Should prayers be covered?

Some see prayer treatment as an effective alternative to doctors and other medical care.

Chicago Tribune

WASHINGTON — As the health-care battle moved forward last week, Phil Davis, a senior Christian Science church official, hurriedly delivered bundles of letters to Senate offices promoting a little-noticed proposal in the legislation requiring insurers to consider covering the church’s prayer treatments just as they do other medical expenses.

Critics say the proposal would essentially put Christian Science prayer treatments on the same footing as science-based medical care by prohibiting discrimination against “religious and spiritual health care.”

While advancing below the radar as debate focuses on larger issues such as the “public option,” the Christian Scientists’ proviso has begun to stir controversy because it rekindles debate on three long-running and sensitive issues: freedom of religion; the constitutional separation of church and state; and the question of whether faith-based approaches should be treated as equivalent to science-based medicine.

The Christian Science Church believes that prayer treatment is an effective alternative to doctors and other medical care.

“We are making the case for this, believing there is a connection between health care and spirituality,” said Davis, a senior church official, after distributing 11,000 letters.

“We think this is an important aspect of the solution, when you are talking about not only keeping the cost down, but finding effective health care.”

And Rep. John Shimkus, R-Ill., who sponsored the provision in the House and whose district includes a Christian Science school, Principia College, said, “Those religious traditions that utilize nontraditional care ... should have them covered in any health-care bill.”

On the other side of the issue, Erwin Chemerinsky, dean of the University of California, Irvine, law school, said, “It raises serious establishment clause questions” — a reference to the First Amendment clause that reads, “Congress shall make no law respecting an establishment of religion.”

“I think when Congress mandates that health companies provide coverage for prayer, it has the effect of the government advancing religion,” Chemerinsky said.

Chemerinsky predicts that if the provision becomes law, it will immediately spark court challenges questioning its constitutionality. But other legal scholars, such as Michael McConnell, who heads the Stanford University Constitutional Law Center, say that’s unlikely.

“As long as patients are the ones who choose, and religious choices are given no legal preference or advantage, the proposals would appear to be consistent with constitutional standards,” McConnell said.

Christian Science officials and some other supporters of the legislation say it is not a mandate. Instead, they say, it is an instruction to insurers not to discriminate against spiritual care.

Others, including some congressional staff members and legal and health authorities, read it differently.

“It’s the opposite of discrimination,” said Dr. Norman Fost, a pediatrician and medical ethicist at the University of Wisconsin. “They want a special exception for people who use unproved treatments, and they also want to get paid for it. They want people who use prayer to have it just automatically accepted as a legitimate therapy.”

Other critics say covering prayer treatments runs counter to the goal of reducing health-care costs with evidence-based medical practices. The government’s attitude about Christian Science prayer treatments has seemed ambivalent.

The Internal Revenue Service, for example, allows the cost of Christian Science prayer sessions to be counted among itemized medical expenses for income tax purposes — one of the only religious treatments explicitly identified as deductible by the IRS.

Moreover, some federal medical insurance programs, including those for military families, now reimburse for prayer treatment.

At the same time, criminal courts have convicted Christian Scientists in cases where children have died after visiting prayer healers instead of receiving traditional medical care.

The church says no such cases have been brought for two decades.

The Christian Science religious tradition has always emphasized the role of trained prayer practitioners.

Their job, as outlined by the church’s founder, Mary Baker Eddy, is to pray for healing and charge for treatment at rates similar to those charged by doctors.

The outlook for the Christian Science coverage proposal is uncertain.

Final action on health care is still weeks away, and scores of changes and tweaks are likely to be made in the House and Senate before final legislation is approved.

Two House committees voted to include the measure in their versions of the overhaul, but Speaker Nancy Pelosi, D-Calif., stripped it from the consolidated House bill in response to arguments that it was unconstitutional.

Majority Leader Harry Reid, D-Nev., is considering whether to include it in the overhaul bill he sends to the Senate floor.

So far as the health-care overhaul is concerned, the Christian Science provision would apply only to insurance policies offered by a proposed insurance exchange where consumers could shop for policies that meet standards set by the government.

Critics say the effect would be broader, conferring medical legitimacy on practices that lie outside the realm of science.