The Moral Vacuum of the Health Care Debates

On Thursday, the United States Supreme Court upheld the constitutionality of the Affordable Health Care Act.  After months of raucous rhetoric (it’s difficult to use the words “debate” or “conversation”), we will now have accessible health care  for millions of our co-citizens, and guarantees for those of us currently with health care, that we will not be without coverage upon a job loss, catastrophic or chronic illness, or  unexpected disabilities in our families.  For the sake of fair disclosure, if you haven’t already figured it out,  I support this important move and believe access to health care is a fundamental human right, given so many other aspects of our lives are contingent  on the ability to seek preventive health care, have routine screenings, and receive quality  medical care.

What has disturbed me most over the months has been the lack of theological and moral arguments for access to health  care.  I am not naive about economic realities (even though I am not an economist) nor about the complexities of implementing imperfect  policies (I am not a social policy expert).  I am just a Christian social ethicist who thinks Christians can add something helpful to this conversation in light of the long historical commitment which the  Church has had in providing health care, particularly to underserved and vulnerable groups of people. 

What is needed to civilize and make our  current “conversations” more adult?  Can Christians add anything helpful to the “debates?” Just a few suggestions here from this particular Christian social ethicist:

1.  We need to recover  an understanding the common good.  We have some commitments that access to such things as a quality education, safe roads, and a clean environment are good for all of us.  Can the same argument be made for access to health care as a common good, which serves all of us?  With God as the Creator we have in common, and as persons who share common spaces, can we not see that the health and well-being of others impacts the health and well-being of all of us?

2.  Persons on both sides of the “debate” recognize that our current health care delivery system is flawed.  Health care costs continue to rise. While it is purported that we have the best health care of any industrialized nation, we also have the most expensive, with the largest numbers of citizens uninsured. Health care is already rationed based on who can pay, or who has insurance, and our choices are already limited.  While I am grateful for employment and the health care coverage that comes with it, we are offered one plan with a designated network of doctors and medical providers from which to choose (all this is to say that the sound bytes of our choices being taken away doesn’t make sense given our choices always have degrees of limitations placed on them).

3.  How about a little empathy? I find it incredibly disingenuous, if not downright immoral, that those with  health care insurance provided for them are often the shrillest in their objections to opening up access to others.  Can we imagine, just for a moment, what it would be like to be unemployed and without coverage?  To fall suddenly ill with very few resources and options available for medical attention?  So, I make the basest of appeals to our  common humanity:  can those of us with adequate coverage provided for us with our shared financial participation at least imagine what it would be like if this wasn’t the  case?

In his book, A Theory of Justice, John Rawls outlines what is necessary for a fair and equitable social and political culture.  He suggests our common decisions ought to be made behind a “veil of ignorance” to remove any biases and prejudice in our common decisions.  Rawls’ “veil of ignorance” means that I don’t know who I am on the other side of the veil.  I may be the one who is ill, vulnerable, and without access to health care.   Decisions are then made on possible contingencies that come with the human experience so that social goods are distributed equitably.

While it is difficult to move straight from Scripture to our health care debates (nothing in our concordances here), perhaps the “original position” narrated in Genesis 1 and 2 is helpful for piquing our theological and moral imaginations when it comes to health  care access.  What was God’s creative vision for human communities?  Why a good earth? Why adequate food?  Why a beautiful and clean Eden? Why healthy relationships?  Why interdependence? Why meaningful work?  Why shared responsibility with God in managing and stewarding God’s good creation?  God’s goods at the onset of creation were meant to be shared.  God shared them with us, with the expectation that we share with others.



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  • Bob Sacamento

    ” … we will now have accessible health care for millions of our co-citizens, and guarantees for those of us currently with health care, that we will not be without coverage … ”

    No, we will have a law that, apparently somewhere in its 2000+ pages, mandates that certain people involved in healtchcare behave in certain ways, and that also mandates behavior for the rest of us. That. Is. All.

