Health care reform is for the most part governmental policy that affects health care delivery in a given place. Health care reform typically attempts to:
Expand the array of health care providers consumers may choose among
Improve the access to health care specialists
Improve the quality of health care
Give more care to citizens
Decrease the cost of health care
Frameworks for health care reform
While
final performance goals are largely agreed upon, different frameworks
suggest different intermediate goals, such as equity, productivity,
safety, innovation, and choice.
Framework
Intermediate Goals
Control knobs framework
Efficiency, Access, Quality
Framework for assessing behavioural healthcare
Effectiveness, Efficiency, Equity
EGIPSS model
Productivity, Volume of care and services, Quality of care and services
WHO Performance framework
Access, Coverage, Quality, Safety
Commonwealth Fund framework
High-quality care, Efficient care, Access, System and workforce innovation and improvement
WHO Building Blocks Framework
Access, Coverage, Quality, Safety
Systems Thinking
Equity, Choice, Efficiency, Effectiveness
Control knobs theory
The five control knobs for health-sector reform
In "Getting Health Reform Right: A Guide to Improving Performance and Equity," Marc Roberts, William Hsiao, Peter Berman, and Michael Reich of the Harvard T.H. Chan School of Public Health
aim to provide decision-makers with tools and frameworks for health
care system reform. They propose five "control knobs" of health reform:
financing, payment, organization, regulation, and behavior. These control knobs refer to the "mechanisms and processes that reformers can adjust to improve system performance".
The authors selected these control knobs as representative of the most
important factors upon which a policymaker can act to determine health
system outcomes.
Their method emphasizes the importance of "identifying goals
explicitly, diagnosing causes of poor performance systematically, and
devising reforms that will produce real changes in performance".
The authors view health care systems as a means to an end. Accordingly,
the authors advocate for three intrinsic performance goals of the
health system that can be adjusted through the control knobs. These
goals include:
Health status: This goal refers to the overall health of
the target population, assessed by metrics such as life expectancy,
disease burden, and/or the distribution of these across population
subgroups.
Customer satisfaction: This goal is concerned with the degree of satisfaction that the health care system produces among the target population.
Financial risk protection: This goal refers to the health
system's ability to protect the target population from the financial
burden of poor health or disease.
The authors also propose three intermediate performance measures,
which are useful in determining the performance of system goals, but are
not final objectives. These include:
Efficiency:
Technical efficiency: maximum output per unit cost
Allocative efficiency: a given budget maximises health system user satisfaction or other defined goals
Access: effective availability by which patients receive care
Quality of care: consideration of both the average quality and distribution of quality
The five proposed control knobs represent the mechanisms and
processes that policy-makers can use to design effective health care
reforms. These control knobs are not only the most important elements of
a healthcare system, but they also represent the aspect that can be
deliberately adjusted by reforms to affect change. The five control
knobs are:
Financing, which encompasses all the mechanisms
and activities designed to raise money for the health system. With
respect to mechanisms, the financing knob includes health-related taxes,
insurance premiums and out-of-pocket expenses among others. Activities
refers to the institutional organization that collects and distributes
finance to participants in the health sector. In other words, financing
is about the resources available to the healthcare system, who controls
them and who receives them. The financing knob has clear implications
for the health status of the population and particular groups in it, as
well as the access to health care and protection from financial risk
that these groups, and the population as a whole, have. The financing
knob involves numerous potential financing mechanisms and processes that
should be selected in accordance with a country's social values and
politics.
Payment refers to the mechanisms and processes through
which the health system or patients distribute payments to providers,
including fees, capitation and budgets on the part of the government and
fees paid by patients. Payment is about the distribution of available
resources to the providers of health services. Health care reform can
implement a variety of incentive schemes for both providers and patients
in a way to optimize limited resources.
Organization of the health system refers to the
structure of providers, their roles, activities and operations.
Essentially, organization describes how the health care market is set
up: who are the providers, who are the consumers, who are the
competitors, and who runs them. Changes in the organization of a
healthcare system happen at multiple levels at both the front-line and
managerial level.
Regulation refers to actions at the state level that
modify or alter the behavior of various actors within the health care
system. The actors may include health care providers, medical
associations, individual consumers, insurance agents, and more.
Regulations are only effective when enforced, therefore laws that are
"on the books" but are not implemented in practice have little effect on
the system as a whole.
Behavior of healthcare actors includes actions of both
providers (e.g., doctors' behavior) and patients (e.g., anti-smoking
campaigns) and involves "changing individual behavior through
population-based interventions".
Healthcare reform with respect to behavior revolves around the
behaviors that can be used to improve the outcomes and performance of
the health care system. These behaviors include health-seeking behavior, professional/doctors' behavior, treatment compliance, and lifestyle and prevention behaviors.
Limitations
The
five control knobs of health care reform are not designed to work in
isolation; health care reform may require the adjustment of more than
one knob or of multiple knobs simultaneously. Further, there is no
agreed-upon order of turning control knobs to achieve specific reforms
or outcomes. Health care reform varies by setting and reforms from one
context may not necessarily apply in another. The knobs interact with
cultural and structural factors that are not illustrated within this
framework, but which have an important effect on health care reform in a
given context. Rather than a prescriptive proposal of recommendations,
the framework allows users to adapt their analysis and actions based on
cultural context and relevance of interventions.
One key component to healthcare reform is the reduction of healthcare
fraud and abuse. In the U.S. and the EU, it is estimated that as much
as 10 percent of all healthcare transactions and expenditures may be
fraudulent.
Comparison between countries
As
evidenced by the large variety of different healthcare systems seen
across the world, there are several different pathways that a country
could take when thinking about reform. In comparison to the UK, physicians in Germany have more bargaining power through professional organizations (i.e., Medical association); this ability to negotiate affects reform efforts.
