American Catholic Hospitals: A Century of Changing Markets and Missions

5. Catholic Hospitals and the Federal Government

103 Consistent with their support of racial justice, Catholic hospital leaders eventually supported the right of all to affordable health care. In 1981, with competition growing between general and investor-owned hospitals, the U.S. Conference of Catholic Bishops (USCCB) called for a national health insurance program.1 But this was a change in policy. Catholic and nonCatholic hospital leaders had traditionally resisted government intervention in their affairs, early on opposing a national health insurance program managed by the government. Over the last quarter of the twentieth century, however, Catholic health care leaders softened their stance as they extended their religious values in the area of universal health care, and they called for greater government intervention. They also added the prevention of abortion and reproductive services to their policy agenda. These events offer a lens through which to view the role Catholic hospitals have played in overall U.S. health policy, and how Catholic leaders have defined their roles in light of the larger society. As early as the eighteenth century, Catholics in the United States endorsed separation of church and state, religious tolerance, and religious pluralism.2 This separation, however, did not affect their engagement with the government over issues they deemed important. In 1909, Monsignor John Ryan, a priest on the faculty of Catholic University of America, strongly advocated a minimum wage that would help workers afford medical care. Ryan stated his claims in terms of human rights, which was exceptional for that day, and based on religious principles espoused in Pope Leo XIII’s 1891 Rerum Novarum (Of Catholic Hospitals and the Federal Government Chapter 5 104 American Catholic Hospitals New Things), the Church’s first social encyclical to address workers’ rights. In succeeding years, popes broadened and refined those teachings, primarily through encyclical letters.3 During World War I, Catholics for the first time had the confidence to speak as an American body through the National Catholic War Council to assist servicemen and servicewomen, an organization that became the National Catholic Welfare Council after the war, later the National Catholic Welfare Conference. Catholics earlier had been active in municipal politics and building Catholic institutions such as schools and hospitals, as a group focusing on servicing their own members, who were primarily immigrants, but by the 1930s, they were ready to progress to the national arena.4 As the number of Catholic hospitals increased, their leaders recognized their potential for power in the policy arena. They consistently argued that voluntary hospitals should be equal partners with public or governmental institutions that were run by city, county, state, or federal governments. Using a rhetoric of service, they asserted that they were charitable institutions providing a community benefit.5 But there lay the tension, as Catholic hospitals also were growing in technology and science and providing services for a fee.6 The Politicization of Catholic Hospitals The Catholic Hospital Association (CHA) formed in 1915 to bring Catholic hospitals into compliance with the hospital standardization movement. While sisters, priests, and physicians played significant roles in hospitals, conservative bishops and priests prohibited nuns from being appointed presidents and other full-time officers. The CHA originated as the sisters’ organization since they ran most of the Catholic hospitals, but their own congregations had rules that constricted their travel and attendance at meetings. Until the 1960s, priests held the highest leadership positions, although sisters could serve on executive boards, head committees, participate in conventions , make speeches on hospital policies, testify before Congress, and set standards for Catholic nursing education. Beginning in the 1930s the major hospital associations, including the CHA, became political lobbies at the state and national levels.7 Individual sister nurses such as Sister John Gabriel Ryan, SP, were foot soldiers in this movement. A member of the Sisters of Providence congregation in Seattle, Sister John Gabriel in the 1930s worked extensively with social and legislative issues as they related to hospitals and nursing. With a Catholic Hospitals and the Government 105 master’s degree earned in 1937, she served as hospital consultant and directress of schools of nursing for the Sisters of Providence in the West and taught classes on nursing administration all over the country (see figure 10). She also was vice president of the Washington State Hospital Association, a councilor and member of the Legislative Committee for the Western Hospital Association, a member of the boards of directors of the...