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THE AMERICAN ECCLESIASTICAL REVIEW

For it seems to me that you only pardon the sins that you don’t really
think sinful. You only forgive criminals when they commit what you
don’t regard as crimes, but rather as conventions. So you tolerate a
conventional duel, just as you tolerate a conventional divorce. You for­
give because there isn’t anything to be forgiven. . . . Go on your own
primrose path pardoning all your favorite vices and being generous
to your fashionable crimes; and leave us in the darkness, vampires of
the night, to console those who really need consolation ; who do things
really indefensible, things that neither the world nor they themselves
can defend; and none but a priest will pardon.3

The Catholic who is privileged to defend the Church and its
teaching against a book such as our anti-Catholic agitator is said
to be preparing will have the opportunity to show' how the Church
works consistently with its own divine teaching to the effect that
sins are forgiven in the sacrament of penance through a definite
juridical absolution. The confessor must know what a sin is in
order to exercise his absolving power. The Church does not ex­
empt its confessors from the study' of any material which they will
need to know in order to perform their sacerdotal works for the
glory of Christ.
There are certain faults which almost completely nullify the
value of those works of Catholic polemic which they infect. The
most glaring of these is the tendency to use the polemic itself as an
instrument to score a point against some rival viewpoint within
the Catholic Church itself. Thus Newman’s Letter to the Duke of
Norfolk was ostensibly a defense of the Church against the charges
leveled against it by the English politician, Gladstone. Unfortu­
nately, however, Newman himself fashioned it also as a kind of side
attack on his Catholic fellow-countrymen who had worked for the
definition of papal infallibility in the Vatican Council.4* As a result
the booklet lost most of its effectiveness as a statement of Catholic
doctrine and as a defense of the Catholic Church. Occasionally,
even now, we see this procedure repeated, and always with disas­
trous results for the presentation of Catholic truth.
3 Chesterton, The Secret of Father Brown (New York; Dodd, Mead and
Company, 1935), p. 803.
4 Cf. the article “John Henry Newman and the X7atican Definition of
Papal Infallibility, ” in AER, CXHI, 4 (Oct. 1945), 300-320.

THE DIRECTION OF CATHOLIC POLEMIC

55

Another weakness in some contemporary Catholic polemic is
the tendency to interpret every outburst against the Catholic
Church as an attack against all religion. Some non-Catholic
groups have used a variation of this tactic as a highly effective
debating procedure. The Catholic controversialist, however, is not
primarily concerned with cleverness in repartee, but with truth.
An attack against the true Church of Jesus Christ should be looked
upon and dealt with for what it is. The defender of Catholic truth
will only weaken his position if he gives the impression that the
struggle for Christ in this world is in some way a joint concern
of the Catholic Church and of other religious societies. The Church
and the Church alone is Christ’s kingdom, His Mystical Body on
earth. Any effective defense of the Church or of its teachings must
take explicit cognizance of this paramount truth.
In his paper, “Clements of Modern Religious Controversy,”
Bishop John Cuthbert Hedley, O.S.B., considered Catholic polemi­
cal writings chiefly from the point of view of converts who might
be brought into the Church by means of it.5 This, of course, will
always be an important aspect of this type of work. There is, how­
ever, still another function of this labor which must be kept in
mind. The Catholic polemist, in setting forth the truth about points
which have been misstated by enemies of the Church is likewise
defending and protecting the faith of those within the fold of
Christ. These children of God’s household will profit also from
a vigorous and accurate defense of Catholic truth.
Joseph Clifford Fenton

The Catholic University of America
Washington, D. C.
5 In AER, XVI, 3 (March, 1897), 241-53.

Mission Intention
“Mission, Threatened by Atheists” is the Mission Intention for the
month of January, 1950.

SHOULD WE SUPPORT SOCIALIZED MEDICINE?
The compulsory health insurance program, now pending before
Congress, has pointed up what is undoubtedly one of the sharpest
issues of our time. In our attempt to combat “galloping Commun­
ism” are we slowly but surely falling victims to “creeping Social­
ism” ? It would be tragic indeed if in attempting to quell the flam­
ing faith of totalitarian zealots we ourselves should slip into some
basically similar system of collectivism in the shape of a welfare
or, if you will, a slave State. For the clergy especially this should
constitute a matter of deep concern since the Papal Encyclicals are
crystal clear in their condemnation of outright socialism. In an
effort toward clarification of this vital question we shall try to offer
here a summary review of the main facts and specific issues in­
volved. Other larger and perhaps more interesting phases of the
problem lie outside our present scope.1
Although the proper care of health is not quite on a par with
the ownership of property the principles pertinent to the national­
ization of industry, which we have already reviewed, will be help­
ful in giving us a general picture or pattern of Catholic thought
relative to more personal problems.2 This pattern accords very
well with the American tradition which has been to encourage, in