Germany makes use of sickness funds, which citizens are obliged to join
but are able to opt out if they have a very high income (Belien 87).
The Netherlands used a similar system but the financial threshold for
opting out was lower (Belien 89). The Swiss, on the other hand use more
of a privately based health insurance system where citizens are
risk-rated by age and sex, among other factors (Belien 90).
In the United States, the debate regarding health care reform includes questions of a right to health care, access, fairness, sustainability, quality and amounts spent by government. The mixed public-private health care system in the United States is the most expensive in the world, with health care costing more per person than in any other nation, and a greater portion of gross domestic product (GDP) is spent on it than in any other United Nations member state except for East Timor (Timor-Leste).
Hawaii and Massachusetts
Both Hawaii and Massachusetts
have implemented some incremental reforms in health care, but neither
state has complete coverage of its citizens. For example, data from the
Kaiser Family Foundation shows that 5% of Massachusetts and 8% of Hawaii
residents are uninsured. To date, The U.S. Uniform Law Commission, sponsored by the National Conference of Commissioners on Uniform State Laws has not submitted a uniform act or model legislation regarding health care insurance or health care reform.
Healthcare was reformed in 1948 after the Second World War, broadly along the lines of the 1942 Beveridge Report, with the creation of the National Health Service or NHS. It was originally established as part of a wider reform of social services and funded by a system of National Insurance, though receipt of healthcare was never contingent upon making contributions towards the National Insurance Fund.
Private health care was not abolished but had to compete with the NHS.
About 15% of all spending on health in the UK is still privately funded
but this includes the patient contributions towards NHS provided
prescription drugs, so private sector healthcare in the UK is quite
small. As part of a wider reform of social provision it was originally
thought that the focus would be as much about the prevention of
ill-health as it was about curing disease. The NHS
for example would distribute baby formula milk fortified with vitamins
and minerals in an effort to improve the health of children born in the
post war years as well as other supplements such as cod liver oil and
malt. Many of the common childhood diseases such as measles, mumps, and
chicken pox were mostly eradicated with a national program of vaccinations.
The NHS has been through many reforms since 1974. The Conservative Thatcher
administrations attempted to bring competition into the NHS by
developing a supplier/buyer role between hospitals as suppliers and
health authorities as buyers. This necessitated the detailed costing of
activities, something which the NHS had never had to do in such detail,
and some felt was unnecessary. The Labour Party generally opposed these changes, although after the party became New Labour, the Blair government
retained elements of competition and even extended it, allowing private
health care providers to bid for NHS work. Some treatment and
diagnostic centres are now run by private enterprise and funded under
contract. However, the extent of this privatisation of NHS work is still
small, though remains controversial. The administration committed more
money to the NHS raising it to almost the same level of funding as the
European average and as a result, there was large expansion and
modernisation programme and waiting times improved.
The government of Gordon Brown proposed new reforms
for care in England. One is to take the NHS back more towards health
prevention by tackling issues that are known to cause long term ill
health. The biggest of these is obesity and related diseases such as
diabetes and cardio-vascular disease. The second reform is to make the
NHS a more personal service, and it is negotiating with doctors to
provide more services at times more convenient to the patient, such as
in the evenings and at weekends. This personal service idea would
introduce regular health check-ups so that the population is screened
more regularly. Doctors will give more advice on ill-health prevention
(for example encouraging and assisting patients to control their weight,
diet, exercise more, cease smoking etc.) and so tackle problems before
they become more serious. Waiting times, which fell considerably under
Blair (median wait time is about 6 weeks for elective non-urgent
surgery) are also in focus. A target was set from December 2008, to
ensure that no person waits longer than 18 weeks from the date that a
patient is referred to the hospital to the time of the operation or
treatment. This 18-week period thus includes the time to arrange a first
appointment, the time for any investigations or tests to determine the
cause of the problem and how it should be treated. An NHS Constitution
was published which lays out the legal rights of patients as well as
promises (not legally enforceable) the NHS strives to keep in England.
Numerous healthcare reforms in Germany were legislative interventions
to stabilise the public health insurance since 1983. 9 out of 10
citizens are publicly insured, only 8% privately. Health care in Germany, including its industry and all services, is one of the largest sectors of the German economy. The total expenditure in health economics of Germany
was about 287.3 billion euro in 2010, equivalent to 11.6 percent of the
gross domestic product (GDP) this year and about 3,510 euro per capita.
Direct inpatient and outpatient care equal just about a quarter of the
entire expenditure - depending on the perspective. Expenditure on pharmaceutical drugs
is almost twice the amount of those for the entire hospital sector.
Pharmaceutical drug expenditure grew by an annual average of 4.1%
between 2004 and 2010.
These developments have caused numerous healthcare reforms since
the 1980s. An actual example of 2010 and 2011: First time since 2004 the
drug expenditure fell from 30.2 billion euro in 2010, to 29.1 billion
Euro in 2011, i. e. minus 1.1 billion Euro or minus 3.6%. That was
caused by restructuring the Social Security Code: manufacturer discount
16% instead of 6%, price moratorium, increasing discount contracts,
increasing discount by wholesale trade and pharmacies.
The Netherlands has introduced a new system of health care insurance based on risk equalization through a risk equalization pool.
In this way, a compulsory insurance package is available to all
citizens at affordable cost without the need for the insured to be
assessed for risk by the insurance company. Furthermore, health insurers
are now willing to take on high risk individuals because they receive
compensation for the higher risks.
A 2008 article in the journal Health Affairs
suggested that the Dutch health system, which combines mandatory
universal coverage with competing private health plans, could serve as a
model for reform in the US.