    If a law can guarantee healthcare, can it guarantee, I don’t know, food? Let’s pass a law then: Food providers always have to give people food. Housing? Construction companies always have to give people houses! If all you have to do is pass a law to make something happen, then how about, Providers of everything always have to provide for everybody else! There. Now *everybody* is happy!

    Sorry (sort of) for the snark, but the first paragraph of your column is Exhibit A of the fundamental mistakes in thinking that have led to this law in the first place: There’s this law that is styled “The Affordable Care Act.” Well, what could possibly be wrong with afforable care? Let’s get on board! We get health care now! The government says so!

    But life just doesn’t work that way. I am sure that, a few decades ago, when the Brits were dismantling a perfectly good private care system and putting socialized medicine in its place, their government was also saying things like “Affordable care! The government say so!” They weren’t saying things like, “Ten per cent of you will have to pull your own teeth because there won’t be enough dentists and there will be lots of perfectly good drugs that will cure some of you but we won’t allow them to be sold here in the UK because, well, they just won’t fit with the program. But that’ll be OK, because you’ll have affordable care! The government says so!”

    Put it this way: Do you want 1) the most people to get the most affordable care possible? or 2) the government passing laws with names like “Affordable Care Act”? Which is really what you want? I opt for number 1), and I think you do as well. (I certainly hope so, anyway.) But I further stipulate that there is alot of empirical evidence to convince the inquisitve that option 1) and option 2) are mutually incompatible. And sorry (sort of) again for the snark, but it really bothers me that an erstwhile thoughtful public blogger on an erstwhile thoughtful Evangelical site can just *assume* that option 2) is the way to get to option 1). It really speaks of a blog that is not just something I disagree with, but something that is dismayingly uninformed.

    • Government regulation does require that food providers provide food, rather than toxic waste, garbage, or some cheap chemical compound that looks and smells good but causes cancer.

      Government regulation does require that builders build houses and not cardboard Hollywood sets that melt at the first sign of rain.

      And boy oh boy, do they HATE that regulation. They lobby against it all the time. I wonder why….

      • Bob Sacamento

        You’re comparing apples and appaloosas Themon. Sure, there are plenty of rules that say these companies have to provide the services they claim to provide. But rules that force them to provide those services in the first place? Don’t think so. This point is pretty obvious, by the way.

        • Bob Sacamento

          And, well heck, I just missed my own argument there. The real point (though my previous point was valid as well) is that regardless of what kinds of rules the government can pass or has lready passed, there is ample evidence that a government Simply. Cannot. make it happen that everybody gets “X” by legislating that everybody gets “X”. In fact, historically, such legislation has the opposite effect.

    • Amen.

    • Tom Wiley

      Thank you Bob, for making the point that I was going to make. Once we start claiming these “rights”, where does it end? Why not start by claiming much more basic rights like food, water, clothing and housing? Because it not only doesn’t make sense, it just doesn’t work that way.

      • But we do provide access to those things! What on earth are you talking about? We have food stamps and food shelves, section 8 housing, homeless shelters, Habitat for Humanity, the Salvation Army, etc., etc., etc. What kind of people would we be if living here in the richest country the world has ever known we didn’t provide food, water, clothing and housing to those who need them? And for all the problems that Great Britain or Canada has with their socialized health care, only very rich British or Canadian citizens would trade it for ours.
        And why is it that the same people who seem to think that we allow people to starve and walk around naked in this country have nothing to say about the 45,000 Americans who die from lack of health care each year or the millions forced into bankruptcy due to medical bills? This bill is wildly imperfect, but can’t you spare a thought for the suffering that our wildly imperfect health care system causes? Or should we just let the sick die next to the naked, hungry and thirsty? Good grief.

  • Bryan O.