;r*·

1 One wonders, for instance, how certain aspects of the whole present phi­
losophy of planned security and a completely comfortable society are to be
harmonized with the Christian ideal. True, as Quadragesimo anno points out
and Divini Redemptoris repeats, we should strive for a sound economic order
in which everyone would have “sufficient to supply all necessities and reason­
able comforts” because the higher standard of life thus attained “provided it
be used with prudence is not only not a hindrance but is of singular help to
virtue.” At the same time it would be misleading to over-emphasize mere
social and economic remedies in such a way as to convey the impression that
these are the primary business of the Church. Actually, in practice, the ad­
vocacy of such remedies must ultimately lead to further control by the State.
Neil Kevin in No Applause in Church has some appropriate remarks in the
section “On Putting the Second Commandment First.” From the point of
view of the opportunity for asceticism in the welfare society his delightful
description of how many contemporary daily annoyances can be more irri­
tating than a hair-shirt is also relevant.
2 Cf. “Nationalization and the Catholic Tradition,” AER, CXXII, 1 (Jan.
1950). The problem of health has, of course, obvious connection with basic
living standards, education, etc.
82

,

■

SHOULD WE SUPPORT SOCIALIZED MEDICINE?

83

so far as is consonant with social welfare, individuals and groups
to solve their own difficulties in their own way. The very variety
existing in the different states and regions makes this approach
more necessary here than, for instance, in the smaller, tighter coun­
tries of Europe. Our political and social history as wrell as the
continuing progress of our free way of life require a broader and
more equitable basis for insuring personal and national well-being.
It is not in the American spirit to risk the curtailment of basic
liberties even in the interest of supposedly greater security. Never­
theless, as we have seen, the increasing complexity of modern life
and the enormous power wielded by huge, wealthy organizations
seems to necessitate a larger protective rôle on the part of the
government than at any time in the past.
SOCIALIZED OR STATE MEDICINE?

It is still true, however, that, as in the case of education, the
matter of health is not the government’s primary responsibility.
Therefore it becomes important to determine what precisely the
proposed health measure means. What has been frequently for­
gotten in the debate so far is that socialized medicine differs from
State medicine. Lest Catholics be scared by accusations of near­
Socialism we must explain that “socialization” is not necessarily
Socialism, much less “nationalization.” When any group of indi­
viduals promotes a program of medical services designed to mu­
tualize cost and care we have socialized medicine. It may mean a
system of free medical practice sponsored, financed by, and respon­
sible to the government but organized, operated, and regulated
democratically by the medical and allied professions.
Socialized medicine may thus be a very broad term covering the
whole science and art of preventing and curing disease through
collective effort with the financial support of social groups and
governmental units. It might be said that anything is socialized
when it is supported by people as groups according to ability to pay,
rather than by individuals according to use. A public library is a
socialized institution since it is maintained by the taxpayers. The
citizen with the most property pays the largest sum toward its
support whereas the school child who occasionally takes out a book
pays nothing. Private physicians in a sense socialize medicine when

!
;!

.1

84

they charge according to the patient’s respective financial status
and make the wealthy help pay for the poor.
In the case of State medicine the control is not in the hands of
the physicians. Such a system is run by the government for the
medical and allied professions. Medical services are furnished by
State employees who are paid out of taxes much as public education
is conducted by teachers paid from public funds. There are two
main differences between State medicine and health insurance. The
first concerns means of support, the second, methods of administra­
tion. (1) State medicine secures its support from taxation: health
insurance from periodic payments of those insured. (2) State
medicine implies an organization of medical practitioners working
directly for the State. Health insurance would be maintained by
the medical societies or insurance companies with State supervi­
sion ; it is really a plan for private medicine with group support.
True health insurance, paid for by the purchasers, may be volun­
tary but the social insurance type is compulsory. Otherwise those
receiving larger incomes would not be likely to join. When each
person is compelled to belong and to pay according to his ability,
rather than according to the service he is to receive, this method
of support comes very close to being a form of taxation. A system
of health insurance enforced by law and supported on the basis
of ability to pay is almost State medicine. If the government, in
addition to collecting the funds, insists on maintaining rigid super­
vision of the medical services offered then the system is practically
State medicine.