Following the collapse of the Soviet Union, Russia embarked on a
series of reforms intending to deliver better healthcare by compulsory
medical insurance with privately owned providers in addition to the
state run institutions. According to the OECD
none of 1991-93 reforms worked out as planned and the reforms had in
many respects made the system worse. Russia has more physicians,
hospitals, and healthcare workers than almost any other country in the
world on a per capita basis,
but since the collapse of the Soviet Union, the health of the Russian
population has declined considerably as a result of social, economic,
and lifestyle changes. However, after Putin
became president in 2000 there was significant growth in spending for
public healthcare and in 2006 it exceed the pre-1991 level in real
terms. Also life expectancy increased from 1991 to 1993 levels, infant mortality rate dropped from 18.1 in 1995 to 8.4 in 2008. Russian Prime Minister Vladimir Putin
announced a large-scale health care reform in 2011 and pledged to
allocate more than 300 billion rubles ($10 billion) in the next few
years to improve health care in the country.
Taiwan changed its healthcare system in 1995 to a National Health Insurance model similar to the US Medicare system for seniors. As a result, the 40% of Taiwanese people who had previously been uninsured are now covered.
It is said to deliver universal coverage with free choice of doctors
and hospitals and no waiting lists. Polls in 2005 are reported to have
shown that 72.5% of Taiwanese are happy with the system, and when they
are unhappy, it's with the cost of premiums (equivalent to less than
US$20 a month).
Employers and the self-employed are legally bound to pay National
Health Insurance (NHI) premiums which are similar to social security
contributions in other countries. However, the NHI is a pay-as-you-go
system. The aim is for the premium income to pay costs. The system is
also subsidized by a tobacco tax surcharge and contributions from the
national lottery.
Historians have studied the motivations for anti-Catholicism during the history of the United States. The historian Arthur M. Schlesinger Sr. characterized prejudice against Catholics as "the deepest bias in the history of the American people." The historian John Higham described anti-Catholicism as "the most luxuriant, tenacious tradition of paranoiac agitation in American history".
The historian Joseph G. Mannard says that wars reduced
anti-Catholicism: "enough Catholics supported the War for Independence
to erase many old myths about the inherently treasonable nature of
Catholicism. ... During the Civil War, the heavy enlistments of Irish
and Germans into the Union Army helped to dispel notions of immigrant
and Catholic disloyalty."
American anti-Catholicism originally derived from the theological heritage of the Protestant Reformation and the European wars of religion (16th–18th century). Because the Reformation was based on an effort to correct what was perceived as the errors and excesses of the Catholic Church, its proponents formed strong positions against the Roman clerical hierarchy in general and the Papacy in particular. These positions were held by most Protestant spokesmen in the Thirteen Colonies, including those from Calvinist, Anglican, and Lutheran traditions. Furthermore, English, Scottish, and Scots-Irish identity to a large extent was based on the opposition to Catholicism. "To be English was to be anti-Catholic", writes Robert Curran.
Many of the English colonists who settled in North America during the 17th and 18th centuries, such as the Puritans and Congregationalists, had themselves fled Europe due to religious persecution by the Church of England, whose doctrines and modes of worship they believed to be firmly rooted in Roman Catholicism.
Because of this, much of early American religious culture exhibited the
more extreme anti-Catholic bias of these Protestant denominations. John Tracy Ellis wrote that a "universal anti-Catholic bias was brought to Jamestown in 1607 and vigorously cultivated in all the thirteen colonies from Massachusetts to Georgia."
Colonial charters and laws contained specific proscriptions against
Roman Catholics having any political power. Ellis noted that a common
hatred of the Roman Catholic Church could bring together Anglican and
Puritan clergy and laity despite their many other disagreements.
In 1642, the English colony of Virginia enacted a law prohibiting the entry of Catholic settlers. Five years later, a similar statute was enacted by the Massachusetts Bay Colony. In 1649, the Act of Toleration was passed in the Province of Maryland,
where "blasphemy and the calling of opprobrious religious names" became
punishable offenses, but it was repealed in 1654 and thus Catholics
were outlawed once again. By 1692, formerly Catholic Maryland overthrew
its government, established the Church of England by law, and forced
Catholics to pay heavy taxes towards it. They were cut off from all
participation in politics and additional laws were introduced that
outlawed the Mass, the church's sacraments, and Catholic schools.
Following the passage of the Quebec Act granting Catholic emancipation
and freedom of religion to Catholics in Quebec at the start of the
American Revolutionary War, New Yorkers were angry about it, as they
feared it would spread Catholicism around British North America, particularly in the Anglican colonies. The Act was termed one of the Intolerable Acts which sparked the American Revolution. American Patriot organisations, as a result, designed the George Rex Flag as a symbol of protest against the act and Catholicism. After the Battle of Lexington, people such as Isaac Low made claims that the King had violated his oath by allowing Catholicism in Quebec.
John Adams
attended Vespers on a Sunday afternoon at a Catholic church in
Philadelphia one day in 1774. He praised the sermon for teaching civic
duty, and enjoyed the music, but ridiculed the rituals engaged in by the
parishioners. In 1788, John Jay
urged the New York Legislature to require office-holders to renounce
the pope and foreign authorities "in all matters ecclesiastical as well
as civil," which included both the Catholic and the Anglican churches.
Once the American Revolution was underway and independence was at hand, Virginia, Pennsylvania, and Maryland passed acts of religious toleration in 1776. George Washington,
as commander of the army and as president, was a vigorous promoter of
tolerance for all religious denominations. He believed religion was an
important support for public order, morality and virtue. He often
attended services of different denominations. He suppressed
anti-Catholic celebrations in the Army.
The Patriot reliance on Catholic France for military, financial,
and diplomatic aid led to a sharp drop in anti-Catholic rhetoric.
Indeed, George III replaced the Pope as the "demon" Patriots fought against. Anti-Catholicism remained strong among Loyalists,
some of whom went to Canada after the war while 80% remained in the new
nation. By the 1780s, Catholics were extended legal toleration in all
of the New England states that previously had been so hostile, and the
anti-Catholic tradition of Pope Night was discontinued.
