BY: CHARLES BOUCHARD, OP, STD
Illustration by Roy Scott
All of us would like to see the ministry of Catholic health care as prophetic and oriented to the common good. That should be easy, except for two things. First, the common good is widely misunderstood, and second, prophets have an image problem.
The popular image of a prophet is a wild-eyed, marginal character who promotes extreme and anti-social ways of life. John the Baptist is a perfect example. He wandered around in the wilderness, clothing himself in animal skins and living on bugs. Or we confuse prophecy with foretelling the future, and not in a good way. We dub someone a "prophet of doom" when they are always predicting bad things to come. The prophet Jeremiah was so identified with that notion that the term "jeremiad" entered our vocabulary just to describe a long, plaintive lament that predicted the downfall of society. It is not surprising that we view prophets with skepticism and that "prophetic" has come to be associated with a kind of political extremism that involves demonstrations, confrontation and generally bad news. It is no wonder that prophets, as Jesus said, are not welcome in their own countries.
Biblical scholar Walter Brueggemann has made it part of his vocation to rescue prophecy from these misperceptions.1 Prophets are not future tellers, he says, nor is every prophet a radical social activist. Their message was sometimes harsh, but it was by no means a message of doom. The prophet's job is to reveal God's plan and call us to participate in it, whatever the cost.
In his view, the authentic prophets of the Scriptures were mainly concerned with uprooting what he calls a "royal consciousness." In the time of the classic prophets, and even for Jesus, this consciousness involved actual royalty — kingdoms or rulers who oppressed and persecuted people. For the Jews under Moses, it was Egypt's Pharaoh; for Jeremiah, it was King Zedekiah and the priestly class that opposed him; for Jesus, it was King Herod, the Pharisees and the Sadducees. In each case, royal privilege and power created an interlocking system that favored royalty and wealth and relegated everyone else to cycles of poverty and dependence.
We may not have a monarchy in the U.S., but something like a "royal consciousness" is alive and well in our society. It is marked by collusion among the privileged to secure their own interests, often at the expense of the poor. Brueggemann describes this dynamic as having three aspects: an economics of affluence, in which most of us are well enough off that others' pain is not noticed; a politics of oppression, in which the cries of the marginalized are not heard; and a religion of immanence and accessibility, which means we have domesticated God and stripped God of transcendence. We choose idols or what C.S. Lewis referred to as "kingdom substitutes." God is so present to us, but so minimized, that "his abrasiveness, his absence, his banishment is not noticed, and the problem is reduced to psychology." If God is not transcendent, there is no higher law, no route to appeal. The goal of royal power is to make people numb and superficially satisfied so that they stay in their place. It takes little imagination, Brueggemann says, to see the parallels with our own cultural situation.2
We see interests today that maintain the status quo, widen the gap between rich and poor, penalize minorities, and inequitably distribute basic goods like health care, education and public safety. For the ministry of health care, the contemporary equivalent of the royal consciousness is the market, the power of big business (especially pharma and the insurance industry), and the political influence they wield. The leaders of these organizations all live securely and have easy access to health care and education, so they may not feel the pain of those who lack them.
Brueggemann says that then and now, the "loop of power" limits our vision and leads to a failure of imagination. We become used to the way things are and we can't even see how different things might be. This "royal consciousness" and the structure it creates are complicated and opaque. Most of us could not trace it if we tried, even though we are trapped and victimized by it. These structures short-circuit the common good and, by extension, the Reign of God. They engender a state of numbness that makes us feel as if there is no alternative.
If you doubt this, there are two movies you need to see. The Big Short is a brilliant, humorous and ultimately depressing explanation of how the housing collapse of 2008 occurred. It shows how many financial organizations, including some banks, were able to generate enormous profits for themselves, leading to a mortgage crisis that destroyed the housing market in the process. It leads us step-by-step through the decidedly non-transparent process, pausing for occasional mini-seminars that explain how new and dangerous investment strategies hid the pending disaster.
The Laundromat provides an equally sobering picture that starts with the story of a widow (played by Meryl Streep) being deprived of her rightful insurance payment. It reveals how the leaked Panama Papers uncovered a system of offshore banking that maintains the wealth of "15 million millionaires in 200 countries." In showing things we'd rather not see (like details of human organ trafficking), the film uncovers aspects of how this global "royalty" relies on shell corporations, human exploitation, secrecy and deceit.
These two movies show in detail how the "royal consciousness" functions in our own time. They show exactly what the prophets would denounce.