i
«

HISTORY AND BACKGROUND

Another popular misconception is that socialized medicine is
something entirely new. Actually it has been advocated and tried
in one form or another and in various parts of the world for almost
a century. As far back as 1864 Russia established a rather com­
plete system of State medicine for the rural districts. In the past,
when the Soviet Union was somewhat more accessible to foreigners,
it was studied by American physicians and some, notably Dr.
Sigerst of Johns Hopkins, seemed to regard it as satisfactory. Ger­
many experimented with it on a large scale when, in 1883, Bis­
marck introduced comprehensive social and health insurance for
industrial workers. Dater it was extended to commercial employees

f,
Γ

SHOULD WE SUPPORT SOCIALIZED MEDICINE?

85

and agricultural laborers. Medical care was, in fact, free—at least
in the sense that the patient made no direct payment for the service.
The entire cost came out of a fund raised by general taxation. The
German system spread to Austria in 1888 and was introduced in
France in a modified form in 1918. Later the Scandinavian coun­
tries followed and in South America Chile has had compulsory
insurance since 1927.
In England, under Lloyd George, a national health insurance act
was passed in 1911. In more recent times the Beveridge Report
presented a comprehensive system of social planning but it did not
decide the question as to whether a national health and hospital
service should be established and maintained by the State. Under
the present Labor government, however, “panel medicine” was set
up. At first opposed strenuously by the British Medical Associa­
tion it is said that now most physicians are sufficiently satisfied with
it not to desire a return of the old “rugged individualism.’’3 The
doctors are paid according to the number of patients cared for each
year at the rate of $2.16 per patient. It is, of course, too soon to
pass judgment on a system still in the throes of its growing pains
but already costs have increased at such a rate as to be alarming.
The Health Minister has found it necessary to reduce expenses by
imposing a twenty-five per cent cut on dentists and by slashing
$38,000,000 from the hospital budget. While theoretically the pa­
tient may change doctors at will, in practice it appears that such a
transfer requires the permission of his former physician and the
approval of a government board.
New Zealand enacted extensive social security legislation in 1938
which covered all phases of health. The New Zealand system also
has a pension clause. With a doctor’s certificate one can get on the
pension list, at least temporarily, and sometimes for life. The an­
nual cost is $60 per person. It is levied as a direct tax of five and
8 On a recent visit to England the writer observed that while there was con­
siderable "griping” about the loop-holes in the new system, e.g. the fact that
production of free "spectacles” lagged behind to the tune of more than a mil­
lion and a half with the result that before they were delivered the prescrip­
tion already needed to be changed, nevertheless, there was no thought of
going back to the past. It is also indicative of the modern temper that the
recent defeat of the Labor party in New Zealand was made possible only
because their opponents pledged themselves to retain most of the existing
social welfare program.

♦

86

THE AMERICAN ECCLESIASTICAL REVIEW

a half cents out of every dollar paid in wages and the balance comes
out of a general fund. It is, perhaps, worth noting that Ireland still
pursues the traditional program of personal medicine with, how­
ever, free “dispensaries” to provide medical care for those unable
to pay. Care is thus provided for the poor while insurance is com­
pulsory for the working classes. An Irish physician, writing re­
cently in Studies, points out that the preservation of this doctor­
patient relationship is “both the true expression of our individual­
istic outlook and a far humaner basis than the card-index and the
case-number which has so benumbed much of modern continental
practice.”
From time to time it had been suggested that one or other of
these European plans be introduced into the United States. The
chief objection thus far has been that economic and social conditions
are different in America. The various states have not sufficient
uniformity to warrant that any system yet devised would be suc­
cessful in meeting the needs of the country as a whole. It was as­
sumed that the development of sickness insurance would have to
be on a local rather than on a national level, and the basic conten­
tion of the American Medical Association has been that the pro­
motion of public health and medical care are primarily local respon­
sibilities. The determination of needs and the administration of
affairs should be in the hands of local authorities. Grants in aid
and technical assistance may be received from State and Federal
Government sources but not the determination of policy.
The United States Government held a conference in July, 1938,
to discuss a new and better system for the distribution of medical
care to the poor. One hundred seventy-one delegates from various
professions were present. In the following year Senator Wagner
of New York introduced the National Health Act or, as it is some­
times called, the Wagner Health Bill. The bill was based upon the
findings of the Health Conference and was intended to fill the gaps
in the Social Security Act.
Toward the end of 1948 Oscar Ewing, the Federal Security Ad­
ministrator, submitted a report to the President on the state of the
nation’s health and on plans to raise the national health level dur­
ing the next decade. The report recommended that “further rapid
improvement in national health can be achieved only by concerted

SHÔULD WE SUPPORT SOCIALIZED MEDICINE?

