American Christians and the Healthcare Decision

I originally wanted to write on the recent healthcare decision and its implications for Christian life and practice.  However, this morning I came across this post on Scott McKnight’s Jesus Creed blog.  I like the take by his guest poster David Opderbeck so I thought I would just repost.  I look forward to your responses.

American Christians and the Health Care Decision

David Opderbeck is Professor of Law and Director of the Gibbons Institute of Law, Science & Technology at Seton Hall University Law School.  He is also a doctoral candidate in philosophical theology at the University of Nottingham.

Thursday last week the U.S. Supreme Court issued its decision in National Federation of Independent Business v. Sebelius – the health care law case.  Not surprisingly, the talk shows, the newspapers, the blogosphere, Twitter, Facebook, and every other imaginable outlet are lit up with comments and arguments.  What should Christians think about this case?

I will offer some thoughts about how I think Christians should think about it. But first, and perhaps most importantly, I’d like to suggest that there is no single position that can be called the Christian view on this particular case.  It’s a complex issue in terms of economics, social policy, history, and the law.  Let’s try to give each other the freedom to express nuanced opinions on these difficult questions.

There are at least two common themes running through much of the Christian commentary on the decision.  On the right, the view is that the Court’s decision, as well as the law itself, represents a threat to freedom.  For example, here is something posted on the Trinity Forum’s Facebook page, from TTF Trustee Edwin Meese:

The Court was correct to find that Congress does not have the authority to compel purchases under the Commerce Clause.  But it erred in contorting the statute to declare the penalty a tax.  And the fact that the Court decided to allow this abuse under the government’s taxing authority, not the Commerce Clause, doesn’t change the fact that individual freedom has been dealt a serious blow.

On the left, the decision, and the law itself, are viewed as an important victory for justice.  Here is Jim Wallis of Sojourners:   “This is an important victory for millions of uninsured people in our country and ultimately a triumph of the common good.”  Nevertheless, Wallis qualifies his praise:

While I believe the decision is reason to celebrate, it doesn’t mean that this legislation is somehow the flawless will of God; it is an important step in expanding health care coverage and reducing long term costs, but it still is not perfect and more work is yet to be done.

The U.S. Conference of Catholic Bishops opposed aspects of the law but did not ever argue for its repeal.  Their concerns about the law were not based on the notion of universal health care itself, which is something Catholic Social Teaching supports (or at least can be read to support).  Rather, the Bishops are concerned that the law that seems to support abortion, compromises rights of conscientious objectors, and does not provide adequately for immigrants.  In their statement on the Court’s decision, the Bishops conclude:

Following enactment of ACA, the U.S. Conference of Catholic Bishops (USCCB) has not joined in efforts to repeal the law in its entirety, and we do not do so today.  The decision of the Supreme Court neither diminishes the moral imperative to ensure decent health care for all, nor eliminates the need to correct the fundamental flaws described above.  We therefore continue to urge Congress to pass, and the Administration to sign, legislation to fix those flaws.

Before I offer my thoughts on these varying representative perspectives, let me step back and note once again that each of them represents good faith efforts to think Christianly about the Court’s decision.  The fact that they finally offer different visions of the end result should give us pause before we argue that there is only one faithful way to think about it.

That said, from my own perspective, the Trinity Forum / Edwin Meese comment is the most theologically problematic of the three I’ve referenced.  Even more problematic, I think, are the more extreme libertarian critiques of the law heard in many outlets.  Meese’s comment is at least measured in tone, which is not the case with much of the libertarian rhetoric that feeds into what many Christians have said and are saying about “Obamacare.”  How quickly does the dreaded “s” word – “socialism” – arise in many of these comments?

I wonder when “individual freedom” became the sine qua non for Christian social ethics about health care? It seems to me that Christians of all people should be willing to sacrifice some of their “individual freedom” in order to ensure that everyone, particularly “the least of these,” has access to health care.  In scriptural and Christian theological terms, true “freedom” is not libertarian license, but rather is the full participation of a person in God’s self-giving love.  And true “freedom” is never about isolated individuals – as God is a Triune community, so we as human beings can only be truly “free” in community.