THE PROPHET AND THE COMMON GOOD
The common good is an antidote to royal consciousness. It focuses on equity rather than personal gain, on participation rather than disenfranchisement, and on the many rather than the few. The Catechism of the Catholic Church defines the common good as the sum total of social conditions that allow people, either as groups or as individuals, to reach their fulfillment more fully and more easily. The common good concerns the life of all.3 I sometimes describe it as those things that we all need, but which none of us can acquire on our own. The common good is second only to the idea of human dignity itself; it is to society what human dignity is to the individual. It is so important that we cannot become fully human unless we are part of a network of relationships that enables us to seek it. Health care providers have a special role in shaping and realizing the common good because health care is such a key element of it.
The common good is an eminently human good. It has social, economic and political dimensions. But it has theological significance, too, in that it foreshadows and to some extent begins to realize the Reign of God in the temporal order.4 The Reign of God was the focus of Jesus' mission: not only did he come to proclaim the Reign of God,5 he is the Reign of God, incarnate.6 Ultimately, the Reign of God will come into its fullness, but this does not mean that we wait around as passive spectators. Like the disciples originally called by Jesus to help bring about this new world, we too are called in baptism to be active participants. Within health care, we have done this largely through political advocacy and our sponsored ministries.
PROBLEMS WITH THE COMMON GOOD
Despite its political and theological importance, the common good, like prophecy, gets a bad rap. It often is regarded with suspicion and even hostility in the secular and political world, especially in the United States. Politicians invoke the concept with caution, and some do their best to avoid it altogether.
There are a number of reasons for this. First, Americans love independence and autonomy, and there is a fear that the common good is code for a massive collectivity that will suppress individual achievement and individual persons who might then be seen as dispensable for purposes of the "greater good." The greater good, however, should never be confused with the common good. Communism or totalitarianism might see individuals as dispensable for the sake of the greater good (i.e., the state), but Catholic social teaching does not. We understand the common good to serve both the group and the individual. Human dignity is inalienable, so no one can ever be dispensable.
Sometimes the common good gets confused with big government, which can threaten individual freedom and diminish the proper role of smaller groups like families and associations. This is a legitimate concern, especially in light of the principle of subsidiarity, which means that matters should be handled at the lowest competent level of an organization in order to maximize participation. For us, however, the common good is not the government or the state, neither of which owns the common good. We the citizens, the whole society, own it or at least steward it. We may use various forms of government to help realize aspects of the common good, but the government is our servant in this, not our master.
Finally, people might think the common good is socialism, which costs too much and involves "free stuff" for people who didn't earn it or who don't deserve it.7 This is a common objection to health care reform, including "Medicare for All" and even Medicaid expansion. Policy analyst and commentator Sally Pipes paints an apocalyptic vision of what universal health care might look like. It might make health care "free," she says, but taxes would skyrocket. There would be no referrals to specialists, no private coverage and health care would be rationed, especially for the elderly. Doctors would become lower-paid employees of the government, the best and brightest would no longer go into medicine and a million people employed in the health insurance industry would lose their jobs.8
These misperceptions of the common good are part of a prosperity myth that tells us hard work and self-reliance are all we need. It is based on a capitalist, consumerist vision of the world where even heath care is understood as product. Brueggemann says the "task of prophetic ministry is to nurture, nourish and evoke a consciousness and perception alternative to the consciousness and perception of the dominant culture around us."9 This requires a "prophetic imagination" that sees the world as it is but refuses to accept it. It means taking hurt seriously, refusing to accept it as normal and natural, but rather as "an abnormal and unacceptable condition for humanness."10 Taking hurt seriously is our mission. Preventing hurt is our prophetic calling. If our ministry is prophetic, it needs to see a different future, enable others to believe it is achievable, and prove that the Reign of God is more than a dream.
PROPHECY, POLITICS AND ADVOCACY
There are some individuals who are graced with a prophetic imagination. Martin Luther King Jr. spoke openly about his dream; many of our founders had an uncommon vision of human dignity. Social activist Dorothy Day, St. Mother Teresa, St. Francis of Assisi, Jesuit and pacifist Daniel Berrigan were all iconic prophets, uncompromising and hard to imitate.
Yet the gift of prophetic imagination is not restricted to saints. Every one of us shares in the prophetic office by virtue of baptism.11 Prophecy is a gift of the Spirit that animates all of our activity for the common good and the Reign of God. Each of us has a personal prophetic call, but the gift of prophecy also extends to our institutional ministries that serve the common good.
Our prophetic efforts toward the common good require a kind of inspirational public preaching which says, "this life is not what God intended." But our preaching can't remain purely inspirational. Our vision and preaching have to take flesh through advocacy and politics.
The Catechism says "Each human community possesses a common good which permits it to be recognized as such; it is in the political community that its most complete realization is found. It is the role of the state to defend and promote the common good of civil society, its citizens, and intermediate bodies" (#1910).