87

effort and that the need for increased Federal action is impera­
tive....... ”4
TERMS OF PROPOSED MEASURE

Now we come to the heart of the present controversy—the Na­
tional Health Program requested by the President which, following
his special message on April 22, 1949, was submitted as an im­
proved comprehensive health bill by eight Senators and two Con­
gressmen. We shall try to see both what is expressed and what
is implied in this bill. In its wording, at least, it guarantees that
payments for benefits shall be in proportion to incomes, and per­
sons “shall, therefore, obtain services as a right and not as a char­
ity.” This aspect is lauded by its proponents on the ground that
subsidies to voluntary plans for those unable to pay premiums
would necessarily involve the indignities of a “means test’’ and thus
be a reversion to “the outmoded charity principle.”
The bill also theoretically guarantees patients free choice of doc­
tors and it is inferred that many will have this privilege for the first
time who have hitherto been prevented by their economic condition.
Furthermore, “physicians and other professions furnishing services
to them shall be assured freedom in the practice of their profession
and assistance in maintaining high standards, and that the ad­
ministration of this act shall be based upon the American principle
of decentralization.” Administrative responsibility is to be placed
“in the hands of local bodies representing both those who pay for
and those who render services, and operating within the framework
of plans made by the several states.” One wonders in this connec­
tion what will happen to volunteer non-profit plans which may
appear to be in competition with the state medical societies? In
England Catholic hospitals were, presumably, exempt by special
privilege. Are we to have a repetition of the so-called “divisive”
effects of public versus private education here with Catholics once
again in the unjust position of having to bear a double burden ?
Of course, and again in theory, there is the banning of “discrim«α The Nation’s Health. A Ten Year Program. By Oscar R. Ewing.
(Washington, D. C. : U. S. Government Printing Office, 1948), p. 12.

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THE AMERICAN ECCLESIASTICAL REVIEW

inations because of race, color, or creed.” What a hackneyed mean­
ingless phrase that has become ! It is said that the private relation­
ship that should exist between doctor and patient will be scrupu­
lously protected. Also that all the people will be completely pro­
tected, but this sounds too much of a panacea to be interpreted
literally. Grants are promised to professional schools for research
and aid to under-doctored areas in the form of ambulance services
and subsidies, all of which could and should be forthcoming with­
out benefit of any such comprehensive scheme as is proposed. Again
and again it is insisted that government control will be at a mini­
mum and that the net result will be stimulation of high quality
medical care. All this may indeed be genuine wishful thinking as
far as the blueprint is concerned but will it be translated into real­
ity with the actual operation of the plan ?
ARGUMENTS IN FAVOR

A summary review of the reasons given for and against the new
health measure may prove helpful at this stage. The affirmative
position generally stresses the points already mentioned, namely :
(1) the comprehensiveness of the plan; (2) the completeness of its
coverage; (3) the high quality of the care offered; and (4) the
lack of loopholes in administration.
(1) It is asserted that eighty-five million Americans have now
no protection against crippling sickness costs. On the basis of pres­
ent statistics voluntary plans are considered inadequate as hos­
pitalization insurance is carried by only 27 million people and hos­
pitalization insurance plus physician’s services in hospital by ap­
proximately the same number while only 3% millions have really
comprehensive, including preventive, care. Moreover it is claimed
that the voluntary plans, since they have no sliding scale of pay­
ments to match salary, would be forever beyond the reach of the
middle-income group which needs protection most.
(2) Voluntary health insurance, it is said, can cover only part
of the subscriber’s annual sickness bills. Hospitalization insurance,
such as the Blue Cross, covers only 21 per cent of the average
family’s medical expenses and the Blue Shield, which includes

SHOULD WE SUPPORT SOCIALIZED MEDICINE?