Of course, even if we agree that Christians should be willing to give up some “individual freedom” to facilitate health care for others – or, perhaps better, that Christian freedom means moving beyond selfishness —  the question remains whether such care should be provided through government, through private associations, through Churches, through families, and so on.  There is a long and tangled tradition of Christian political theology on all of these questions – and, at least in my opinion, there is no simple right answer.  It isn’t enough here merely to refer to “sphere sovereignty” or “subsidiarity,” just as it isn’t enough merely to refer to the immanent “peaceable Kingdom.”  I do think some ways of working through this are much better than others, but these are the subjects of long and carefully worked out philosophies that can’t be reduced to sound bites.  (For a flavor of what I think is a wonderful example of contemporary Christian political theology regarding public goods and markets in areas such as health care, see Pope Benedict’s Encyclical Caritas in Veritate).

From my perspective there is less to criticize in Wallis’ comment on the decision.  Nevertheless, I would much more significantly qualify my enthusiasm for the result because of Justice Roberts’ reasoning on the taxing power.  In fact, ultimately I think it’s a poorly reasoned judicial opinion that opens a can of worms concerning what the government can call a “tax.” It seems to me troublesome development that the Constitution’s taxing power can extend to a choice not to buy a product – a choice not to act.  I don’t want to pay taxes, for example, for choosing not to buy a car or a bicycle or broccoli.  This really does seem to expand the government’s economic power in ways I find troubling.

While “individual freedom,” in libertarian terms, is not the central concern (as I see it) of Christian social ethics, nevertheless the integrity of the person very much is a central concern.  And this does mean that persons, not States, finally are the basic subject of politics, and that freedoms of the person and of private associations of persons are of basic importance.  An essential function of any just political structure therefore must be to hold the State’s power in check through the rule of law.  Whether the majority or the liberal-wing dissenters in the Sebelius case were right about the commerce clause issue – itself a legally and historically complex question — I believe the commerce clause should have been the basis for the decision rather than the taxing power. In my view, the payments required for uninsured persons under the individual mandate clearly are a “penalty,” not a “tax,” and therefore they should stand or fall as an exercise of federal governmental power under the commerce clause.

Given my reference to Pope Benedict’s Caritas in Veritate, it’s perhaps not surprising that I personally find the USCCB statement about the Court’s ruling the most appropriate of the three I’ve referenced.  In my view, Christians should desire that all persons have access to decent health care, and markets alone cannot meet this goal either from a moral or a pragmatic perspective.  A Christian social ethic therefore should recognize that it is a necessary and appropriate function of government to facilitate universal access to healthcare. However, where “healthcare” includes things like elective abortions, which raise serious moral concerns for many persons and religious associations, appropriate exemptions should be included.  And I fully agree with the U.S. Bishops that, particularly from a Christian perspective of welcome, immigration reform is essential, not least as in relation to education and healthcare.

So, I don’t have a final answer concerning how Christians should thing about the Sebelius case and the health care law.  I hope, however, that we can try to think about it in more careful and theologically nuanced terms than usually surface in popular debates.

David Opderbeck

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13 thoughts on “American Christians and the Healthcare Decision

  1. Too complex for me…Living in Canada and having healthcare available to rich or poor seems the logical way for countries like ours and USA (and others that have it) to handle making sure everyone can go to a doctor when they are ill….Christian viewpoint aside….Diane

  2. Part of the problem is your statement regarding “decent health care.” What does that mean? What does that look like? I believe that every single American – and illegal immigrant has “decent health care.” Access to “decent health care” is a very different elephant from “tax-payer funded healthcare.” Everyone in the US has the right and ability to enter a hospital emergency room and receive care without regard to income. Everyone in the US has the right to visit a doctor; and each doctor works on varying charge scales. There are also many free and low-income clinics available and often operated without government funding.