"In the midst of war and crisis, New Englanders gave up not only their
allegiance to Britain but one of their most dearly held prejudices."
19th century
An anti-Catholic cartoon shows the pope's nuncio (ambassador) Archbishop Francesco Satolli in 1894, casting his controlling shadow across the U.S.
In 1836, Maria Monk's Awful Disclosures of the Hotel Dieu Nunnery in Montreal was published. It was a great commercial success and is still circulated today by such publishers as Jack Chick. It was discovered to be a fabrication shortly after publication.
It was the most prominent of many such pamphlets. Numerous ex-priests
and ex-nuns were on the anti-Catholic lecture circuit with lurid tales,
always involving heterosexual contacts of adults—priests and nuns with
dead babies buried in the basement.
Immigration
Anti-Catholicism
reached a peak in the mid nineteenth century when Protestant leaders
became alarmed by the heavy influx of Catholic immigrants from Ireland
and Germany. Some Protestant ministers said that the Catholic Church was the Whore of Babylon who is mentioned in the Book of Revelation.
Propaganda from the American Protective Association,
an anti-Catholic secret society, depicting the pope as the master
decision-maker controlling the White House, Congress, and federal
financial and publishing institutions. (Art from an 1894 book.)"No Catholic Need Apply" job advertisement in The Baltimore Sun, February 14, 1855.
In the 1830s and 1840s, prominent Protestant leaders, such as Lyman Beecher and Horace Bushnell,
attacked the Catholic Church, not just by accusing it of being
theologically unsound, they also accused it of being an enemy of the
nation's republicanism. Some scholars view the rhetoric of Beecher and Bushnell as having contributed to anti-Irish and anti-Catholic attitudes.
Beecher's well-known Plea for the West (1835) urged
Protestants to exclude Catholics from western settlements. The Catholic
Church's official silence on the subject of slavery also garnered the enmity of northern Protestants. Intolerance became more than an attitude on August 11, 1834, when a mob set fire to an Ursuline convent in Charlestown, Massachusetts. However, Catholic cities such as New Orleans and St Louis,
which were founded by French Catholics, did not see anti-Catholicism.
Rather, Catholicism has always had pride of place in these cities which
continues to the modern day. These cities as well as several other towns
on the Mississippi River have always had a majority Catholic
population. The minorities in these cities were English Protestants who
came later. This is why the Catholic churches in these two cities are in
the city center. The minorities in the cities were the WASPS who were
often thrown out of power. Instead, Catholics ruled these cities.
The resulting "nativist" movement, which acquired prominence in
the 1840s, was whipped into a frenzy of anti-Catholicism which led to
mob violence, the burning of Catholic property, and the killing of
Catholics.
This violence was fed by claims that Catholics were destroying the
culture of the United States. Irish Catholic immigrants were blamed for
spreading violence and drunkenness.The nativist movement found its voice in the Know-Nothing Party of the mid-1850s, a short-lived national political movement which (unsuccessfully) ran former president Millard Fillmore as its presidential candidate in 1856.
Nativist, anti-Catholic movements continued with the American Protective Association of the 1890s. This movement began in 1887, in Clinton, Iowa,
to discuss the recent electoral defeat of incumbent mayor Arnold
Walliker, blamed on the organized efforts of Roman Catholics in the
local organized labor movement.
The Association denounced various politicians as Catholic-"controlled",
and claimed credit for aiding Republican electoral victories of the
period.
Famous 1875 editorial cartoon by Thomas Nast depicting Roman Catholic bishops as crocodiles
attacking public schools, with the connivance of Irish Catholic
politicians. Nast was an immigrant from Germany and ex-Catholic.From Klansmen: Guardians of Liberty, 1926
Catholic schools began in the United States as a matter of religious
and ethnic pride and as a way to insulate Catholic youth from the
influence of Protestant teachers and contact with non-Catholic students.
In 1869 the religious issue in New York City escalated when Tammany Hall, with its large Catholic base, sought and obtained $1.5 million in state money for Catholic schools. Thomas Nast's cartoon The American River Ganges (above) shows Catholic Bishops, directed by the Vatican, as crocodiles attacking American schoolchildren.
Republican Minority Leader of the House of Representatives, James G. Blaine
of Maine proposed an amendment to the US Constitution in 1874 that
provided: "No money raised by taxation in any State for the support of
public schools, or derived from any public source, nor any public lands
devoted thereto, shall ever be under the control of any religious sect,
nor shall any money so raised or land so devoted be divided between
religious sects or denominations." President Ulysses S. Grant supported the Blaine Amendment.
He feared a future with "patriotism and intelligence on one side and
superstition, ambition and greed on the other" and called for public
schools that would be "unmixed with atheistic, pagan or sectarian
teaching."
The amendment was defeated in 1875 but would be used as a model for
so-called Blaine Amendments incorporated into 34 state constitutions
over the subsequent three decades. These state-level "Blaine amendments"
prohibit the use of public funds to fund parochial schools.
Sexual themes in literary anti-Catholicism
According to Marie Anne Pagliarini:
The
anti-Catholic literature that appeared during 1830-60 strengthened
Protestant identity and established standards for sexuality. The
literature portrayed Catholicism as a threat to the ideas that comprised
the "cult of domesticity" - family values, gender boundaries, and
sexual norms. In particular it singled out the celibacy of priests as a
sin and violation of the law of nature and assumed men's efforts to
repress their sexual energy would lead inevitably to child abuse,
incest, rape, and murder. The literature claimed that celibate priests,
through their abuse of the confessional and the convent, threatened the
sexual purity of American women.
20th century
A
new appreciation of Catholicism appeared in the early 20th century that
tended to neutralize anti-Catholic sentiments. In the Midwest Jacques Marquette was celebrated as a founding father of the region, with his Catholicism emphasized. In St Louis and New Orleans, both Catholic cities, a focus on the French and Catholic colonial heritage became even stronger.
