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The religion and politics border occupied by Catholic social thought and American health care policy contains rich material for reflection. Religious institutions, particularly Catholic, ate deeply embedded in both health care delivery and health care lobbying. Each activity is consciously driven by understandings of the imperatives of Catholic social thought and by institutional missions formulated with the intention of realizing commitments that flow from Christian faith lived within the Catholic tradition. Because health care delivery is powerfully shaped by public policies at the federal and state levels, Catholic leaders, Catholic institutions such as hospitals, and Catholic theologians have been driven to reflect on and to deliver health care within a context powerfully political and public. They have also for many years engaged in policy advocacy to influence the economic, social, and legal environment of their activity. Moreover, just as Catholic health care acts and advocates, it reacts to public policies that affect not only the "externals" of health care delivery, but also the essential mission and identity of Catholic institutions. Catholic health care has challenged and been challenged by public policy. This mutual questioning on an important boundary between politics and religion makes the topic of Catholic social thought and health care policy reform intensely interesting for students of church and state.

Government and market forces have fundamentally transformed the religious healthcare sector. Religious healthcare organizations are struggling to define their identities and determine what it is that makes them different and what implications the differences have for the delivery of social services and for public life. In response to these questions, the defenders of traditional Catholic healthcare make a variety of responses that first defend the continued relevance of the major institutions of Catholic healthcare, especially its hospitals, and second, specify reforms to make these institutions even more relevant to the new healthcare system. This essay argues that these defenses are inadequate to that challenge and that the reforms proposed are too timid. Catholic healthcare needs a better theoretical account of its mission and more creative institutional adaptations.

Political participation empowers and transforms citizens. To par ticipate in the public affairs of one's community is to call upon and to develop personal capabilities for speaking, taking responsibility, carry ing through projects, and working with others. To participate is to be an autonomous citizen rather than a subject, an actor rather than a specta tor.1 So say advocates of such participation. Moreover, they argue that deliberation responds to the deepening pluralism and the larger scale of complex, post-industrial democratic polities.2 In such societies, every area of life becomes "politicized"; that is, the norms recognized as legit imate (in family, church, workplace, gender roles, for example) must increasingly be negotiated, rather than taken for granted. As society becomes more differentiated, politics also becomes less state-centered. Therefore, citizens must learn the political skills of negotiation, discus sion, argument, persuasion, mediation, and compromise in order to function in most areas of life. It is possible then to think of democracy "as a distribution of empowerments and protections that enable and protect discursive negotiations of conflicts within and between institu