89

physician’s services in a hospital, only 35 per cent.3 Neither do
these provide for check-ups, inoculations, and preventive care.
Medical services, on the other hand, provided by the community,
or government at the public expense, can be as complete as is nec­
essary or desirable. Both the financial burden and the social stigma
attaching to those forced to accept present-day free sendees would
vanish as also the evils of self-diagnosis, self-medication, and patent
medicine, because of the easy access to competent advice and
service.

(3) Moreover, the professionals themselves will benefit from
this public financing. There will be no need of competition : there
will be no over-supply or unemployment resulting from unequal
distribution of personnel; and they will no longer be harassed by
the problem of income since it is assured by the government.
The economic and professional assurance that is inherent in public
service; the definite compensation; the permanent tenure of office en­
forced by civil service law ; the security of old age and disability through
pension retirement; the regular and orderly condition and hours of
service; the assured opportunities for rest, recreation, and travel; the
opportunities for advancement ; for further professional study, for re­
search, for public education, public and preventive medicine, are but
a few of the innumerable advantages of a publicly provided and sup­
ported medical service, which are denied today to most of the profes­
sional workers in the health service.

(4) There will be no danger to professional freedom since all
medical matters will be left strictly in the hands of the doctors.
Neither will there be any infringement of the patient’s right to
privacy. He may go to a doctor of his own choosing or change doc­
tors, supposedly, at will. Sound administration requires a division
of responsibility between the professionals who provide the health
services and the consumers who pay for them. To deny the public
its proper voice in the administration of voluntary programs is to
invest medical societies with all the powers of a monopoly and
5 Agnes E. Meyer in an address entitled, “A Sound National Health Pro­
gram," reprinted from The Washington Post, Nov. 14, 1948, claims that “the
Blue Shield, which is dominated by doctors, has no standards of medical care,
whereas the best cooperative insurance groups under lay control have suc­
ceeded in establishing standards over the opposition of the medical profes­
sion” (pp. 7 f.).

none of the checks against the abuse of that power. (And yet, as
the British physician, Lord Horder, pointed out in a recent ad­
dress, only the doctors really know what is good, and what is not
good, medicine.) Ewing, in rejecting voluntary insurance, con­
cludes that three factors, the inadequacy of benefits offered, of the
number of people covered, and of the distribution of coverage, out­
balance all others.6
THE NEGATIVE SIDE

Impressive as these arguments may be in theory we cannot over­
look the fact that there are also some serious objections to the pro­
posed measure. Since it would be impossible even to outline them
here in any detail we must be content to summarize them under
three headings : (1) bureaucracy; (2) politics; (3) regimentation.
(1) If the plan were enacted medical authorities say most doc­
tors would choose the fee-basis method of payment. This, naturally,
would require vastly more records and administrative machinery.
Despite the protests of non-interference (like Shakespeare, one
suspects too much protesting here ! ) there would have to be regu­
lations under Federal direction for checking and paying claims.
The load would become so great that the system of compensation
would eventually move to the capitation method, as in Britain.
This practically makes the doctors public functionaries working on
government salary. Physicians say that during the last war they
feared the tyranny of paper work more than bullets, bombs, or dis­
ease. It would, in fact, be impossible for them to look after the
details of administration in addition to their purely professional
duties. The cost of a huge army of officers, investigators, auditors,
and clerks would be added to the budget and the whole project
would fall into the clutches of bureaucracy.
(2) For the abuses which the plan would abolish it would sub­
stitute political control which in turn, would lead to even graver
evils. The handling of government forms, records, and cards nec­
essary for the myriad medical services and drugs required would
not only be a waste of tax money. Past experience indicates the
ever-present danger of graft and corruption. Political control in
medicine is especially dangerous since it places the mass of the
people, who may need medical attention but know little about re6 Cf. Ewing, op- cit., p. 88.

SHOULD WE SUPPORT SOCIALIZED MEDICINE?

91

quirements and results, entirely at the mercy of non-medical dis­
pensers of public health. Consequently some authoritative studies,
such as that contained in the report of the Brookings Institution,
oppose the government health insurance plan as revolutionary and
dangerous, tending to freeze policies and eventually retard medical
progress?
(2) It follows immediately that the result is likely to be regi­
mentation in various forms. The doctor's offices, already over­
crowded, would become veritable assembly lines. One can easily
imagine how hypochondriacs would take advantage of this free
attention!8 The standardization might necessarily extend itself to
diagnosis and prescriptions in some such form as : all those who
suffer from headaches take so-and-so. But headaches can arise
from different causes and the doctor himself would, in all probabil­
ity, suffer most. In short, the service would inevitably tend to be­
come soulless.
TOWARD A SOLUTION

