A BETTER KIND OF POLITICS

I appreciate this invitation to participate in this Seminar of Catholic Leaders.

I have been asked to share with you some reflections on THE CULTURE OF ENCOUNTER AND CIVIC FRIENDSHIP from the Magisterium of Pope Francis, and what these categories and doctrines pose – as challenges – for the life and political participation of Hispanic Catholics of this Nation.

In his Petrine Magisterium, and especially in the Encyclical Fratelli Tutti of October 3, 2020, Pope Francis invites us to build a better world through the fraternal coexistence to which Jesus of Nazareth invites us all in his Gospel. He exhorts us to make possible better relationships and communities through civic, citizen, or social friendship; friendships that make possible the “culture of encounter.” The “civic friendship” and the “culture of encounter” are two categories that are not the doctrinal or ideological property of Christianity or anyone else. Rather, they are the heritage of all humanity.

The “culture of encounter” assumes, in individuals, “civic virtue,” which traces its roots to the philosophy and teaching of great Greek philosophers such as Plato and Aristotle (especially in his Nicomachean Ethics). It assumes civic virtue and all that it implies in terms of civic and social life, which entails a form of citizen ethics, a normativity that regulates our indispensable and necessary social coexistence. It assumes a civic virtue that, if practiced among citizens, can strengthen civic or social friendship and, with it, enable a “culture of encounter” as an ideal for human coexistence. We can achieve an understanding that civic virtue is a motivation to act as the good that society requires of us, where self-interest does not take precedence over that which is good. Thus, selfish motivation cannot be virtuous in any case https://www.scielo.org.mx/scielo).

Civic, citizen, or social friendship does not consist of the good manners of civility that we must observe in personal and social relations. Rather, it deals with the relationships that should occur among citizens in the pursuit of the common good. This means that, regardless of our particular interests or our political, religious, etc., differences, there are – in social life – issues (education, health, etc.) where we must all put our best effort in the pursuit of the general social good.

Therefore, civic friendship, while demanding respect for individual human rights, is located at a level of higher interests and rights, which concerns the pursuit of the well-being of all. Civic friendship thus becomes the condition we need for Aristotelian “peaceful and social concord,” because friends watch over the good of all friends.

Pope Francis, “acknowledging the dignity of each human person,” earnestly hopes that “we can contribute to the rebirth of a universal aspiration to fraternity… as a single human family, as fellow travelers sharing the same flesh, as children of the same earth which is our common home…” (FT 8). He hopes that we can contribute to a universal fraternity that is “without borders,” which must be built – and precisely for this reason – amidst “shattered dreams,” “insufficiently universal human rights,” or “conflict and fear,” “globalization and progress without a shared roadmap,” amidst “dark clouds over a closed world,” pandemics and other scourges of history, etc.

Universal fraternity – according to Pope Francis – opens us to the hope to “engender an open world,” having love as its only value, in societies where everyone is integrated, with a solidary and universal love, which promotes people and “rights without borders,” as long as men and women discover the concept of giving freely in everyday life, with “a heart open to the whole world,” to all humanity.

With these assumptions, Pope Francis builds his doctrine of “a better kind of politics,” affirming that “the development of a global community of fraternity based on the practice of social friendship on the part of peoples and nations calls for a better kind of politics, one truly at the service of the common good. Sadly, politics today often takes forms that hinder progress towards a different world.” (FT 154)

We must build this kind of politics upon the foundation of “political love,” and it must be effective, one that integrates and joins us together, through kindness and the pleasure of recognizing the “other.” It is through social dialogue, truth and consensus that we will make possible – in social friendship – the emergence of a new culture: the culture of encounter.

We understand “culture” through Francis’ definition: “something deeply embedded within a people, its most cherished convictions, and its way of life. A people’s “culture” is more than an abstract idea. It has to do with their desires, their interests and ultimately the way they live their lives.” (FT 216)

So, “to speak of a “culture of encounter” means that we, as a people, should be passionate about meeting others, seeking points of contact, building bridges, and planning a project that includes everyone. This becomes an aspiration and a style of life. The subject of this culture is the people, not simply one part of society that would pacify the rest with the help of professional and media resources.” (FT 216)

“A better kind of politics,” “social friendship” and a “culture of encounter,” in the vision of Pope Francis, have as their ultimate purpose the construction of peace or the reign of God (in biblical theology) through forgiveness, as an expression of universal and evangelical love; a task that all religions in the world have to serve. (FT Ch. 8) Because “in many parts of the world, there is a need for paths of peace to heal open wounds. There is also a need for peacemakers, men and women prepared to work boldly and creatively to initiate processes of healing and renewed encounter.” (FT 225)

This dream, this longing of Pope Francis contains many implications for our daily life as citizens and, therefore, for our life and political participation, in the broadest Greek sense of the meaning of the term “politics,” as a search for the common good of the “polis,” of the city and of all citizens in it.

Thus, civic life as an exercise of politics or the exercise of politics as a partisan professional choice and electoral and governmental tasks is not, first of all, a matter of laws but of ethical coexistence, that is, of coexistence that seeks – through the gift of friendship among men – the good of all.

Politics is not an exercise in publicity, untruthful speeches, or the search for privileges and particular interests. Politics is, above all, a daily exercise of shared values and common interests in the search for the common good, especially those most in need of the polis, of society.

Every day, the news tells us that joint efforts benefit us all, but that the exercise of individualistic, selfish politics, full of ambitions for power and profit, leads also to social ruin.

The exercise of daily politics, with our deeds, words, and citizen attitudes, or the professional exercise in socio-political leadership makes us sink or swim together, because we are deeply interconnected and share responsibility both in good and in evil.

Today, unfortunately, especially in the professional and partisan exercise of politics, the concept of friendship is associated with that of complicity in corruption in the management and administration of public affairs.