    Let’s also consider that upward of 75% of the costs of this “decent health care” provided by the federal government will be paid for by those who earn less than $120,000. The poor and middle class will be the ones footing the bill. It seems a bit hypocritical to say that the uninsured poor should be mandated to pay the tax/penalty for health insurance which they can’t afford in the first place. What is “Christian” or “ethical” about that?

    The “Christian social ethic” that government should, as a function of it’s existence, supply health care is a statement unsupported by Scripture. Your conclusion is political, not Biblical. Now politically, government can provide those services which are desired by the people, who must then also be willing to pay for those services. The American people do not want government mandated healthcare nor are they willing to pay for it.

    1. Let me first point out it’s not my writing but that of David Opderbeck from The Jesus Creed blog.

      You’re right about decent healthcare being tricky to define. But that doesn’t mean we can shrug our shoulders and leave it at that. We need to work to constantly raise the “decent” threshold for everyone.

      As for ER’s and doctor access you’re also right. However how much money could be saved by people taking basic preventive steps instead of waiting until something gets serious enough for an ER visit? Also, these visits raise costs for everyone when there is no insurer to cover the bills. That’s the thing about this healthcare issue. We are all interconnected. Decisions made by a few have ramifications for everyone.

      Yes, there are low income programs and clinics. But there are two problems-1) They are a patchwork of various services and thus needlessly inefficient 2) The working poor and middle class often don’t qualify for these benefits. People making say 30-50k are seeing their wages suffocated by massive and increasing premiums. Most face the choice of living on a bare bones budget to meet the premium, or living with the risk of paying a huge deductible in the event of tragedy. We can do better than this as nation.

      No one is saying the “uninsured poor” are going to foot the bill. The mandate will force those young, healthy people who are currently working and CHOOSING not to have insurance to buy into the system instead of free riding until they need it. Additionally, those who cannot afford care are already provided for as you already mentioned. This is about lowering costs and increasing the spending power of the working poor and middle class.

      Who is paying for it? I don’t have numbers in front of me, but I think a much higher number of Americans than 75% make less than 120,000. Therefore, if 25% of the cost is born by those making more than 120,000 that is significant progress, the rich investing in the poor. Nonetheless, you’re right it is young people buying in who will largely allow insurance companies to lower their costs, but as already discussed that’s a good thing.

      No one is saying this plan is the only biblical option, nor denying social ethics are political. The author was clear he doesn’t think there is one Christian position. Christian social ethics are an attempt to organize society and Christian behavior in light of the gospel and its ramifications. Can anyone deny the arc of the bible is towards justice and all living in peace? Can anyone deny we will be judged by how we treat the “least of these?” So my question for those opposed to these new changes is, “Do you have a better idea?” Yes, there are still many issues to be resolved, but at least this is a step in the right direction, a step towards a more just society.

  3. Let me first suggest that if it was God’s design for government to care for the “least of these,” He would have mandated such in the Old Testament Law for Israel. But He didn’t. Care for the needy was the responsibility of individuals – not a government.

    We might look back in history to England in the 17 and 1800s. (I know, some are rolling their eyes, but hear me out). John Wesley and his band of Methodists started schools, hospitals, and other social outreaches – without a single dime (or pence) from the government. These Methodist outreaches, added with efforts from others like William Booth of the Salvation Army, lifted the poor of English society at the height of the Industrial Revolution.

    What would happen if government stopped it’s control through over-regulation and intervention, and allowed the church, private citizens, and corporations to cooperate – free from government mandates – to provide basic services? Yet we now have city governments making it illegal for churches to feed and clothe the needy.

    Ask any small businessman: does the government make it harder or simpler to conduct business? From the doctor to the farmer to the pencil maker to the restauranteur, government regulation makes business more difficult. As a pastor for over 25 years, I know how government regulations make it so difficult for churches to provide basic services to the needy. Government isn’t the answer – it really is the problem!

