wanted undocumented immigrants included in the bill. They are not. Sadly, the Church stands almost alone among organizations in this country in its concern for the undocumented. They wanted universal coverage, and to the surprise of many, it looks like it will happen.

But, though the House bill does not fund or encourage abortion services, the bishops and most Catholics wanted specific language keeping abortion out of the bill entirely, and making it impossible for a future administrative action to change this, effectively bringing the Hyde Amendment into the bill and codifying it in a way that is stronger than its current status. This still could happen, as pro-life Democrats take up the cause. But what if it doesn’t?

The US bishops have a clear answer: Kill the bill. The US Conference of Catholic Bishops began a massive final push on health care this past weekend, hitting 17,000 parishes with a bulletin insert and email campaign to be distributed over the next few weeks. The bishops’ final stand on the absence of strong enough pro-life language: “If these serious concerns are not addressed, the final bill should be opposed.”

But what of universal coverage? What of help for the uninsured, some of whom die and suffer for lack of medical care?

In September, Cardinal Renato Martino, head of the Vatican’s Pontifical Council for Justice and Peace, expressed a very different view, equally grounded in Catholic teaching. Having lived for 16 years in the US, Cardinal Martino said he “could never explain” the fact that a large number of Americans lacked health care assistance, something every other developed nation provides for its citizens, concluding, about President Obama’s efforts for health care reform, “So I cannot but applaud this initiative.”

As I said in my earlier piece, if you oppose the bill on the basis that it should do more to exclude abortion, recognize that choice leads also to denying health care coverage to tens of millions of Americans — your neighbors — whose quality of life would be improved and some of whose lives would be saved.

The bishops’ press release accompanying this latest push reiterates that church teaching says “health care is essential for human life and dignity,” while also saying the bishops “recoil at any expansion of abortion.”

And that’s the point. Both issues are involved and there’s no way to separate them.

There is an imbalance here

But to me, there is an imbalance here. On one side is an incremental political victory — not even a change in current practices. On the other is a massive improvement in the social justice of this nation.

This is the first time in 60 years that a health care reform bill with universal coverage will be before the full Congress, rather than getting killed in committee. The insurance industry and others who profit off of the current system are scrambling to thwart yet another attempt to provide universal coverage to poor Americans.

Which side of this does it feel to you like the Catholic Church should be on?

Denver Archbishop Chaput’s column on Monday, November 2, explaining his frustration with the process, is moving and relatively balanced. The USCCB’s press release stresses that they have always stood for universal coverage. Unfortunately, this kind of nuance is lost in the fistfight of politics and in the headlines of a press that loves to make things look acrimonious.

But it’s one thing to recoil at the prospect of an expansion of abortion. It’s another to actively fight against something that is “essential for human life and dignity.”

I know from many conversations over the past year that many Catholics feel the nagging sense that our Church should have been a leading voice in the battle for universal coverage rather than a special interest speaking mostly about abortion.

Anthony Stevens-Arroyo says, in his latest Catholic America column in the Washington Post’s On Faith section:

“Talking with ordinary Catholic lay persons in the pews… While some of us have higher levels of awareness or commitment to one side or the other of the partisan divide, most people in Catholic America want peace and justice as much as they want the right to life. Catholics look to our Church for unity in the things that matter and expect our clergy to help us think clearly about moral issues when deciding things politically — but not make those decisions for us.”

What the fuss is about

Without getting bogged down in the details, I think it’s important to give you a clear snapshot of what the actual Washington debate is about, free of the rhetoric of activists on both sides. As this goes to press, here’s the narrow issue with the House bill that is causing all the heat: Remember all the fighting over the “public” option? The compromise in the current bill is a government-coordinated, but not owned, “marketplace” where the uninsured can buy cheaper insurance, and those who can’t afford even those lower prices will get subsidies. The existing bill says that a private health care policy bought through this marketplace can include abortion services, but only if those services are funded from the private payments — no funds derived from government subsidies can be used for abortion.

On one level, of course, this is just moving money around. But it is consistent with the idea that no government funds be used. The alternative — forbidding such coverage in any plan that is part of this marketplace system — would mean that the poor, self-employed, and those employed by a company that doesn’t provide insurance could not purchase a plan through the marketplace that included abortion coverage even though their plan is entirely private. This would be an expansion from where we currently are. The Hyde Amendment forbidding federal funding of abortion services has been the law of the land from many years, though, so pro-choice lawmakers may accept its incorporation as a concession.

(There is also a current requirement in the House bill that this regulated marketplace must include at least one plan in any region that does offer abortion services. I can imagine no compromise that would make this palatable to pro-life advocates.)

It’s worth note, though, that abortion is unusual in how this funding argument is made. Do you hear many (any?) pro-life advocates making similar arguments to separate out the tax dollars that go to state executions, war or other anti-life acts? Refusing to pay their taxes unless no tax money at all is used at all for these things? When government gets involved in social problems, social debates get dragged into the political sphere, and not everyone shares the same social values. This is part of democracy.

Where do we go from here?

I understand the distrust at play. Clearly the reason some factions of the Democratic coalition vehemently oppose the amendment from pro-life Democratic Representative Bart Stupak, which would add the Hyde Amendment-type language, is that they hope some day to broaden the national health care plan to subsidize abortion coverage. Could a future administration try to do this? Yes. Could the current one go back on its word and do so? Highly unlikely but technically possible. But I know from my years in politics that things can always change. A victory today can be undone with the next election. All you can do is work towards your principles and preferences. No “battle” is ever “won.”

So pro-life advocates should fight to pass the Stupak Amendment, to codify the anti-federal-funding language. But if they fail to achieve that goal, that fight is for another day — one more step forward or back in the ongoing struggle. The choice then before us all will be whether to stand, as Catholics, as Christians, as people of faith and conscience, with one of the biggest social justice improvements of our lifetimes, or to obstruct and possibly even defeat it in the name of politics.

People complain about the absurd length of the House bill (around 2,000 pages). Like it or not, this is how law happens in America. A two-party parliamentary system generates complex compromises, not clear simple declarations. If you withhold support for any health care reform bill that isn’t perfect, you may maintain purity, but you will never see reform. That’s not amoral realpolitik; that’s reality.

Much as pro-life advocates may wish otherwise, abortion services are legal in this country. And, much as pro-choice advocates may wish otherwise, the ban on government aid paying for abortion services is also the law of the land. If neither side tries to use the current health care debate as an opportunity to change those two facts, then a compromise that will bring universal coverage to America is possible.

Not all choices in life are black and white (in fact almost none are) and we are called upon to use discernment and make difficult decisions about things that affect us, and sometimes others. This is one of those moments.