Katherine Marshall, a senior fellow at Georgetown University’s Berkley Center for Religion, Peace, and World Affairs, leads the center’s work on religion and global development. She is also a professor of the practice of development, conflict, and religion in the Walsh School of Foreign Service, teaching diverse courses on the ethics of development work and mentoring students at many levels. She helped to create and now serves as the executive director of the World Faiths Development Dialogue, an NGO that works to enhance bridges between different sectors and institutions. In September 2022, she was appointed as a member of the Advisory Committee on Voluntary Foreign Aid at the U.S. Agency for International Development. Marshall has five decades of experience on a variety of development issues in Africa, Latin America, East Asia, and the Middle East, particularly those facing the world’s poorest countries. She was a World Bank officer from 1971 to 2006, and she led the World Bank’s faith and ethics initiative between 2000 and 2006.
Sister Carol was a finalist for the 2013 Opus Prize, run by Georgetown University. She caught her breath briefly to answer some questions about her work, her life, and her views on Obamacare. A video about Sister Carol is here, and the full interview is here.
Why do you care so much about Health care?
I have been working in Health care since I was 18, living in or around a hospital for 40 years. I've seen so much suffering, and what it does to patients, children, and their parents. Caring for those in need is the heart of the mission of my order, the Daughters of Charity. Most people who are poor work incredibly hard, many in positions where they wait on the rest of us. They can't get insurance, and without insurance, parents often don't have the money to fill a prescription. Many people forego physician care and preventive studies because they simply can't afford the deductible or co-pay.
We can muster our national genius to get good care that is less expensive and that benefits everybody. Having so many uninsured is so unworthy of the greatness of our nation. We are a better people than that. We have allowed people who are poor to be unjustly demonized. There are 48 million people in America, nine million of them children, who do not have access to Health care. When I point this out to people at the Vatican, they simply cannot comprehend how that can be in a rich country like the United States. The Church's social teaching compels us to address this problem.
What led you to where you are today?
I was born at the old Providence Hospital in Washington, D.C. on Capitol Hill, a wonderful facility whose charter was signed by Abraham Lincoln. My father was the son of first generation immigrants from Ireland while my mother's family was from Maryland. I went to Catholic schools, studied nursing, and then joined the Sisters of Charity.
I worked in various hospitals, starting with St. Ann's Infant and Maternity Home. There immediately I met heroic mothers and saw the effects of abuse and poor Health care. I learned to navigate the politics around hospitals and Health care, and discovered what could be done with effort and commitment to quality care. I studied business along the way, and from that point on administration has been my calling.
I served on the board of the Catholic Health Association (CHA) and when its president resigned, was encouraged to apply. I've been in my present position since 2005.
What is CHA's challenge?
America's Catholic health institutions, a vital part of the care system, are going through a period of dynamic change. They were built by remarkable sisters, at a time when few women were in leadership anywhere. They created the largest not-for-profit health system ever known. It is a remarkable story and a living legacy.
In 1968, there were over 700 Catholic hospitals. Of those, most (all but 28) were led by women religious. Today, sisters head only three hospitals. This transition calls for a tremendous effort to ensure that we find ways to help lay people taking on these roles be equipped with the moral and social justice teachings of the Church, as well as the charisma of the founding community, so that they can govern and manage them as ministries of the Church.
CHA helps to support the management of the Catholic health system. Many of our hospitals have excellent bond ratings, but some are challenged financially because of the large number of uninsured they are committed to serving. Health care has changed dramatically, and is still changing, becoming far more high-tech, expensive, and challenging. We need to combine the competence in medicine, nursing, and finance required of today's hospitals with the mission-oriented components to maintain vibrant Catholic Health care.
CHA works to convey to new, generally lay leaders who are often but not always Catholic, what it is to run a hospital as a ministry of the Church. We help them to understand the moral and social justice teachings of the Church, how they enrich our ministry, and how they affect everyday decisions.
How do you see the recent struggles for Health care reform?
This has been a very difficult but hope-filled time. We must remember that the Catholic Church has spoken for the need for Health care for everyone since the time of President Theodore Roosevelt. The bishops were leaders in advocating for health insurance for everyone. All of our recent Popes have made it abundantly clear that society owes its members basic Health care. The conflicts among people of goodwill break my heart because we have to push forward as strongly as we can to get Health care for everyone, from the moment of conception until the moment of natural death.
I love the Church and have worked in it for almost 50 years. I also know the Gospel and the teachings of the Church and could not see us miss, as we have before, this chance for the poor to get Health care. The fighting has been a bit crazy at times, but my great hope is that we will continue to work it through and that at some point we may see some great good come out even of the misunderstandings.
We must never forget the suffering that is taking place here and now. The Institute of Medicine says we have 18,000 unnecessary deaths a year in this country because Health care coverage is lacking. Health care coverage affects everything -- economics, housing, outsourcing. Our nation's economic structure will be greatly strengthened when these programs are fully implemented and we are not trying to cross-subsidize the cost of care for 48 million uninsured Americans who get their Health care late and in the most expensive venues, primarily the emergency departments. Studies show that over 50 percent of bankruptcies are due to health expenses and some studies demonstrate that four in ten cancer survivors are bankrupt. We need to remember that for insurance, it is the policyholder, not the stockholder who should count. It is the policyholder who is vulnerable with illness. A great thing the new system will do is ensure there are no lifetime limits on coverage, no pre-existing conditions, and mental health will have broader coverage.
What does it mean to be a Daughter of Charity?
The Daughters of Charity are not a religious community in a canon law sense but a society of apostolic life. We take vows for a year at a time, and our sisters have from the start (in the 1600s) been involved in Health care, education and social service. We are one of the largest communities of consecrated women in the world, with 19,000 members today. The Daughters of Charity are a wonderful community whose ministry speaks to poverty and misfortune. We run hospitals that care for the sick, with a special concern about those who cannot find care elsewhere. We also serve immigrant populations in many places. There are fewer of us today than 50 years ago, but today lay people have the same call to live the Gospel, to grow in holiness, and to care for others. Fewer priests and sisters does not necessarily mean there will be fewer people to render the kind of care our baptismal calling demands of us.
What drives you as a leader in the fight for universal Health care?
Our nation has the genius to develop an exceptional Health care system. We need common sense and commitment. We need to find the best and reasonable accommodations or exemptions that will truly serve our nation's people. Even in our differences, we need to continue to dialogue together. I have studied the tensions that preceded the passage of Medicare and Medicaid in 1965; in many ways, they almost seem worse than what we're facing today. However, we have come through that and no one can think of not having Medicare as part of our protection of the senior citizens of this country. We need to remember that and keep working with courage and vision today for the good of everyone in this nation.
A nation is greater when it cares for all its people, not just the top five percent. Hubert Humphrey said it wisely and well: we will be judged by how we treat the most vulnerable, that is the youngest and the oldest.