    If churches were less concerned with tv ministries and larger buildings, erecting kingdoms of our own here on earth, think of the money freed to help the needy. There are already churches that do this without fanfare or government assistance with great success. It is not the role of the government to be Daddy and Mommy to “the least of these.” I believe that was the charge Jesus made to the church!

    We do not need government to create a more “just” society. Governments neither make a “just” society nor better people. The Gospel proclaimed and practiced by individuals through the church, in the power of the Holy Spirit, however, make both.

    These are my ideas. Thank you for providing the forum to discuss this. You’re courageous.

    1. I would challenge your point about the OT and argue God did in fact enshrine caring for the poor, widows, aliens, and orphans in Israelite law. However they carried it out, it was a central tenet and concern for the society.

      Certainly I commend Methodists and many others who made and are making a huge impact on society. But its not enough. Healthcare today is so complex and expansive only the government can insure equitable, consistent services.

      Economically, I don’t see how this could do anything but help. As I stated earlier, it will give the middle class more spending power. I completely agree we don’t need to regulate business too much. Small business is the engine of the economy. I’m all for things such as lowering the capital gains tax and making start ups easy. But don’t you think small businesses will be helped even more if they don’t have to worry about employee health benefits. How many more people will they be able to hire then. Also, there is no disputing nations which invest more public money in healthcare spend less on healthcare per capita.

      You are absolutely correct Jesus was talking to individuals. What I am saying is we as Christian individuals ought to seek to live out those values on a societal level to correct injustices and fight for the common good. Turning our backs on the disenfranchised in the public square is also turning our backs on them personally. Is Christ not Lord of all life, or only of our personal conduct? Does his church have any good news or anything to teach government about living justly?

      You’re also right about pro-life concerns. No doubt about it. Surely, however some type of compromise or exemption system can be worked out. Democracy is messy business. I’m not saying this law is perfect by any means, just a small step in the right direction which will also undoubtedly need some correction.

      I guess I just don’t understand what we’re so afraid of here. Most people in my circle of friends and family have responses similar to yours. I don’t see it is big government vs. freedom or free enterprise vs. regulation. I see it as a recognition that our country is only as strong as its weakest citizens. Even if some or many are getting wealthy, that is unacceptable of others are left out in the cold by systemic imbalances. We are interconnected as a society and the government is simply the best tool for organizing society to give everyone a fair shot. I guess that’s how I see it, as a neutral tool. Many conservatives think anything government is wasteful and nefarious. This is unfortunately true, due to the corruption of pork in our system. However, that doesn’t mean all government is bad. When public money is invested in human capital and not wasted on partisan pork it gets a huge return and the country is better off (ie Medicare, Social Security, military, infrastructure, state schools, and so on). So no, government doesn’t make better people. But it is the God ordained means of organizing society and restraining sin. Why would we not want that to be as fair and just as possible?

      Also, I completely agree with everything you said about the church.

      1. You’re right, God did give explicit directions to Israel regarding care for the poor; however, it was not to be carried out by a governmental body, but by individuals.

        And you’re also quite right that democracy is a messy business. Thankfully the Framers gave us a Constitutional Republic – if we can keep it.

        (I love the give-and-take discussion. Thank you.)

        Happy Fourth of July!

  4. PS. With total control of the health care industry and services, we now must also contend with religious health workers and institutions being forced to violate Scriptural and Christian ethics. Roman Catholic clinics must provide birth control. Protestant doctors must perform abortions. Etc. This is a step toward a more “just” society? I think not.

  5. Ben, I’m very impressed with the article you posted and with the comments you’ve made. I wish more people had your view, and I’m glad you’re offering your perspective.

    1. Thanks again for your kind words. No doubt it’s a tricky issue, but it’s time to move past the knee jerk, eye twitching “socialism” response and build towards solutions. People have to understand its not a zero game here.

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