Although the Supreme Court has upheld President Obama’s signature health care law, we are bound in this election year to have a renewed conversation on what the federal government’s responsibilities are in the health-care field.
Will liberals rest content with this achievement, or press for even more steps on the road to their long-sought goal of a “single-payer” health care system on the Canadian or British model?
Will conservatives pull together what have, up until now, been disparate threads of policy ideas into an intelligible fabric for conservative, market-based reform? Or will they simply stump for “repeal and replace” without much concrete talk about what would replace the president’s system?
One thing is certain. Christians will continue to argue among themselves about the gospel command to love our neighbors, and the gospel admonition, “as you did it not to one of the least of these, you did it not to me” (Matthew. 25:45). Christians are called upon to heal the sick, feed the hungry, clothe the naked, visit the prisoner, and comfort the afflicted.
The corporal works of mercy and charity find expression in the tradition of Christian hospitals, schools, soup kitchens, homeless shelters. Catholics in particular have been major contributors in the health care field, training doctors, nurses, and other professionals, and operating many of the country’s great hospitals. Just look around and notice how many hospitals near you have “Saint” or “Holy” or “Sacred” or “Good Samaritan” in their names. But is there a single “Christian view” on health-care policy—or even a single Catholic view?
Not exactly. Like everyone else, those who take a self-consciously Christian perspective on health care fall out along familiar liberal-vs.-conservative lines. Some will claim that the responsibility for “the least of these” necessarily falls chiefly on government, because government really is all of us. The responsibility being everyone’s, the response must be collective, and what is government but the active arm of the whole society? Therefore, according to this view, the Christian love for neighbor is frustrated wherever the government is held back from doing all it can do, in mercy and charity.
Others will point out that this obscures the extent to which “everyone’s responsibility” means each individual’s. Human needs are personal, one by one, and the works of charity and mercy must be equally personal, calling forth the virtues of voluntary action. The state is by nature impersonal (viewed in the right light, this is actually one of its virtues); it cannot love anyone, and is not a reliable channel for the love of neighbors for one another. On the way from Neighbor A to Neighbor B, if the love has to be transmitted through the state, what might have begun in charity and mercy will wind up distorted by coercion, inattention to the human element, and stunting of the free actions of persons.
In Catholic social teaching, this is one reason why subsidiarity is important—the principle that (as the Compendium of the Social Doctrine of the Church has it) the “smaller, essential cells of society” are expected to “properly perform the functions that fall to them without being required to hand them over unjustly to other social entities of a higher level,” an injustice that “denie[s] their dignity and essential place.” Christians see the love of neighbor as embedded in a “network of relationships,” and the state is the great de-personalizer of relationships. This is a necessary concomitant of the rule of law, the benchmark of legitimate political action. So subsidiarity is not some notion of hostility to government, but it is founded in a recognition of the attenuation of human relations that necessarily occurs under the aegis of the state.
The more positive side of subsidiarity, where public policy is concerned, is that the state should do what it can to aid and facilitate the actions of those “smaller, essential cells” like the family, the church, and the local community. In the health care field, as the U.S. Catholic bishops argued three decades ago, this means policy that fosters the “cooperative resources of both the public and private sectors, the voluntary, religious and non-profit sectors.” The very next sentence of the bishops’ 1981 pastoral letter on health care is a reminder of another issue we face today: “In any national health system, provision should be made for the protection of conscience in the delivery of care.” The Obama administration’s neglect of this principle is the reason it now faces 23 lawsuits filed by 56 plaintiffs on religious freedom grounds, thanks to its imposition of the HHS mandate on employer provision of contraceptive, abortifacient, and sterilization coverage in nearly all health insurance plans.
The bishops also called in 1981 for “national health insurance,” though they did not spell out in any policy detail just exactly what that meant. As the national debate over health care reform rolls forward, it’s time to think deeply, creatively, and without illusions regarding the state’s capacities, about how we can be Good Samaritans toward one another.
Matthew J. Franck is Director of the William E. and Carol G. Simon Center on Religion and the Constitution at the Witherspoon Institute in Princeton, New Jersey.