    Thank you for this post. The people I often encounter are those who are extremely distraught over the recent Supreme Courts ruling. What I find disturbing about their response is that, often, their outcries are a public lament over the danger that such a ruling has on our economy in general, and their own economic well-being, in particular. While I understand that healthcare, as it is currently envisioned, is considered a commodity, to allow economics to ultimately guide our healthcare decisions is a significant part of the problem. When we as Christians are more willing to allow economic decisions drive the way we relate to others we inadvertently show how we have been co-opted by a particular economic ideology. As you pointed out, the appeal to a common humanity really is needed. Perhaps this is the most fundamental Christian affirmation: “We are all created in the image of God and placed in this world to reap the benefits of creation.” This affirmation, as I see it, is in direct conflict with the notion that good economic sense is the best way for determining healthcare issues. My intent is not is minimize the economic issues at hand, but to suggest that they must be put in their proper place. Thanks again for the post.

  • doug mitchell

    Supporters of the bill seem to think the government is capable of compassion. It is not. These issues are complex, made more so by the technology that seems to leapfrog itself each generation. When left to government, which is the ultimate end of the current bill…the taxes, enforcement, and cost will shift the burden to the citizens pockets, and decisions determining care, innovation, and quality of life will be left to a policy driven bureaucrat, far removed from the patient. Though imperfect, charitable organization, many works of faith, who value the lives of individuals would provide the compassion that comes with freedom in Christ.

    • WhiteBirch

      “decisions determining care, innovation, and quality of life will be left to a policy driven bureaucrat, far removed from the patient. ”

      If you don’t see that this is already true, you haven’t interacted much with our private insurance system. As a former employee of theirs, I *assure* you, this is already the case. It’s far, far better than nothing.

  • Micah

    If charitable organizations were covering all uninsured, then this wouldn’t be a problem. Plus, if children are covered, and poor are covered, then God bless em. Jesus would love this healthcare law. He handed out free healthcare to poor and children all the time…

    • I wish you folks would simply look at the numbers.

      Medicare alone — which applies only to retirees — requires approximately 5% of all the working wages in the whole country. Assuming the churches were to take on the “charity” of Medicare, AND assuming that 100% of the working population of the country could be forced into churches, you’d have to demand a half-tithe of everyone’s income JUST TO SUPPORT MEDICARE.

      So how are you planning to force everyone into churches, and force them to contribute a half-tithe on top of whatever else they’re ALREADY giving? And then, there’s distribution. Will the rich Southern Baptist church in a community share its charity funds with the poor Mennonite church down the street? As well as care for Jews? And Muslims? And Pagans? And Atheists? Or is this YOYO (You’re On Your Own?)

      Guess what? You try this, and your “rich” churches are going to be buried in new converts, most of them poor, sick, and desperate. You’ll need to start giving your guests a “means test” to see if you can AFFORD to have them in your congregation. Sounds like what Jesus would do…..

      You guys have no concept of how BIG this issue is. And I’m only talking numbers.

    • Sorry, Micah, I pushed the wrong reply button. I’d intended to reply to Doug.

  • Wyndy,

    Thank you for this article.

    I agree with you that there is a near-complete absence of moral, ethical, or compassionate thought in any of the so-called “discourse” on most issues in the so-called “culture war.” Which includes Obromneycare.

    I think the core of the problem is straightforward. We’ve implicitly accepted a definition of the good as making the wealthy wealthier. The “common good” is therefore a contradiction in terms: there is nothing “common” about the good — good applies only to the successful. Furthermore, any idea of the “common good” encroaches on “freedom,” which means the freedom for the masses to be poor, to be sick, and to be oppressed — balanced by the freedom of the very few to be exceptionally wealthy, exceptionally well-cared-for, and to oppress anyone they see fit to oppress to achieve these benefits for themselves and their class.

    The American people, conservatives in particular, seem to have bought into this perverse definition, and — frankly — I’ve seen this nowhere more clearly than the Evangelical tribe. I don’t really understand why that is the case — it seems self-contradictory — but it’s a pretty clear observation.