The good news is that we have a political system that can, in principle, deal with inequity and distribute the world's goods in a way that serves the common good. The bad news is that political life is messy and the common good is a moving target that is realized in various ways in different times and places. The difficulty of arriving at consensus about what constitutes human flourishing or "the good life" in a pluralistic society is daunting.
Advocacy and politics play a much bigger role today than they did in the past when health care was primarily a work of charity that involved little public funding. Today Catholic health care is part of a much larger network of providers that all depend to some extent on public funding. Our mission now includes not only clinical considerations and individual patients, but also social determinants like education, economic status, race and climate. These are all aspects of the common good.
Both the Catholic Health Association and the U.S. bishops have policy experts at the federal level. Every state has a Catholic Conference that lobbies on the state level. These policy experts continually fine tune the delicate political structures — laws, rules, regulations and elections — that determine who gets what, how much it will cost and whether the votes are there. They do their best to wring some justice and equity from the complications of a political system that barely tolerates familiar voices, much less prophetic ones.
HOW CAN ADVOCACY BE PROPHETIC?
Stefano Zamagni is an economist from the University of Milan who says we need people "who look ahead and dare to gaze beyond the obstacles to find a way through, who are prophetic. The current economic and social models no longer work. The prophetic economy offers liberation from the old ways of thinking by daring to try out new pathways." This is what Brueggemann means when he talks about the prophetic imagination — not just fine-tuning but re-visioning.
Jeffrey Sachs, an economist at Columbia University, says, "Prophetic economy means an economy that operates in the vision of the prophets and…in the vision of justice, a vision of peace, a vision of meeting the needs of the poorest people, a vision of protecting creation. We need an economy of sustainable development which means an economy in which prosperity is shared, [one] that is socially fair and environmentally sustainable."12
As an international Catholic organization, CHA has a foot in both worlds. We stand in the economic and political reality in which we live, full of balance sheets, bonds and strategic plans. We also stand in the transcendent promise of the Gospels. The common good needs the practical, the political and the prophetic. It needs ethicists, theologians, advocacy experts and economists.
Let me suggest three steps that might help us bridge the gap between the political and the prophetic.
First, we need more sustained conversation among ethicists, advocates and policymakers. Ethicists need to help advocates discern the ethical and "kingdom" dimensions of policy, and advocacy officers need to help ethicists understand the complexity of policy. All of us need to remind our politicians of their primary responsibility for the common good and to demand greater accountability.
Second, we need to implement our entire advocacy agenda more fully. The Catholic Church in the U.S. has a broad agenda, which is outlined in Forming Consciences for Faithful Citizenship: A Call to Political Responsibility. This guide is put out by the U.S. bishops and used by many Catholics in advance of their voting decisions. It includes explicit reference to every important policy issue: human life, peace, marriage and family, ecology, discrimination, immigration, violence and more. Yet in practice, this broad agenda often gets boiled down to a single "pro-life" issue. Catholics who would not dream of dissenting from the church's teaching on unborn life feel perfectly free to oppose immigration, gun control and even religious tolerance. It is hard to be credible about pro-life if we appear to tolerate other kinds of injustice. If the common good has to do with human flourishing, it must include more than just getting born.13
Excessive focus on this aspect of the common good enables others to dismiss us as single-issue, or to see our concerns as merely "religious" rather than the full scale of human dignity and human fulfillment. It also creates the illusion that we can solve the abortion problem by legal interdiction alone. I believe that our most effective pro-life tool is improving social conditions like education, health care and poverty that lead to abortion in the first place.
A PROPHETIC SPIRITUALITY
Finally, all of us need to cultivate a "prophetic spirituality" even if we are deep in the weeds of clinical care or public policy or advocacy.
Religious historian and theologian Philip Sheldrake says we tend to see spirituality as private and otherworldly, but he says it is more than that.14 He quotes the great scholar of mysticism, Evelyn Underhill, who says, "The defining characteristic of Christian mysticism is that union with God impels a person towards an active, outward, rather than purely passive inward life." He also notes that "all sanctification, all inner transformation, is ultimately for the sake of transformative action and redemptive practice in society." The mystical contemplative life is "not carried out only in the sacred space of prayer, or in the sacred precinct of the church … it also finds its place in political and social practice."15
Asceticism is necessary, too, because commitment to any noble endeavor requires self-sacrifice. The Jewish scholar Abraham Heschel says that the fundamental experience of a prophet is a "fellowship with the feelings of God, a sympathy with the divine pathos … the prophet hears God's voice and feels it in his heart."16 This means that prophets need to develop a deep interior life, but not a private interior life. Because humans are essentially social, and because the "purpose of human conduct is to have an effect on others rather than to be primarily ascetical," prophetic spirituality must have an outward focus.
