A recent article in The Wall Street Journal on the Daughters of Charity, founded by St. Vincent DePaul in 1633 to minister to the poor, reports that the order is now being dubbed "the Daughters of Currency." According to the article, the Daughters, who each live on $40 per month, back a nation-wide system of 49 hospitals with a $2 billion investment fund. But hospitals, says the article "are playing second fiddle to the sisters' investments." Sister Irene Kraus, former president of the Daughters of Charity National Health System, is quoted delivering what purports to be the order's motto: "No margin, no mission."

The WSJ piece raises some interesting questions between the lines. Though the article focuses narrowly on the Daughters of Charity, it also touches on an issue that is central to the healthcare debate that currently rages in this country, the notion that it is somehow morally suspect for hospitals and other healthcare providers to make money, to be, in other words, businesses.

The article is somewhat selective in its use of facts, providing examples of financial acumen on the Daughters' part, augmented by quotes from people who feel the sisters have fallen short in their charitable mission by being too concerned about that "black bottomline." A cursory overview of the WSJ article on the Daughters could easily result in the inference that the order has made growing its portfolio at least as high a priority as providing healthcare services to the poor. The article states that, in fact, many Daughters of Charity hospitals are in affluent suburban areas. The Daughters have divested 11 money-losing hospitals in the past five years, in at least one case leaving a community without Catholic in-patient care. And they treat fewer Medicaid patients than the national average (6 to 8% v. 14%). The WSJ article points out that the Daughters of Charity today derive most of their income from their portfolio, as opposed to hospital operations.

In fairness, the article also reveals that the Daughters spend 86 cents out of every dollar in earnings on charity care and community work. Their Providence Hospital in Washington, D.C., which serves mostly black and Hispanic patients, gives five free admissions each month to Health Care for the Homeless, a local non-profit.

But is it enough? The perception created by the article is that the Daughters' financial acumen is coming under growing fire, that what Sister Carol Keehan, who runs Providence Hospital, calls the "clinking cash register" in her brain dominates the other side that asks "what's the right thing to do?"

Public skepticism about profit in health care is strong and probably based on the idea that it is wrong to benefit from the suffering of another. And rightly or wrongly, the public believes that the path to profit is paved by denying access to services and procedures. But is that really what the Daughters of Charity have done?

Historically, the Daughters of Charity are noted for adhering to St. Vincent's legacy of responsible stewardship. According to WSJ, they were among the first to create bold financing projects much like today's managed-care contracts. And they continue to think of themselves as missionaries who do good by doing well.

To find out more about how the Daughters of Charity go about pursuing their mission in the 20th century, we contacted Monsignor Charles Fahey, who serves on the Daughters of Charity National Health System board, and asked him about some of the things reported in the WSJ article. Monsignor Fahey told us that the closed Daughters' hospitals have been in "over-bedded communities." He pointed out that where the Daughters have closed hospitals, they have substituted outpatient healthcare services needed by the community "to strengthen local systems by taking the redundancy out of them."

Fahey also took issue with the article's emphasis on the size and strength of the Daughters' portfolio. "None of this money is owned by the Daughters of Charity," Fahey asserts. "They can't care for old nuns or put in stained glass windows with this money. It exists to back up health care."

So is the Daughters' belief in "no margin, no mission" a statement of greed? Or is it actually a commitment to surviving in the real world? The key question is, does the money support the mission? Or is the reverse now true?

No margin, no mission. True enough. But how is that margin produced? And how does it affect the mission? Of course it's possible that too much attention to the margin could result in no mission after all. But for today, all we can say for certain is that, without that dollar in profit, the Daughters of Charity wouldn't have 86 cents to take care of the poor.