    I’d put the question this way. We are (or were) the richest nation on Earth. So what should we do with that wealth? The answer seems to be: make the rich richer! They (somehow) deserve it — just as the poor (somehow) deserve their hardship. It is immoral to hold back the avaricious, and immoral to help the helpless.

    So what should we do with all our national wealth? Make the rich richer?

    • Bob Sacamento

      “I agree with you that there is a near-complete absence of moral, ethical, or compassionate thought …”

      Here’s my reason for opposing O-care: It is clear that the government ….

      Waitaminit. You’re still hearing why *you know* I oppose O-care. If you can turn that tape off, I will try to tell you why I, in fact, do. Please don’t read further until the tape is off. OK. Here goes.
      I simply don’t believe the government will do a better job with healthcare than it has with education or alternative energy or pretty much anything. Further, looking at the societies with government run health care that are most similar to us — Canada and the UK — I just don’t want to go down that road. 10% of adult Brits pulling their own teeth at some point in their lives because the dentists are affordable but just not available. Canadians making trips to the Dakotas or Minnesota for medical treatment because they just can’t stand in line in their own medical system any longer. The British Health Service refusing to allow the sales of certain tried and true medicines that actually cure people simply because those medicines don’t “fit with the plan.” I do not want this for America. I do not want it for America’s rich, not for America’s poor, not for America’s middle class. I don’t want to see people dealing with chronic pain all their lives because they can’t the MRI scan they need to diagnose the pain. I don’t want to see some woman with a large family told that she can’t have pre-natal care for the next kid on the way but she can get abortion serveces. I don’t want to see anyone who is now on the way to living to 75 or 80 having to kick the bucket at 65 0r 70 because — forget about the death panels — the services Just. Aren’t. There. In short, I am convinced that O-care will mean more sick people, more hurting people, more people dying 10 years earlier than they would otherwise. I don’t want this for my friends, my neighbors, my family.

      So, go ahead. Tell me where I am factually wrong. (Good luck.) But the point it: How am I, and all those who make similar arguments along with me, lacking in compassion??? The difference *I* see is that there is alot of compassion on both sides but only one side (that would be mine) has actually looked at the facts to try to determine what the actual outcome, intentions notwithstanding, of this legislation will In. Fact. Be. Well, that’s how I see it anyway. This talk about how everyone on my side of the argument lacks compassion is really insulting.

      • MumbleMumble

        “So, go ahead. Tell me where I am factually wrong. (Good luck.)”
        Challenge accepted.
        You were factually wrong when you said that 10% of Brits pull their teeth. Recent reports suggest that 10% are not registered with a dentist, and that 6% self-treat (which yes, often includes pulling their own teeth). I would also point out here that according to the CDC in 2010 an estimated 14.5% of Americans lack dental insurance. I would also like to point out that according to the US Census Bureau almost 50 million people (around 16.3% (not sure how that jives with the CDCs numbers)) in the US lack any health insurance. Statistics vary, but reports have suggested that anywhere between 18,000 to 45,000 people die each year because of a lack of health insurance. According to the World Health Organization, in 2000, the US ranked 72nd for overall level of health, despite spending the most amount of money on health care. Life expectancy ranks 50th in the US (the UK ranks 13th). This is something that the private health care system has. Not. Been. Able. To. Fix.
        Yes, the government may do a crappier job of it. But they’d be pretty hard pressed.

        • Bob Sacamento

          Only 3% of those who are in this country legally have no recourse to health care assistance. Everybody else has insurance, has available options (usually government) that they just aren’t aware of, or they just don’t want to pay for it. I could get on board for something that would help that 3%, but this Rube Goldberg O-care is not the fix.

