Monday, December 7, 2009

(At Long Last) Followup on "What Does the Bible Say About Nationalized Health Care?"

Last summer I asked the readers of this forum for their opinions on what guidance the Bible offers on the issue of nationalized health care. I promised that I would post my own thoughts on the matter once I had received some responses and had time to formulate my own thoughts. Here, at the eleventh hour, are my long promised thoughts.

In general, the Bible will tell us very little with regard to specific techniques and standards of care. It will tell us somewhat more about the principles that ought to govern us as we trade-off various considerations to propose solutions. And it will speak extensively to the worthiness of our individual and societal motivations in defining both the problem we wish to solve and potential solutions to it.

Note that in this post I'll stay at the level of summary with regard to "what the Bible says". I'll add supporting Scripture for a number of my assertions below in a later post.

So then let's begin at the level of motivation. Why we are undertaking a change at all? What problem or set of problems are we trying to solve? In a democratic republic such as that of the United States, there are, of course, many parties aiming at different ends in seeking to shape public policy, but is there a broad national consensus on what are the main reasons for proposing a change? Are we doing it principally for humanitarian reasons? For economic ones? For reasons of political philosophy?

The Humanitarian Motivation

If the principal reason put forward for a change is the "humanitarian" consideration, then the important thing is that there be clear evidence that there is a humanitarian problem to be solved. That is, to the extent that there really is a group of significantly poor people who can't afford basic care at all, the Bible is abundantly clear that it is morally mandated to care for such. On the other hand, if all can afford basic care
(meaning that they still have a place to live and enough to eat after getting said care) by some means or another, and the principal difference between "rich" and "poor" is the fact that the former can afford to extend their lives for a few weeks longer on average, it's unclear how strong the moral imperative supporting a change is here.

The Economic Motivation

Another common motivation for change is economic. That is, some say that health care costs are consuming too high a percentage of national income and that the percentage in question is continuing to grow at an unacceptable rate. In considering such a motivation we should determine what the cause is for the high and growing cost and decide if it is legitimate or illegitimate, addressable or unaddressable. For example, if the cost level and growth rate can be explained by the fact that our population is aging, then it's unclear that there's a problem to be solved at all. Or, if the cost level and growth rate are investments in medical research that have shown measurable results in length and quality of life, that would be entirely legitimate.

On the other hand, if the high costs and growth rate are caused by some group of people who are able to charge monopoly prices without producing economic value then there may actually be a problem worth solving there.

To the extent that there is an economic problem to be solved at all, the question will come down to whether there is "unjust" distribution of cost/benefit in the health care industry (that is, people stealing from others by taking more money than they are entitled to for value produced). That type of injustice is spoken to by the Bible's injunctions against greed in general and in favor of love for neighbor.

But, in order for this consideration to come into play, there needs to be evidence that such injustice is actually happening. That is, who's getting richer at the expense of whom, and how do we know that they are?

Political Philosophy

Some argue that health care is a right that ought to be provided by the government because the government is a more effective guarantor of individual rights than is private industry. There are two issues that need to be considered here: first, the nature of a "right", and second the issue of which type of entity is the appropriate one to guarantee and secure rights.

First, we must be clear on what constitutes a "right". For the purposes of definition, a "right" is that to which one is morally entitled. That is, a right is something which pertains to a person (whether inherently, by universal moral law, or by explicit or implicit promise or contract) and the taking of which constitutes injustice.

It's possible that some group of people could decide to constitute a society in which every member of that society undertook to collectively provide a certain standard of health care to all members of the society. Once made, that collective promise would constitute a "right" of the members of that society. Then, if some members of that society undertook to deprive other members of that society of this right, they would in fact be morally culpable of depriving others of their rights. However, this sort of right depends upon prior agreement by members of the society.

In the United States no such promise has been made and there is no such preexisting "right". What is being contemplated here is the creation of such a promise and such a "right". And the question which faces us is whether it is advisable to do so.

In my opinion, the Bible does not speak directly to the advisability of making health care a part of the social compact. It does provide some indirect guidance in the making of such compacts, however. It is not morally obligatory that a society create such a "right", but if we are going to do so, it is imperative that we as a society be clear about the nature of the covenant being entered into -- viz., who is providing what to whom in exchange for what. And it is imperative that we use the biblical principle of honest weights in setting forth the covenant. That is, no-one should lie or twist facts in order to create confusion. This is a societal agreement and therefore it is imperative that it be clear and understandable to all participants in the system.

Second, with regard to who is the best guarantor of "rights". It generally is true that it is the province of human government to secure people against the theft and depredations of morally lawless people. Therefore government should be involved in making sure that the social compact embodied by a health care system is faithfully adhered to.

This does the raise the issue of separation of powers. It would be highly inadvisable to have one and the same power involved in being party to the agreement and enforcer of the agreement. If we as a society create a right to health care it is important that a truly independent group be created and maintained to ensure justice. If it is not practical or reasonable to create such an independent group then we ought not to create the social compact because it cannot be enforced and is therefore subject to significant corruption.

Solution Constraints and Trade-offs

In addition to the motivational aspects discussed above, it's also important that any particular solution adhere to God's Law.

Some examples:

- if a principal reason for nationalizing health care is economic, in adhering to a Biblical view we must affirm that life is sacred and ought never to be taken for economic reasons.

- a national health care plan can not be said to be valid on a biblical basis to the extent that it supports the taking of life in abortion.

- a national health care plan that doesn't allow freedom of conscience to physicians would not be acceptable.


There's nothing inherently bad about national health care (and it MIGHT actually be a good thing), ASSUMING THAT

- clear statement of the problem we're trying to solve is made
- clear evidence is produced of the nature and magnitude of the root causes
- significant consensus for solution actually exists
- we're very clear AND HONEST about the social compact being created
- there is separation of powers and alignment of incentives to ensure honest and just administration of the compact
- it adheres to God's Laws with regard to sanctity of life
- it respects freedom of conscience

On the basis of these principles, I believe that it is
premature for American Christians to support this type of legislation. That is, I believe a clear and honest accounting of the nature of the problem we are trying to solve has yet to be articulated, and that most of the legislation currently pending in Congress fails the test of simple and honest explanation of a proposed social contract. I also believe that there are not adequate safeguards for freedom of conscience in any current legislation. Finally, I believe that the legislation doesn't have sufficient safeguards to ensure compliance with God's Law regarding the sanctity of life.

Beyond these concerns (founded in my understanding of biblical principles as enumerated above), I have doubts about the practical ability of the federal government to administer even a worthily conceived system of this sort (even in a system with adequate separation of powers). And I generally believe that the more power a governmental body has, the more the tendency to corruption, and therefore that we ought to be very cautious about the powers we give the national government.

As always, I'm interested in your thoughts on the matter.