While one naturally tends to admire the idealism manifested by
many proponents of the plan we must be on guard against utopian
dreams. The fact is that complete medical service for all is an ob­
jective extremely difficult to realize. State medicine elsewhere has
worked no miracles. It is one thing to admit that the nation’s health
is in serious condition (although it is not as deplorable as some­
times described since about 80 per cent of the people receive good
medical care) but it is quite another to claim that only a compul­
sory system can provide a satisfactory solution.9 It is recognized
that, generally speaking, the rich and the poor fare well enough
in this respect. It is a question mainly of providing for middle­
income families and for rural districts. The leaks and gaps in the
present system certainly require attention but the system itself need
not necessarily be scrapped. Nationalization means getting things
the hard way. It is like taking over a hotel simply because you
can’t get a room for the night !
7Cf. G. W. Bachman and Lewis Merriam, The Issue of Compulsory Health
Insurance (Washington, D. C., 1948).
8 In Britain a nominal charge per visit has been recently imposed on each
patient in an effort to prevent this.
9 According to Ewing every year 325,000 die who could be saved by exist­
ing knowledge and skills. Cf. op. cit., p. 1.

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THE AMERICAN ECCLESIASTICAL REVIEW

We have already seen the general principles governing Catholic
thought in this matter.10 The government charged with promoting
the general welfare certainly has some responsibility for the main­
tenance of proper health standards.11 Therefore it should supply
help where needed and it has, in fact, been doing this. To supple­
ment the present aid, the American Medical Association, at its 1949
Convention, offered to sponsor a twelve-point health program.
This would set up an independent national health agency, establish
a national science foundation, and encourage rapid extension of
voluntary hospital and medical care insurance. In addition, it rec­
ommends the establishment of a medical care authority in each
State to administer and distribute government funds as well as ex­
tension of hospital and diagnostic facilities and the expansion of
public health education.
The Catholic tradition, here or elsewhere, is that the function of
government is to aid and encourage but not to replace and control.
It shall step in only when individuals and voluntary groups fail to
do the job. Universal well-being is not to be expected from the
State’s activity, says Pope Pius XI :
Just as it is gravely wrong to take from individuals what they ac­
complish by their own initiative and industry and give it to the com­
munity, so also it is an injustice and at the same time a grave evil and
disturbance of right order to assign to a greater and higher association
what lesser and subordinate organizations can do. For every social
activity ought of its very nature to furnish help to the members of the
body social, and never destroy or absorb them.12

Therefore, as in the case of education and in economic matters,
health is not the primary responsibility of the government.
10 Cf. “Nationalization and the Catholic Tradition,” AER, CXXII, 1 (Jan.
1950).
11 It is not so much the principle of taxation for health insurance which is
opposed as the monopoly which would result under the government system.
Cf. A Voluntary Approach to a National Health Program (St. Louis, Mo.:
The Catholic Hospital Association), p. 8.
12 Quadragesimo anno, New Translation. (Washington, D. C. : National
Catholic Welfare Conference, 1942), par. 79. This warning of the Holy
Father was literally verified recently when the Royal Commission on Popu­
lation urged the British Government to give free advice on birth control under
the National Health Service.

SHOULD WE SUPPORT SOCIALIZED MEDICINE?

93

The Church has as its long range objective the creation of a new
society in which the emphasis will be on having less needy for the
benefits than more benefits for the needy. Meanwhile it is realistic
enough to recognize that something must be done immediately to
patch up the evils of the existing order. Hence its advocacy of a
family wage. As far back as 1919 the Bishop's Program for the
United States stipulated that “wages should be high enough to
make possible that amount of saving which is necessary to protect
the worker and his family against sickness, accident, invalidity and
old age.” It is interesting also that the Hierarchy adds that “those
women who are engaged in the same tasks as men should receive
equal pay for equal service.”
Pope Pius XI in Atheistic Communism insists that
Social justice cannot be said to have been satisfied as long as workers
are denied a salary that will enable them to secure proper sustenance for
themselves and their families ... as long as they cannot make suitable
provision through public and private insurance for old age, for periods
of illness and unemployment.13