Holding spirituality, contemplation and political life together is not easy. My own religious community, the Dominicans, was founded in the 13th century and sought to foster a contemplative life in the city rather than in the rural monasteries that were the norm at the time. Many thought this was a crazy idea that would never work. In the 800 years since we were founded, we have had our struggles and pushed this unlikely charism to the limit many times. But we are still here.
Policymakers, too, are "in the city" with all the actual and political noise urban life suggests so they too need the stability and centeredness of the contemplative and the mystic. They need political skill as well as a prophetic imagination to keep them focused on the Common Good, God's own self, who is our ultimate destination.
FR. CHARLES BOUCHARD is senior director, theology and sponsorship, the Catholic Health Association, St. Louis.
- Walter Brueggemann, The Prophetic Imagination, 40th Anniversary Edition (Minneapolis: Fortress Press, 2018) 31, 35.
- Brueggemann, The Prophetic Imagination, 35-36.
- The Catechism outlines three essential aspects of the common good: First, respect for the person as such. In the name of the common good, public authorities are bound to respect the fundamental and inalienable rights of the human person; second, the social well-being and development of the group itself. Development is the epitome of all social duties; finally, the common good requires peace, that is, the stability and security of a just order. (CCC, #1907-1910)
- See, for example, David Hollenbach, The Common Good and Christian Ethics (Cambridge, England: Cambridge University Press, 2002): "The terrestrial common good of human society is thus analogous to the full communion of the Trinity and to the full union with God and neighbor that Christians hold will be a gift of divine grace in heaven," 132; and "For the communion of the Kingdom of God can have an anticipatory, though incomplete, presence in the political sphere just as it can in friendships, family life, and other terrestrial communities," 135.
- See Luke 8:1, 4:43; Matthew 4:17, 9:35.
- See Benedict T. Viviano, "The Kingdom of God in Albert the Great and Thomas Aquinas," The Thomist 44, no. 4 (October 1980) 502-22. Viviano points out that the early Christian scholar Origen held that "the kingdom was identical with Jesus himself," the "self-kingdom," 503.
- In the 2016 presidential campaign Jeb Bush implied that Democrats were luring black voters with promises of "free stuff," presumably including health care. See Charles Blow, "Jeb Bush, Free Stuff and Black Folks," The New York Times, September 28, 2015, https://www.nytimes.com/2015/09/28/opinion/charles-m-blow-jeb-bush-free-stuff-and-black-folks.html. Sally Pipes, a columnist and commentator, appeared on the Bob Zadek Show on August 15, 2019 in a segment entitled, "The High Cost of Free Stuff," http://www.bobzadek.com/past-shows/2019/6/20/public-option-single-payer-medicare-for-all.
- Pipes is the author of The False Promise of Single Payer Healthcare (New York: Encounter Books, 2018) and False Premise, False Promise: The Disastrous Reality of Medicare for All (New York: Encounter Books, forthcoming 2020).
- Brueggemann, The Prophetic Imagination, 3.
- Brueggemann, The Prophetic Imagination, 85.
- "The holy people of God has a share, too, in the prophetic office of Christ, when it renders [us] living witnesses, especially through a life of faith and charity." Documents of the Second Vatican Council, Lumen Gentium, 12.
- Stefano Zamagni and Jeffrey Sachs are both part of Prophetic Economy (www.propheticeconomy.org), an intergenerational and international assembly of thinkers who want to raise up current prophetic economy actions and imagine new ones. These quotes are taken from talks given at the 2018 conference in Italy.
- Efforts to place more weight on other aspects of our policy agenda, notably by Cardinal Blase Cupich of Chicago, were rejected by the U.S. bishops at their November 2019 meeting.
- Philip Sheldrake, "Christian Spirituality as a Way of Living Publicly: A Dialectic of the Mystical and Prophetic," Spiritus 3 (2003) 19-37, at 19, quoting Archbishop Rowan Williams. This idea of spirituality as private and having little to do with political life (or prophecy, for that matter) has a long history, perhaps going back as far as Augustine, whose views may have led Christians to regard the public and political life with suspicion. Sheldrake, 20.
- Evelyn Underhill, Mysticism: The Nature and Development of Spiritual Consciousness (Oxford/One World, 1993) 172, quoted by Sheldrake on 24; the second quote is from John Eagan, "The Mystical and the Prophetic: Dimensions of Christian Existence," The Way Supplement (2002) 92-106, Sheldrake on 25; third quote from liberation theologian Leonardo Boff, "The Need for Political Saints," Cross Currents 30, no. 4 (Winter 1980-81) 371.
- Abraham Heschel, The Prophets (New York: Harper and Row 1969) 1:26. Cited in Ormond Rush, "The Prophetic Office in the Church," in When the Magisterium Intervenes: The Magisterium and Theologians in the Church, ed. Richard Gaillardetz (Collegeville, Liturgical Press, 2012): 100.