ARTICLES

Catholics Against Managed Care

Things Should Be Decided at Lowest Level

By Anne Knight

You can get almost anything on the Internet these days, including professional advice from a Catholic perspective. The Moscati Institute (named after Italian physician, Guiseppe Maria Moscati, declared a saint by Pope John Paul II in 1987) is directed by Marianne Fightlin, a registered nurse with a master's degree in administration and over thirty years in nursing education and administration and home health care. As her website (www.familyhealthconsulting.com) explains, the Moscati Institute "... is committed to respect for the dignity of the human person from conception to natural death." Three bishops serve on the institute's advisory board: Roger Schwietz of Anchorage, Alaska, Fabian Bruskewitz of Lincoln, Nebraska, and Raymond Burke of La Crosse, Wisconsin. Marianne first read about Dr. Moscati in the late 1980s, as she was becoming alarmed by trends in the her field.

"The cost of the care of the person was becoming more important than the care to the person," she said in an interview with this reporter. In the mid-1980s, as the director of a hospital's home care department, she noted changes in patient care orders: "Blood work that should have been ordered was not; I couldn't stay with the patient in the home, visiting, for the length of time I felt that that patient needed. When we had patients in the home who became sick enough ... to be returned to the hospital ... the doctor wouldn't issue an order to get them back in." She began advocating on patients' and nurses' behalf but was told she was working too hard. After a year and a half, Marianne left the hospital, investigated other medical facilities, but found that "they were the same and worse." She faced a dilemma: "If you believe, as I do, that I am treating Christ Himself, then you cannot do what is going to injure Him."

Marianne founded the Moscati Institute in 1990 and struck out on her own as patient advocate. Her first undertaking was with Minnesota Power, which has granted its employees up to three hours of consultation with her a year. Marianne suggests solutions, attempts to get the employee to manage the problem himself, makes home visits, and contacts clinics or hospitals when necessary.

Marianne is working with predominantly Catholic physicians and members of the insurance industry to develop an alternative to managed care. She identifies managed care as a component of "the culture of death. That is what the Holy Father refers to.... It begins with a lack of respect for the human person, and then it means to do with him whatever one wills.... The problem is, trying to get the [health insurance] benefit when you get sick. In other words,... you get just the bare minimum...." Marianne believes the matter was addressed in Humanae Vitae, Pope Paul VI's 1968 encyclical against contraception: "He said that if you disrespect life at its root, then you can do anything to it." She continued: "Who are you caring for? It is Christ Himself, and when you ... get away from that, then you've lost your way. And when instead you value money ... more than the person, then you're in deeper trouble...."

Marianne refutes the argument that health resources are limited and must be rationed: "I say that Catholic actuaries, insurance people, doctors, nurses, and others can create the alternative and can develop the insurance. We already have it; it's a matter of getting it through and allowing it to be used." Development and implementation of an alternative system requires less energy than fighting the dominant system, she maintains.

In August 1999 she launched the Moscati website, which enables her to offer medical information and referrals nationally. The next project she hopes to tackle is development of a new model for home care, because, she says, "if we don't, that's where the killing fields are going to be. People will go home and die; you can't live with a lack of care."

Marianne does not practice medicine; a client requesting diagnosis would be referred to a physician. Frequent questions concern dissatisfaction with a doctor or how to care for an invalid family member. She can be reached by dialing 1-877-360-9300, toll-free, Monday, 2 pm to 4 pm; Tuesday, 2 pm to 4 pm and 8 pm to 10 pm; Wednesday, 2 pm to 4 pm; Thursday, 2 pm to 4 pm; and Friday, 10 am to noon and 2 pm to 4 pm (Eastern Time). Questions can also be submitted by e-mailing Questions@FamilyHealthConsulting.com. An effort will be made to answer all e-mail within two business days.

In January the Moscati Institute launched a second website, Catholic Psychological Consult (www.catholicpsychconsult.org), a telephone consultation service offered by Marianne's husband, Marshall Fightlin. Marshall is a psychologist with over twenty-five years of experience. In addition to degrees in psychology and counseling he has a master's degree in theology and a licentiate in sacred theology.

The Fightlins moved from Connecticut, where Marshall had run a diocesan-sponsored mental health clinic, to Duluth, Minnesota in 1985. There he headed the office for marriage and family life, under San Diego's current bishop, Robert Brom, then bishop of Duluth. At Bishop Brom's request, Fightlin initiated a natural family planning program. After a year he returned to private practice in Duluth.

Marshall explains on his website that "each psychologist practices his art from a certain perspective.... My perspective is Catholic. My practice of psychology is shaped, in part, by the following beliefs: 1. The human person ... has been endowed with an intellect, by which he can know truth, and a will, by which he can make free choices and give himself to others in love. 2. A person's behavior is determined partly by genetic endowment..., partly by early childhood experiences ... but also by free choice. 3. I believe that sex is sacred.... Any use of sex outside of a marital context is destructive of both parties.... I promote NFP as a unique way of safeguarding that sacredness.... 4. I am committed to the concept of the sanctity of human life from the first moment of fertilization to the moment of natural death."

Marshall emphasizes that the telephone service offered through his website should not be construed as therapy or treatment. "Somebody who has serious emotional problems needs to go into therapy, but an awful lot of people who wind up in mental health clinics don't really need all that." Marshall can be reached by calling 1-877-360-9800, toll-free, Monday through Friday, 9 pm to 11 pm, Eastern Time. He can also receive e-mail at Marshall@CatholicPsychConsult.com. Consultations are done in twenty-five minute units, which are charged at $25 each. "Catholics, I think rightly, are shy of going into mental health clinics, because they're afraid that their faith will not be taken seriously," Marshall observed. "Psychologists as a group are not typical of America as a country." Marshall believes the managed care phenomenon has had a negative impact in the mental health field. When insurance companies require prior authorization, "there's a lot of paper work involved; there's a lot of saying things to the insurance company that are personal." Although some insurance companies advertise generous mental health care benefits, those benefits are rationed. "If you tell them that the client is making progress, they'll say, 'Well then, he doesn't need any more therapy' and if you say, 'He isn't making progress,' they'll say, 'Well then, it isn't doing any good.'" To convince insurers of the need for sessions a therapist must talk to an insurance company employee, who serves as "the gatekeeper." Marshall notes that, over the past decade or so, insurance companies have decreased the amount of benefits paid out and have restricted choices, particularly in employer-based insurance programs. According to the Fightlins, such programs function like socialized medicine. If a clinic receives a yearly contract and a fixed payment to provide services, the facility has no incentive to accommodate increases in client volume. Instead clients may be forced onto a waiting list -- de facto rationing. Marshall: "First you have this managed care outrage, and then you have 60 Minutes gleefully reporting all this and asking for more federal intervention to stop it. That, of course, is leading toward universal health care, which is universal 'no health care,' really."

Among the health care reform ideas supported by the Fightlins is scaling back health insurance to cover catastrophic events only, medical savings accounts, reduction of professional fees to facilitate payment out of pocket, more charity for needy patients and significant reductions in government regulation and intervention. The common denominator is returning health care to the individual and his family. Marshall: "Things should be decided at the lowest level that they can be decided, and you should only have recourse to the higher level when the lower level doesn't have the wherewithal to make a decision." Marianne added, "Let us be in charge of our own care, let us be free, and let us, as Catholics, develop an alternative in which freedom can exist, where we can be a trendsetter, where we can get rid of this culture of death."

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