The present Holy Father is even more specific. In his address to
the Italian workers in 1944 he asks for a salary which will not
only be sufficient to cover the living expenses of a family but which
will make it possible to rear healthy, nourished children as well as
to foresee and forestall times of stress, sickness, and old age. The
State, whose duty it is to promote the common good should supply
support “through social institutions such as insurance and social
security societies.”
In line with this general philosophy three important Catholic
agencies, the NCWC Bureau of Health and Hospitals, the National
Conference of Catholic Charities, and the Catholic Hospital Asso­
ciation have made public a statement called A Voluntary Approach
to a National Health Program. The statement, which warns against
the monopoly that would inevitably result from a government sys­
tem of compulsory health insurance wisely notes that “a right ap­
proach to the problem depends not only on a correct analysis of the
concrete situation, but also on a correct social philosophy.”
13Divini Redemptoris, in Five Great Encyclicals (New York: The Paulist
Press, 1939), p. 196.

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THE AMERICAN ECCLESIASTICAL REVIEW

Bishop Karl J. Alter, in a foreword, describes the discussion as
revolving in large part around the issue of an exclusive and com­
pulsory government health system versus private and voluntary
efforts supported by government assistance instead of control.
“Many competent authorities fear that an exclusive state system
under a compulsory tax will necessarily involve a loss of freedom
for the voluntary health agencies and put an end to private initia­
tive to the ultimate detriment of the health of the nation.”14 Society,
he says, is a much broader concept than the State which, indeed, has
a definite responsibility; but voluntary agencies also have a right
“to exercise an important function in planning as well as executing
such a program. Monopoly means control ; partnership means
freedom.”
The Catholic program is based on the principle of subsidiarity
mentioned in our previous article. With a view to safeguarding
moral and social principles which should underlie the problem of
national health as well as the proper autonomy of hospitals and
professional groups it is recommended that a division of health be
created within the Federal Security Administration composed of
nine members ; three physicians, three hospital administrators (one
a nurse), and three representatives of the public. Similar health
councils should also be established at state and local levels. This
program would also cover dentists, nurses, practical nurses, and
other professional personnel. It is unnecessary to elaborate further
on it here as the details are easily available. The main advantage
from our point of view is that “under localized sponsorship and
administration, health care by pre-payment of cost on a universal
basis could be obtained by all residents of a state. At the same time,
there would be developed a strong incentive to utilize the volun­
tary systems and extend this coverage.”1®
For the sake of brevity and clarity we shall conclude with the
following observations from the Catholic point of view :
14 Cf. A Voluntary Approach etc. Foreword by Bishop Alter, pp. 3 f.
15 Ibid., p. 19. Cf. also, in reference to combining public and private action
in a democratic society, Voluntary Social Services: Their Place in the Mod­
ern State, edited by A. F. C. Bourdillon (London Methuen and Co., Ltd.,
1945).

(1) Physical health, important though it be, is not the highest
good. If it were we might ask—even on the purely human level —
why nearly a million of our citizens, the flower of our manhood,
were but recently sacrificed on the battlefields of the world? It
was, of course, a recognition of the fact that there are certam prin­
ciples the defense of which is more important than human health
or even life itself. Incidentally, if only the untold millions now
lavished on the race for armaments and weapons of destruction
could be channelled into a universal health program we might
succeed in creating, if not a brave new world, at least one that
would be, under God, reasonably strong and free.
(2) We must not blindly oppose every co-operative endeavor
for mass health protection. Instead, however, of authoritarian,
over-centralized plans for a Federally dominated organization with
a top-heavy bureaucracy we favor a decentralized national health
program which, based on sound principles and recognizing the ele­
mentary rights of every citizen, is at the same time dynamic in the
sense of being responsive to local and changing community needs.
This is in accordance with the thoroughly American and Catholic
tradition of Federal, State and community co-operation and is the
best check for “the frightful impersonality of the centrifugal forces
that make for socialism.”
(3) There is involved here also, in addition to the democratic
method of approach, a proper philosophy of the human person.
Scholastic psychology, as distinct from Platonism, will permit no
complete divorce between the soul and the body. It is, therefore,
an over-simplification to assign temporal aspects to the State and
spiritual to the Church. Their interests necessarily overlap in the
sense that the latter is concerned with physical health—witness, for
example, the effects of Extreme Unction—and the former ought to
be anxious to promote the virtues without which good citizenship
is impossible. Besides, the body is the temple of the Holy Spirit.
Therefore it is more than a matter of costs and organization. It is
the spirit that vivifies. One thinks in this connection of Mr. Doo­
ley’s famous dictum : “Hinnissy, if the Christian Scientists had
more science or the doctors more Christianity you’d be safe with
either provided you had a good nurse.” Caritas Christi urget nos.
We must try to re-orient the present outlook more in terms of
total well-being which includes the eternal. The surest curb for

96

THE AMERICAN ECCLESIASTICAL REVIEW

the totalitarian potentials latent in so many contemporary move­
ments is to stress anew the final indestructibility of the human per­
son inherent in the true Christian notion of immortality.

