American Catholic Hospitals: A Century of Changing Markets and Missions

1. From Sisters in Habits to Men in Suits

1 The public face of Catholic authority has always been decidedly male; it is indeed ironic, then, that the overwhelming majority of Catholic hospitals in the United States were established and originally managed by women. While mission driven, these Catholic sisters, or nuns, were nevertheless skillful business managers who learned to understand fully and work within the often perilous hospital marketplace.1 The exception to female-founded institutions was the hospital established by the Alexian Brothers from Aachen, Germany, who were founded to care for the sick and dying. Using U.S. Catholic women’s religious congregations (sometimes called orders or communities) and one men’s congregation as vehicles for examination, this book provides a historical analysis of the changing identity and influence of Catholic hospitals from the Great Depression to the present. Many of these changes are emblematic of how the health care system as a whole has changed. Indeed, much of the argument I make applies to the rest of the hospital sector: the effect of large changes in the economics of health care; the spread of health insurance and negotiations between the hospitals and insurers; the increase in government funding and regulation; authority issues; ideas about a good work atmosphere; and unions as a danger to hospitals. For Catholic hospitals, in particular, a gender disparity developed in leadership as institutions run primarily by religious women came to be administered, for the most part, by men.2 In the United States, religious-affiliated hospitals play a significant role in delivering health care to medically underserved, diverse, and poverty-stricken communities. The Catholic Church, in particular, is a major stakeholder in From Sisters in Habits to Men in Suits Chapter 1 2 American Catholic Hospitals the health care field. Yet few historians have investigated the importance of religious-affiliated hospitals for U.S. society and the inevitable awkwardness when they attempt directly to shape medical policies in a diverse milieu. This is especially important in the health care arena, where life, birth, and death are critical benchmarks for quality and justification for services. Catholic hospitals began as individual, stand-alone institutions, and they have a long and rich history in the United States. They were established with religious missions to care for both Catholics and non-Catholics. Sisters and brothers served with distinction despite considerable hardship. These hospitals experienced massive transformations, however, mainly in the last forty years as modern medicine made new demands and the number of Catholic women and men in religious orders plummeted. The dramatic evolution of Catholic hospitals must be seen within the context of landmark events such as the passage of Medicare and Medicaid, the civil rights movement, and the Second Vatican Council (Vatican II). Debates over hybrid Catholic-secular organizational partnerships and the articulation of Catholic social values with respect to workers’ rights, labor laws, and abortion have accelerated. These issues have forced significant structural changes in how hospitals are run. For example, most Catholic hospitals, like secular institutions, are no longer stand-alone facilities but parts of regional or national systems governed by boards populated by large numbers of lay experts. Questions about the changing hospital cannot be adequately understood without addressing the impact of pluralism on the secularization of social problems in twentieth-century America. Philip Gleason shows how U.S. Catholics ’ conceptions of their identity and their relationship to U.S. culture and institutions changed after World War II, when they adopted a “participationist version of pluralism” and denigrated ‘separatism,’ ethnic or otherwise.”3 The 1950s were a time when the lower and middle classes were secularizing as traditional ethnic enclaves were breaking up. Charles Morris asserts that people were “assimilating into a broader American culture that, if not quite areligious, was at least highly latitudinarian.”4 A major thesis of this book is that as Catholic hospital leaders reacted to increased societal secularization over the course of the twentieth century, they extended their religious values in the areas of universal health care, abortion, and reproductive services, which led to tensions among the values of the Church, the government, and society. Not only do Catholic hospitals determine the types of services they offer based on Catholic religious beliefs, but they do this while supported with large pools of public funding—more From Sisters in Habits to Men in Suits 3 than $45 billion in 2002, according to one study.5 This support...