I am referring to the increasing number of US hospital mergers between Catholic missions-driven not-for-profit hospitals and secular hospitals. This hospital merger phenomenon has been happening for years, but is picking up speed in large and small cities—and even rural communities—across the country. Most health policy wonks attribute this uptick in hospital mergers to health care reform measures, which have increased hospital accountability for Medicare and Medicaid expenditures. Hospital systems are under more pressure to perform well, and following basic economic principles, the hospitals want to gain larger and larger market share by gobbling up competitors. It has happened here in Seattle, with Providence Health and Services (Catholic) merging with Swedish Medical Center/Health Services (secular). In this case, Swedish was the smaller fish (pun intended), and is now a division of Providence. Swedish has agreed to stop performing abortions, but is trying to staunch the outcry by funding a new (and not needed) Planned Parenthood office near the hospital. My family doctor is a part of the Swedish Medical System. I’m going  elsewhere in protest.

There are close to 600 Catholic charity hospitals in the US and they are all explicitly Catholic missions. That means they ‘do’ hospital care as an extension of their Catholic faith, as a way to evangelize through the provision of health care.  In their book God Is Back: How the Global Revival of Faith is Changing the World, Micklethwait and Wooldrige point out that in a decidedly Protestant young America, Catholicism had to fight for its market share of the faithful. The Catholic Church did this by developing a private welfare state in the US, complete with hospitals and schools. There are other religiously affiliated hospitals in the US (New York-Presbyterian is perhaps at least historically), but Catholic hospitals account for close to 80% of all such hospitals. In addition, Catholic hospitals are alone in working under special “Religious and Ethical Directives for Health Care Services.” These directives include bans on the provision of contraceptives (including condoms), sterilization, infertility treatments, abortion services, or end-of-life decision-making by patients. These bans fall disproportionately on the backs of poor, uninsured women who rely on charity-care hospitals. When Catholic hospitals merge with secular hospitals, the Catholic hospitals insist on contract clauses whereby the secular hospital has to abide by the Catholic religious/ethical directives.

Catholic leaders take their Religious and Ethical Directives for Health Care Services very seriously, going so far as to excommunicate a nun, nurse Margaret McBride, for being part of a hospital decision to allow an abortion in order to save a mother’s life. This happened in Phoenix, Arizona in 2009 when McBride was an administrator at St. Joseph’s Hospital and Medical Center. It involved a young woman with life-threatening pulmonary hypertension who was 11 weeks pregnant. If she had not had an emergency pregnancy termination, the young woman would have died.

I am all for religious freedom, and I even support—to a point—conscience exclusions for health care providers. But I also believe that the separation of church and state goes both ways—not only protecting the church/religion from the bully-power of the state, but also the state (government and civil society) from the bully-power of the church. Medicare and Medicaid account for over half of the total funding for Catholic hospitals. In addition, they (the Catholic hospitals) enjoy benefits such as tax-exempt status and low-cost financing through government bonds programs. In some cases they even enjoy free use of municipal buildings. Perhaps it is time to re-think those arrangements.

(The statue of Jesus included in this post is Christ the Divine Healer, an 11 foot marble statue in the foyer of the original hospital building at Johns Hopkins (a Quaker). When I went there it was still a ritual for patients, family members and students to touch Jesus’ big toe for luck, blessing, whatever you wanted to call it. It was a well-worn toe….)