But selfishness and individualism in the public sphere and political corruption due to the absence of “social friendship” and fraternal and universal sense in civic life, are undermining democratic institutions and generating “social discord,” which translates into tragic forms of violence, injustice, inequality, and death.

Ladies and Gentlemen, you are leaders in different areas of life in society. You are leaders of the Hispanic community present in this Nation.  

You are called to organize, guide, and lead people in your Hispanic professional and community environments in building social friendship for the culture of encounter, a “better kind of politics,” and social peace.

You are charged with forming, educating, and leading our Hispanic communities for the daily exercise of citizenship for the benefit of all and for the best causes.

You have the capacity and responsibility to “give freely what you have received freely,” to build the world of which Francis dreams and of which we all dream: a world in universal fraternity and with an abundance of life for all.

A world in which we all respect our rights and fulfill our duties.

A world in which we go from being anonymous individuals aggregated socially or partners and competitors to recognizing ourselves as brothers and sisters with a common destiny, in a common home.

A world in which, as disciples of Christ, and through the commandment of love, we all live together as brothers, children of the same Father.

We all share a responsibility in creating, for present and future generations of Hispanics in the United States, better and greater citizen and political participation and, with it, better lives and a better Nation.***

Thank you very much!

***The words and phrases in quotation marks are from FRANCIS, in his Encyclical Fratelli Tutti.

Mario J. Paredes is a member of the Board of Directors of the Latin American Academy of Catholic Leaders.

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Value-Based Care holds promise to transform healthcare— especially for the underserved

By 2030, the Centers for Medicare and Medicaid Services plans to see all Medicare beneficiaries and most Medicaid beneficiaries enrolled in Value-Based Payment (VBP) or Value-Based Care (VBC) programs. Simply put, VBC links the compensation of healthcare providers to patients’ health outcomes in the longer run. The formula holds doctors more accountable for improving the well-being of the people under their care and provides them with sufficient freedom and incentive to deliver the right care at the right time.

VBC is a remedy for the pitfalls of the traditional fee-for-service system. Fee-for-service means doctors and hospitals are compensated for each service they deliver; they are rewarded for volume—they are paid more if they deliver more services, even if these do not achieve the desired result. VBC changes that dynamic by incentivizing the provision of quality care for the good of the patient—bringing costs down in the process.

VBC also offers a solution for the troubled state of healthcare in the US. The country spends a greater percentage of its GDP on healthcare than other countries. Yet, the US sees the highest incidence of preventable deaths and has the highest infant mortality rate. What’s more, longstanding inequality of access to healthcare leaves people of color and the underserved more vulnerable to illness and disease than the rest of the population. VBC promises to revolutionize healthcare for the most vulnerable.

VBC produced significant savings for taxpayers, as better health keeps people out of ERs and costly hospital beds, and all along, doctors are rewarded for doing a better job. The latter depends to a large degree on the coordination of a patient’s care; that means a primary care physician keeps close track of all the services a patient is getting or needs. This includes medical care as well as behavioral health services. Significantly, doctors are also encouraged and rewarded for being aware of patients’ social needs. Such needs would never be attended to in the fee-for-service model.

Quality of care in the VBC is driven by key dimensions, including efficiency, meaning doctors only use resources that are needed; equity in care stipulates that quality of care does not vary based on race, gender, or income; care is centered on the patient and respects values, preferences, and particular needs; and timeliness means care is given without lengthy delays.

VBC models feature different approaches to doctors’ risks. There is an upside-only risk, with doctors getting more revenue if meet or exceed standards when it comes to quality, cost, or equity. A two-sided risk means doctors also stand to lose revenue if they fail to achieve specific measurements of success. This formula is believed to discourage risk-averse doctors from joining VBC programs.

There are also non-financial rewards for doctors who join VBC programs. The freedom to deliver the right aid at the right time can give providers a sense of purpose and mission. Participation in VBC also enhances a doctor’s reputation.

There is growing interest in VBC models on the part of the commercial healthcare sector. It seems clear the significant growth of the model will require that VBC models become more accessible and offer greater incentives, especially for those providers serving disadvantaged populations. Overall, more research is needed to determine the impact of VBC models on patients, doctors, and the healthcare system at large.

There is a success story in New York City, where SOMOS, a network of 2,500 doctors—most of them primary care providers—is serving some one million of the city’s most needy Medicaid patients. Caring for Hispanics, African Americans, and Asian Americans, the organization has been developing a VBC program since 2014, when it joined New York State’s Delivery System Reform Incentive Payment (DSRIP) program—one of the country’s first such programs.

SOMOS puts its doctors in the optimal position to deliver superior care to their patients. Thanks to the work of Community Health Workers—who visit patients’ homes to remind patients to keep medical appointments—doctors learn of the social circumstances of the patients’ households. These are the Social Determinants of Health. For example, mold in subpar housing may impact physical as well as mental health, while poverty can mean that there are no means to buy fresh and healthy foods.

SOMOS transforms doctors’ practices into Patient-Centered Medical Homes, a gateway to all the care needed for patients, with staff keeping close track of, for example, care given by specialists and its contribution to the patient’s overall health. SOMOS doctors bring another dimension to the job: in many cases, they share a cultural and ethnic background with their patients in whose communities they live and work. Their intimate knowledge of their patients’ health needs and their personal circumstances make doctors into trusted figures and leaders of their communities. This dimension is key to SOMOS’s VBC success. That success translated into savings of $330M through a reduction of 25 percent in the number of ER visits and the number of unnecessary hospitalizations.

There is no doubt that the transformation of US healthcare—especially for the neediest Americans—will require the adoption and embrace of VBC programs. Both doctors and patients are the better for it.