          The US trails the UK in life expectnacy by 6 months. 6months. Take away gunshot wounds and traffic accidents and we outlive the UK. In fact, adjust for *lifestyle choices* and we have one of the longest lived populations in the world. In the first place, government is going to make a mess of health care (more on that below). And in the second place, fixing lifestyle choices with health care is like fixing a leaking roof with cheesecloth. And really, insurance or not, are 6-10% of all US adults pulling their own teeth? (Answer: No.)

          Our health care system is so expensive for two reasons. One, it is expensive for the same reason that our “automotive transport system” and our “housing system” and our “nutritional delivery systems” are so expensive: The best costs money. It is also expensive because most Americans are actually *over-insured*, and this is because of all the government mandates, pre-dating O-care, that have been put on insurance companies. If people didn’t have to pay (because of gov’t) for insurance they don’t need or want, healthcare costs would go way down. And, oh yeah, the ever-*optimistic* CBO is telling us that O-care is going to cost us $2 tril a year, way more than we are paying now. Even the government supporters of this bill don’t tell us that it will cut costs anymore.

          As for the WHO, the name says it all. But snark and my aversion to studies from “international experts” aside, there are a host of diseases and disorders that are best treated in the US, and our system — despite its flaws — is just simply more efficient than the socialized medicine of almost any country. And that study said we were 72nd in “overall health”, not in health care. Here come those lifestyle choices again.

          But your comment completely missed what I said was my main point. (And dang, but that happens alot on this site. But, I don’t know, maybe you just didn’t care about it.) Themon, and the author of the original post, say that the people on my side of the argument are a bunch of blue meanies completely lacking in compassion. We just want to keep all the drugs and doctors’ hours to ourselves. My main point is: Given the objections I given to O-care, and not the objections that you “really know” I want to give, how can you — or Themon or the author here — argue that I, and all the folks with me saying similar things, are lacking in compassion?

          • MumbleMumble

            I never suggested you were lacking in compassion. And I did realize that was your main point, but no, I didn’t care. I merely pointed out where you were factually inaccurate (side note: I would not hesitate at all to think a similar percentage of Americans pull their own teeth).
            I understand your point that you are insulted by others suggesting you lack compassion, when the actual differences are between the best possible means to go about solving the problem. My guess is that arises from the belief that a purely free-market driven system is dispassionate. The belief that we, as a society, should not spend government resources to ensure that all citizens have access to life-saving health care (again, the 18,000 – 45,000 dead comes in handy with this argument) is lacking in compassion.
            Me personally, I don’t believe you’re a demon-monster wishing for death and destruction. I do think that you are wrong that the private market is the best possible solution. We could probably both throw numbers and arguments back and forth at each other, but, honestly, what’s the point? I’m guessing there’s no magic statistic or statement that will change either of our minds. My belief is that a profit-based system cannot provide the best amount of care for all people, you believe it can. Neither of us have a pure example to draw from, so the argument just bounces around.

  • Chip Atkinson

    Does the mandate requiring the largest faction of evangelical Christians, the Roman Catholic Church, to act against its conscience bother your ethics? The Bishops supported the bill provided they would not be required to provide services the Church has always condemned.

    • Roman Catholics are the largest faction of evangelical Christians??? 🙂

      • Bob Sacamento

        OK, Themon, maybe Chip isn’t “hip” on how the usual buzz words are used, but his main point, which you are trying to sidestep, remains.

  • Chris Pinson

    A good start to any conversation would be honest framing. You have fallen short. This is not, and has never been, about “access to health care.” It is about incremental expansion of the federal government’s control of the health care industry via an impenetrably complex law that was rammed through Congress with the intention of eventually granting the State complete control.

    • What is this paranoia about “complete control?” And why should anyone care?

      The government actually has “complete control” of the military and our entire nuclear weapons program, and always has. Why isn’t that a problem?

  • scotmcknight

    Wyndy, splendid piece, simply splendid.

  • India Marie Knowles

    I am so with you, Wyndy. Thank you for being a voice in the wilderness.