Wrong call on faith healing

A U.S. appeals court has upheld a law that provides Medicare and Medicaid reimbursement for the custodial care of individuals undergoing spiritual treatment at Christian Science sanatoria and other "religious nonmedical health care institutions."

Editorial. June 26, 2000.

Maybe there is something to the restorative power of Christian Science. After all, the faith healing sect has kept alive a nonsensical Medicare reimbursement scheme that should have expired years ago.

The payment provision's latest near-death experience was in a St. Paul, Minn., courtroom of the U.S. Eighth Circuit Court of Appeals. By a 2-1 decision, the panel upheld a law that pays Medicare and Medicaid money for the custodial care of individuals undergoing spiritual treatment at Christian Science sanatoria and other -- as if there were any -- "religious nonmedical health care institutions," or RNHCIs.

The estimated $8 million a year that the government gives to support such spiritual treatment may strike some observers as paper-clip money for the gigantic government health programs involved. However, the principles go deep. There is a constitutional requirement to separate church and state. Also at issue is what the "med" in Medicare and Medicaid really stands for.

The provision that allows Christian Science healing centers to get government checks dates back to when the original Medicare bill was passed in 1965. Children's Healthcare Is A Legal Duty Inc., a group critical of faith healing, mounted a successful federal court challenge to the law in 1996.

Congress' response was to drop the exclusive right of Christian Science sanatoria to be reimbursed and it created the generic RNHCI designation, although only Christian Science institutions have so far been found to fit the RNHCI description. CHILD challenged the law, which led to this latest ruling. The American Academy of Pediatrics, with the AMA and other medical and nursing organizations, filed a friend-of-the-court brief in support of CHILD.

The appeals court's two-member majority rejected the notion that the RNHCI designation amounted to religious gerrymandering, as well as other church-state arguments. In a key ruling, the court termed custodial care -- nursing duties such as feeding, bathing, changing dressings -- as an acceptable "subset" of reimbursable treatment.

But it is the sharply worded dissent by Judge Donald P. Lay that warrants closer attention. "Congress' incredibly narrow crafting of the new provisions leaves no doubt regarding their lack of neutrality and denominational preference for Christian Scientists," he wrote.

Lay then turned his attention to the issue of custodial care, which under similar circumstances is not reimbursed for non-RNHCI patients. "The majority's reasoning defies sensibility. ... The entire nature of Medicare and Medicaid is to provide medical services in a manner managed by medical criteria and qualifications and governed by the medical profession. RNHCIs and the care they provide are, by definition, 'nonmedical.' That which is defined as not being X cannot logically be a subset of X."

In addition to the matter of proper medical oversight, medicine has a special reason to get involved in this case. Christian Science has invoked this law when seeking religious exemptions from child abuse and neglect statutes.

A mentally competent adult has the right to refuse even life-saving medical care. But withholding necessary medical care from a child is another matter. This payment law has given Christian Science and other faith healing sects a government seal of approval with implications not limited to reimbursement. (The journal Pediatrics, reviewing the cases of 172 deaths of children from whom medical care was withheld for religious reasons, found that 140 had a 90% chance of survival with proper medical care.)

CHILD plans to appeal. First it will try for a rehearing in the Eighth Circuit. After that, its only recourse is to the U.S. Supreme Court. Courthouse handicappers know that the farther you go in the legal system, the less chance there is of such an appeal being accepted; this most recent ruling could be the last for this challenge. The well-being of RNHCIs may be secure, but at a cost beyond the millions in tax money spent on them each year.