In California, where Protestantism was not strong, local boosters celebrated the history of Spanish Franciscan missions.
They not only preserved old missions (which had been inactive since
the 1830s) but began appealing to tourists with a romantic mission
story. The mission style became popular for public schools and
non-Catholic colleges.
In the newly acquired Philippines, American government officials,
journalists, and popular writers celebrated the Catholic missionary
efforts that had transformed a "pagan" land, arguing that Filipino
Catholic faith and clerical authority could aid in economic and cultural
development. Future President William Howard Taft, the top American official in Manila, was a leader in the new movement. He gave a speech at the Catholic University of Notre Dame
in Indiana in 1904, and praised the "enterprise, courage, and fidelity
to duty that distinguished those heroes of Spain who braved the then
frightful dangers of the deep to carry Christianity and European
civilization into the far-off Orient." Taft, in 1909, went to California
to praise Father Junípero Serra as an "apostle, legislator, [and] builder" who advanced "the beginning of civilization in California."
Anti-Catholic cartoon depicting the church and the pope as a malevolent octopus, from the H.E. Fowler and Jeremiah J. Crowley's 1913 anti-Catholic book, The Pope: Chief of White Slavers High Priest of Intrigue
The Menace,
a weekly newspaper with a virulently anti-Catholic stance, was founded
in 1911 and quickly reached a nationwide circulation of 1.5 million.
Anti-Catholicism was widespread in the 1920s; anti-Catholics, led by the Ku Klux Klan,
believed that Catholicism was incompatible with democracy and that
parochial schools encouraged separatism and kept Catholics from becoming
loyal Americans. The Catholics responded to such prejudices by
repeatedly asserting their rights as American citizens and by arguing
that they, not the nativists (anti-Catholics), were true patriots since
they believed in the right to freedom of religion.
With the rapid growth of the second Ku Klux Klan (KKK) 1921–25, anti-Catholic rhetoric intensified. The Catholic Church of the Little Flower was first built in 1925 in Royal Oak, Michigan, a largely Protestant town. Two weeks after it opened, the Ku Klux Klan burned a cross in front of the church.
On August 11, 1921, Father James Coyle was fatally shot on his rectory porch in Birmingham, Alabama. The shooter was Rev. E. R. Stephenson, a Southern Methodist Episcopal minister.
The murder occurred just hours after Coyle had performed a wedding
between Stephenson's daughter, Ruth, and Pedro Gussman, an American from
Puerto Rico. Several months before the wedding, Ruth had enraged her
father by converting to Roman Catholicism. Stephenson was defended by Hugo Black, a future Justice of the Supreme Court.
In Alabama, Hugo Black
was elected to the U.S. Senate in 1926 after he had built a political
base in part through his delivery of 148 speeches at local Klan
gatherings, where his focus was the denunciation of Catholicism. Howard Ball characterizes Black as having "sympathized with the [Klan's] economic, nativist, and anti-Catholic beliefs."
As a Supreme Court justice, Black has been accused of letting his
anti-Catholic bias influence key decisions regarding the separation of
church and state. For example, Christianity Today editorialized
that, "Black's advocacy of church-state separation, in turn, found its
roots in the fierce anti-Catholicism of the Masons and the Ku Klux Klan
(Black was a Kladd of the Klavern, or an initiator of new members, in
his home state of Alabama in the early 1920s)." A leading Constitutional scholar, Professor Philip Hamburger
of Columbia University Law School, has strongly called into question
Black's integrity on the church-state issue because of his close ties to
the KKK. Hamburger argues that his views on the need for separation of
Church and State were deeply tainted by his membership in the Ku Klux
Klan, a vehemently anti-Catholic organization.
In 1922, the voters of Oregon passed an initiative amending Oregon Law
Section 5259, the Compulsory Education Act. The law unofficially became
known as the Oregon School Law. The citizens' initiative was primarily
aimed at eliminating parochial schools, including Catholic schools.
The law caused outraged Catholics to organize locally and nationally
for the right to send their children to Catholic schools. In Pierce v. Society of Sisters
(1925), the United States Supreme Court declared the Oregon's
Compulsory Education Act unconstitutional in a ruling that has been
called "the Magna Carta of the parochial school system."
The Klan collapsed in the mid-1920s. It had been denounced by most
newspapers and had few prominent defenders. It was disgraced by scandals
at high levels and weakened by its pyramid scheme
system whereby organizers collected fees and then abandoned local
chapters. By 1930 only a few small local chapters survived. No later
national nativist organization ever achieved even a tiny fraction of the
Klan membership.
In 1928, Democrat Al Smith became the first Roman Catholic to gain a major party's nomination for president, and his religion became an issue during the campaign.
His nomination made anti-Catholicism a rallying point especially for
Lutheran and Southern Baptist ministers. They warned that national
autonomy would be threatened because Smith would be listening not to the
American people but to secret orders from the pope. There were rumors the pope would move to the United States to control his new realm.
Across the country, and especially in strongholds of the
Lutheran, Baptist and Fundamentalist churches, Protestant ministers
spoke out. They seldom endorsed Republican Herbert Hoover, who was a Quaker. More often they alleged Smith was unacceptable. A survey of 8,500 Southern Methodist
ministers found only four who publicly supported Smith. Many Americans
who sincerely rejected bigotry and the Klan justified their opposition
to Smith because they believed the Catholic Church was an "un-American"
and "alien" culture that opposed freedom and democracy.