Msgr. William J. McDonald
The Catholic University of America
Washington, D. C,

Fifty Years Ago
The Leading article in The American Ecclesiastical Review for Feb­
ruary, 1900, is a lengthy review of a work by Fr. E. Dubois, C.SS.R.,
entitled De Exemplarismo Divino. The author of the review has given
his article the heading : “A Recent Encyclopaedia of Theology.” The
purpose of the work in question is to point out that God, in the Trinity
of Persons, is the efficient, exemplary and final cause of all reality.
Fr. Siegfried praises the book highly, designating it as a “modern
Summa." . . . Fr. C. Coppens, S.J., defends an article which he had
contributed to the December, 1899, issue, denouncing Freemasonry in
the United States as hostile to the Catholic Church. He derives his
information mostly from the writings of Albert Pike, whose life he
summarizes in this present article. . . . This issue carries another in­
stalment of Luke Delmege, from the pen of Canon Sheehan, of Ireland.
. . . Fr. A. Kroll contributes an article in praise of the virtue of
eutrapelia, intended to encourage especially among priests the spirit
of gaiety and cheerfulness. ... In the Analecta appears a letter from
Pope Leo XIII to Msgr. William H. O’Connell, Rector of the American
College in Rome, congratulating the College on its fortieth anniversary.
. . . The Conference section contains a response of the Sacred Congre­
gation of the Inquisition, given in 1869 to the Archbishop of Quebec,
and recently republished in the Analecta Ecclesiastica. He had asked
if a previous decree, issued for England, requiring the integral con­
fession of sins on the part of converts being rebaptized conditionally,
was a universal law; and the answer was in the affirmative. . . . There
is also a letter from an irate subscriber, complaining that a question he
had submitted had not been answered after four months, and demanding
that his name be taken from the roll of the subscribers. The editor’s
answer states that the Review gives no guarantee that all questions will
be answered, either in print or by letter.

F. J. C.

RECENT DOGMATIC THEOLOGY
Undoubtedly, the most important and significant theological con­
troversy that has arisen in recent years is that which centers around
the relation between the natural and the supernatural. This con­
troversy was occasioned by a book entitled Surnaturel, written by
Fr. Henry de Lubac, S.J.1 The work is intended primarily as an
historical study of the meaning of the sujærnatural. Yet the author
devotes considerable space to the explanation and the defense of his
theological ideas. The fundamental theme of Fr. de Lubac is that
the beatific vision, though it is supernatural, is the normal and only
possible destiny of an intellectual being. Man can therefore have
an absolute—not merely conditional—desire of supernatural beati­
tude as something to which his nature is destined. However, since
de facto the attainment of this goal surpasses the natural powers
of man, the desire of the beatific vision is inefficacious with respect
to man’s own abilities. But God freely grants man the means of
arriving at his end, supernatural grace. Fr. de Lubac believes that
in this manner the doctrine of the gratuity of grace is sufficiently
safeguarded. A state of pure nature, in which man would be des­
tined to a merely natural end he believes to be impossible. And he
holds that this concept of the supernatural expresses the mind of
St. Thomas and actually represents the true and traditional Catho­
lic thought.
Confronted with the fact that the Church condemned certain
propositions of Baius which seem to be identical with his denial of
the possibility of a state of pure nature,2 Fr. de Lubac contends
that the error of Baius consisted in the theory that man in his primi­
tive state of innocence was not dependent on the bounty of God,
and had rights in commutative justice to supernatural gifts which
God bestowed on him. There is no proposition in the list of those
condemned by the Church, he says, whose contradictory asserts the
possibility of an order in which man would have a purely natural
end. It was the notion of a debitum, a strict obligation on the part
of God toward man, that Pope Pius V condemned in the writings
of Baius.
1 Études Historiques (Paris: Aubier, 1946). Cf. SER, CXVII. 6 (Tune,
1947), 482.
2 Cf. DB, 1021, 1023, 1024, 1026.
97