The National Lutheran Editors' and Managers' Association opposed
Smith's election in a manifesto written by Dr. Clarence Reinhold
Tappert. It warned about "the peculiar relation in which a faithful
Catholic stands and the absolute allegiance he owes to a 'foreign
sovereign' who does not only 'claim' supremacy also in secular affairs
as a matter of principle and theory but who, time and again, has
endeavored to put this claim into practical operation." The Catholic
Church, the manifesto asserted, was hostile to American principles of
separation of church and state and of religious toleration.
Prohibition had widespread support in rural Protestant towns, and
Smith's wet position, as well as his long-time sponsorship by Tammany Hall
compounded his difficulties there. He was weakest in the border states;
the day after Smith gave a talk pleaded for brotherhood in Oklahoma
City, the same auditorium was jammed for an evangelist who lectured on
"Al Smith and the Forces of Hell." Smith picked Senator Joe Robinson, a prominent Arkansas Senator, as his running mate. Efforts by Senator Tom Heflin to recycle his long-standing attacks on the pope failed in Alabama. Smith's strong anti-Klan position resonated across the country with voters who thought the KKK was a real threat to democracy.
When the pro-Smith Democrats raised the race issue against the
Republicans, they were able to contain their losses in areas with black
majorities but where only whites voted. Smith carried most of the Deep
South—long identified with anti-Catholicism-although losing the
periphery. After 1928, the Solid South returned to the Democratic fold.
One long-term result was a surge in Democratic voting in large cities,
as ethnic Catholics went to the polls to defend their religious
culture, often bringing women to the polls for the first time. The
nation's twelve largest cities gave pluralities of 1.6 million to the
GOP in 1920, and 1.3 million in 1924; now they went for Smith by a
razor-thin 38,000 votes, while everywhere else was for Hoover. The surge
proved permanent; Catholics made up a major portion of the New Deal Coalition that Franklin D. Roosevelt assembled and which dominated national elections for decades.
New Deal
President Franklin D. Roosevelt
depended heavily in his four elections on the Catholic vote and the
enthusiasm of Irish-led Democratic machines in most major cities,
especially New York, Boston, Philadelphia, Pittsburgh, St Louis, Kansas
City, Chicago, and Detroit. At the grassroots, Catholic bishops, priests
and pastors gave very strong support to Roosevelt in the New Deal.
On election day Catholic turnout soared and it overlapped heavily with
the rapidly growing labor unions which organized workers to support
Roosevelt. The Gallup poll found 78% of Catholics voted for FDR in 1936.
At the elite level Al Smith and many of Smith's business associates broke with FDR and formed the American Liberty League, which represented big business opposition to the New Deal. Catholic radio priest Charles Coughlin
supported FDR in 1932-1934, but broke with him in 1935 and made
strident attacks. There were few senior Catholics in the New Deal.
Postmaster General James Farley handled patronage and broke with FDR in 1940. He was replaced by another Catholic, Frank C. Walker. Ambassador Joseph P. Kennedy Sr. was on the verge of breaking in 1940 on foreign policy but finally supported FDR in the interest of his sons.
In foreign policy the Catholics demanded American neutrality regarding the Spanish Civil War,
and were joined by isolationists. Liberals wanted Washington to help
the anti-Catholic Loyalist cause, but FDR kept the nation neutral.
The second serious tension arose with the renewed anti-Catholic
campaign in Mexico. American Catholics bitterly attacked Ambassador Josephus Daniels for failing to combat the virulent attacks on the Catholic Church by the Mexican government.
Daniels was a staunch Methodist and worked well with Catholics in the
U.S., but he had little sympathy for the church in Mexico, feeling it
represented the landed aristocracy that stood opposed to his version of
liberalism. For the same reason he supported the Loyalist cause in the
Spanish Civil War, which was even more intensely anti-Catholic. The main
issue was the government's efforts to shut down Catholic schools in
Mexico; Daniels publicly approved the attacks, and saluted virulently
anti-Catholic Mexican politicians. In a July 1934 speech at the American
Embassy, Daniels praised the anti-Catholic efforts led by former president Calles:
General Calles sees, as Jefferson saw, that no people can
be both free and ignorant. Therefore, he and President Rodriguez,
President-elect Cairdenas and all forward-looking leaders are placing
public education as the paramount duty of the country. They all
recognize that General Calles issued a challenge that goes to the very
root of the settlement of all problems of tomorrow when he said: "We
must enter and take possession of the mind of childhood, the mind of
youth."
In 1935, Senator William Borah
of Idaho, the chief Republican specialist on foreign policy, called for
a Senate investigation of anti-Catholic government policies in Mexico.
He came under a barrage of attacks from leading Protestant
organizations, including the Federal Council of Churches, the Episcopal
Church, and the board of foreign missions of the Methodist Church. There
was no Senate investigation. A call for an investigation signed by 250
members of the House was blocked by Roosevelt. The Knights of Columbus
began attacking Roosevelt. The crisis ended with Mexico turning away
from the Calles hard line policies, perhaps in response to Daniels'
backstage efforts. Roosevelt easily won all the Catholic strongholds in
his 1936 landslide.
World War II
World War II was the decisive event that brought religious tolerance
to the front in American life. Bruscino says "the military had
developed personnel policies that actively and completely mixed
America's diverse white ethnic and religious population. The sudden
removal from the comforts of home, the often degrading and humiliating
experiences of military life, and the unit- and friendship-building of
training leveled the man the activities meant to fill time support of in
the military reminded the man of all they had in common as Americans.
Under fire, the men survived by leaning on buddies, regardless of their
ethnicity or religion." After coming home, the veterans helped reshape
American society. Brucino says that they used their positions of power
"to increase ethnic and religious tolerance. The sea change in ethnic
and religious relations in the United States came from the military
experience in World War II. The war remade the nation. The nation was
forged in war."
Mid-1940s
In 1946, the judge David A Rose, called upon Boston's attorney general to investigate anti-Catholic and anti-Jewish alleged activities and publications of the Anglo-Saxon Federation of America.
Elites: Vice President Wallace, Eleanor Roosevelt and Paul Blanshard
At the elite level, tolerance of Catholicism was more problematic. Henry A. Wallace,
Roosevelt's vice-president in 1941–1945, did not go public with his
anti-Catholicism, but he often expounded it in his diary, especially
during and after World War II. He briefly attended a Catholic church in
the 1920s, and was disillusioned by what he perceived to be the
intellectual straitjacket of Thomism.
By the 1940s, he worried that certain "bigoted Catholics" were scheming
to take control of the Democratic Party; indeed the Catholic big city
bosses in 1944 played a major role in denying him renomination as vice
president.
He confided in his diary that it was "increasingly clear" that the
State Department intended "to save American boys lives by handing the
world over to the Catholic Church and saving it from communism."
In 1949, Wallace opposed NATO, warning that "certain elements in the
hierarchy of the Catholic Church" were involved in a pro-war hysteria. Defeated for the presidency in his third-party run in 1948, Wallace blamed the UK's Conservative Party, the Catholic Church, capitalism, and various others forces for his overwhelming defeat.
Eleanor Roosevelt,
the president's widow, and other New Deal liberals who were fighting
Irish-dominated Democratic parties, feuded publicly with church leaders
on national policy. They accused her of being anti-Catholic. In July
1949, Roosevelt had a public disagreement with Francis Joseph Spellman, the Catholic Archbishop of New York, which was characterized as "a battle still remembered for its vehemence and hostility".
In her columns, Roosevelt had attacked proposals for federal funding of
certain nonreligious activities at parochial schools, such as bus
transportation for students. Spellman cited the Supreme Court's decision
which upheld such provisions, accusing her of anti-Catholicism. Most
Democrats rallied behind Roosevelt, and Spellman eventually met with her
at her Hyde Park home to quell the dispute. However, Roosevelt
maintained her belief that Catholic schools should not receive federal
aid, evidently heeding the writings of secularists such as Paul Blanshard. Privately, Roosevelt said that if the Catholic Church gained school aid, "Once that is done they control the schools, or at least a great part of them."
During the Spanish Civil War in the late 1930s, Eleanor Roosevelt favored the republican Loyalists against General Francisco Franco's Nationalists; after 1945, she opposed normalizing relations with Spain.
She told Spellman bluntly that "I cannot however say that in European
countries the control by the Roman Catholic Church of great areas of
land has always led to happiness for the people of those countries." Her son Elliott Roosevelt suggested that her "reservations about Catholicism" were rooted in her husband's sexual affairs with Lucy Mercer and Missy LeHand, who were both Catholics.
Roosevelt's biographer Joseph P. Lash denies that she was anti-Catholic, citing her public support of Al Smith, a Catholic, in the 1928 presidential campaign and her statement to a New York Times
reporter that year quoting her uncle, President Theodore Roosevelt, in
expressing "the hope to see the day when a Catholic or a Jew would
become president".
In 1949, Paul Blanshard wrote in his bestselling book American Freedom and Catholic Power
that America had a "Catholic Problem". He stated that the church was an
"undemocratic system of alien control" in which the lay were chained by
the "absolute rule of the clergy." In 1951, in Communism, Democracy, and Catholic Power, he compared Rome with Moscow as "two alien and undemocratic centers", including "thought control".
In the mid-20th century, the rhetoric of separation was revived
and ultimately constitutionalized by anti-Catholic elites, such
as...Protestants and other Americans United for the Separation of Church
and State...who feared the influence and wealth of the Catholic Church
and perceived parochial education as a threat to public schools and
democratic values.
In the 1950s prejudices against Catholics could still be heard
from some Protestant ministers, but national leaders increasingly tried
to build up a common front against communism and stressed the common
values shared by Protestants, Catholics and Jews. Leaders like Dwight D. Eisenhower emphasized how Judeo-Christian values were a central component of American national identity.
Prominent Protestant spokesmen, led by Billy Graham and Norman Vincent Peale,
organized Protestant ministers by warning that the pope would be giving
orders to a Kennedy White House. Many established Evangelical groups
were mobilized. Two organizations took active roles, the National
Conference of Citizens for Religious Freedom and Protestants and Other Americans United for Separation of Church and State.
Peale was blasted by the media for his anti-Catholicism and retreated,
denying the facts of his organizing role. Graham pushed hard against
Kennedy, keeping Nixon informed of his progress.
To allay such Protestant fears, Kennedy kept his distance from
Catholic Church officials and in a highly publicized speech told the
Protestant ministers of the Greater Houston Ministerial Association on
September 12, 1960, "I am not the Catholic candidate for President. I am
the Democratic Party's candidate for President who also happens to be a
Catholic. I do not speak for my Church on public matters – and the
Church does not speak for me."
He promised to respect the separation of church and state and not to
allow church officials to dictate public policy to him. Kennedy
counterattacked by suggesting that it was bigotry to relegate
one-quarter of all Americans to second-class citizenship just because
they were Catholic. In the final count, the additions and subtractions
to Kennedy's vote because of religion probably canceled out. He won a
close election; The New York Times reported a "narrow consensus" among the experts that Kennedy had won more than he lost as a result of his Catholicism, as Catholics flocked to Kennedy to demonstrate their group solidarity in demanding political equality.
Concern about Catholic power and influence did not disappear with
Kennedy's victory in 1960. Many Protestants would not take the
Democratic candidate at his word. That was still apparent in 1961 and
1962 as the Kennedy Administration navigated treacherous issues like
federal aid to education and Peace Corps
contracts. Only gradually, by living up to his campaign pledges, could
the president appease fears about the Catholic Church's role in
politics. The Second Council of the Vatican
and the sense that the church was reforming itself also helped diminish
bigotry. The rise of more pressing issues – the campaign for racial
equality and the Vietnam War – and the prospect of new political
alliances had the same effect. Anti-Catholicism did not undermine William E. Miller's vice-presidential nomination in 1964 or Robert Kennedy's bid for the Democratic presidential in 1968.
Starting in 1993, members of Historic Adventist splinter groups paid to have anti-Catholic billboards that called the pope the Anti-Christ placed in various cities on the West Coast, including along Interstate 5
from Portland to Medford, Oregon, and in Albuquerque, New Mexico. One
such group took out an anti-Catholic ad on Easter Sunday in The Oregonian, in 2000, as well as in newspapers in Coos Bay, Oregon, and in Longview and Vancouver, Washington. Mainstream Seventh-day Adventists denounced the advertisements. The contract for the last of the billboards in Oregon ran out in 2002.
Philip Jenkins, an Episcopalian
historian, maintains that some who otherwise avoid offending members of
racial, religious, ethnic or gender groups have no reservations about
venting their hatred of Catholics.
In May 2006, a Gallup poll found that 57% of Americans had a
favorable view of the Catholic faith, while 30% of Americans had an
unfavorable view. The Catholic Church's doctrines, and the priest sex
abuse scandal were top issues for those who disapproved. The church's
view on homosexuality, and the celibate priesthood were low on the list
of grievances for those who held an unfavorable view of Catholicism.
A slightly higher unfavorable view of the Catholic Church was the
common preaching of poverty theology which was in stark contrast to the
splendor of the Vatican. While Protestants and Catholics themselves had a
majority with a favorable view, those who are not Christian or are
irreligious had a majority with an unfavorable view.
In April 2008, Gallup found that the number of Americans saying
they had a positive view of U.S. Catholics had shrunk to 45% with 13%
reporting a negative opinion. A substantial proportion of Americans,
41%, said their view of Catholics was neutral, while 2% of Americans
indicated that they had a "very negative" view of Roman Catholics.
However, with a net positive opinion of 32%, sentiment towards Catholics
was more positive than that for both evangelical and fundamentalist
Christians, who received net-positive opinions of 16 and 10%
respectively. Gallup reported that Methodists and Baptists were viewed
more positively than Catholics, as were Jews.
In August 2012, the New York Times reviewed the religion
of the nine top national leaders: the presidential and vice-presidential
nominees, the Supreme Court justices, the House Speaker, and the Senate
majority leader. There were nine Catholics (six justices, both
vice-presidential candidates, and the Speaker), three Jews (all from the
Supreme Court), two Mormons (including the Republican presidential
nominee Mitt Romney) and one African-American Protestant (incumbent President Barack Obama). There were no white Protestants.
The United States Conference of Catholic Bishops
currently maintains a list of anti-Catholic attacks aimed at Catholic
churches in the U.S. From May 2020 to May 2022, they reported that at
least 139 incidents occurred across 35 U.S. states & the District of
Columbia. These included cases of arson, beheaded statues, gravestones
defaced with swastikas, smashed windows, pro-abortion graffiti, theft,
and more having taken place in Catholic churches and buildings.
In 2021, The Wall Street Journal has noted that according to FBI
statistics, anti-Catholic hate crimes have risen in recent years, with
an annual increase since 2013. 73 anti-Catholic documented hate crimes
occurred in 2019, an increase from 64 in 2019, and 51 in 2018.
LGBT
activists and others often target the Catholic Church's teachings on
issues relating to human sexuality, contraception and abortion.
In 1989, members of ACT UP and WHAM! disrupted a Sunday Mass at Saint Patrick's Cathedral
to protest the church's position on homosexuality, sex education and
the use of condoms. The protestors desecrated Communion hosts. According
to Andrew Sullivan, "Some of the most anti-Catholic bigots in America are gay". One hundred eleven protesters were arrested outside the cathedral.
On January 30, 2007, John Edwards' presidential campaign hired Amanda Marcotte as blogmaster. The Catholic League,
a pressure group not affiliated with the Catholic Church, took offense
at her obscenity- and profanity-laced invective against Catholic
doctrine and satiric rants against Catholic leaders, including some of
her earlier writings, where she described sexual activity of the Holy
Spirit and claimed that the church sought to "justify [its] misogyny
with [...] ancient mythology."
The Catholic League publicly demanded that the Edwards campaign
terminate Marcotte's appointment. Marcotte subsequently resigned, citing
"sexually violent, threatening e-mails" she had received as a result of
the controversy.
According to the Jesuit priest James Martin, the U.S. entertainment industry is of "two minds" about the Catholic Church. He argues that:
On the one hand, film and television producers seem to find
Catholicism irresistible. There are a number of reasons for this. First,
more than any other Christian denomination, the Catholic Church is
supremely visual, and therefore attractive to producers and directors
concerned with the visual image. Vestments, monstrances, statues,
crucifixes – to say nothing of the symbols of the sacraments – are all
things that more "word oriented" Christian denominations have foregone.
The Catholic Church, therefore, lends itself perfectly to the visual
media of film and television. You can be sure that any movie about the
Second Coming or Satan or demonic possession or, for that matter, any
sort of irruption of the transcendent into everyday life, will choose
the Catholic Church as its venue. (See, for example, "End of Days," "Dogma" or "Stigmata.")
Second, the Catholic Church is still seen as profoundly "other"
in modern culture and is therefore an object of continuing fascination.
As already noted, it is ancient in a culture that celebrates the new,
professes truths in a postmodern culture that looks skeptically on any
claim to truth, and speaks of mystery in a rational, post-Enlightenment
world. It is therefore the perfect context for scriptwriters searching
for the "conflict" required in any story.
He argues that, despite this fascination with the Catholic Church,
the entertainment industry also holds contempt for the church. "It is as
if producers, directors, playwrights and filmmakers feel obliged to
establish their intellectual bona fides by trumpeting their differences
with the institution that holds them in such thrall."
