Theological Health and Healthcare

What makes for healthy theology on the subject of healthcare?

I suppose it all depends on which theologian you are asking. From my vantage point, drawing as I do from certain Trinitarian thought forms, one must be attentive to guard against the extremes of individualism and collectivism respectively. The ground of all reality is neither an individual(s) in isolation who is selfishly concerned nor a collective without distinctive particularity and responsibility. God is three distinct persons in eternal communion. As those created in the image of this God who is eternally one in relational otherness, we are not left to fight for ourselves; nor are we parasites.

While some may find treatments of the Trinity rather parochial, I beg to differ. The Trinity is the very basis for addressing the age old conundrum of the one and the many, the collective and the individual, as my own doctoral mentor, Professor Colin Gunton maintained. Moreover, not only are Christian Trinitarians created in the image of the triune God. All people are created in the image of the Trinity. Thus, Christians should not be surprised when they find people who don’t hold their religious convictions living in a way that models them. Take for example the story of the Good Samaritan in Luke 10. We don’t know anything about the religious convictions of this Samaritan of extraordinary mercy; nor do we know anything about the religious views of the person left for dead whom he helps. All we do know is that Jesus uses this Samaritan to rebuke a religious scholar who knew well the Scriptures.

What would modeling Christian or Trinitarian convictions look like as it pertains to the subject of healthcare? Should Christians and those in the community at large be committed to individualized healthcare, corporatized healthcare, or socialized healthcare? Certainly, opinions vary widely. While I believe we all want affordable, quality healthcare, and better public health, we differ on how that should be effected.

Whatever the case may be as to the specific policy we advance, hopefully we are biblical and seek to account for the biblical exhortation to care for our neighbor and to foster shalom in the communities where we live and work.

Consider once again the Samaritan of extraordinary mercy in Luke 10. He did not leave it to Obamacare or Medicaid, but attended to the person left for dead on the side of the road. So, the socialized soul must also understand that he or she has a personal responsibility to care for the person in need; he cannot leave it to the system.

And yet, that does not mean that the individual alone is left to care for the person in need. Nor is the church alone responsible before God to care for those in their midst. The society at large has a responsibility in Scripture to care for the widow, the orphan and the alien in distress.

Someone responded to one of my posts on public health by saying that the church should not look to the society as a whole to assist with caring for the needs of the poor; the church alone should take up that challenge.  In response I wrote that Christians don’t have a corner on civic virtue. So, why shouldn’t taxpayers, including Christians, care for the poor in our society? In fact, many people outside the church desire to pay taxes to address the needs of people in poverty. Moreover, while according to Scripture, Christians are to care for those in need in their own ecclesial communities, why should our concern as Christians end there? The Samaritan in Luke 10 is set forth as a model for how all of us (Christians and those not yet Christian) are to care sacrificially for our neighbors. The Samaritan’s neighbor in this case was someone he did not know; the person in need was not part of his personal community. Moreover, Jesus tells a religious scholar who does not believe in him that he, too, is to act in this way (like the Samaritan). While this parable does not speak directly to the subject of taxes, it does speak to the issue of how all people are to care for their neighbors in need in a sacrificial manner. The biblical call to care for the poor is not limited to care for our Christian communities or limited to Christians to be those who care. In fact, I often come across people outside the church who have a concern for the poor that outweighs many Christians’ concerns. Such people give sacrificially to the poor and are willing for their tax dollars to go toward the poor. They sense their responsibility to give, which I take to be a reflection of the image of God and God’s grace at work in their lives. They also realize that without the government’s help, we are not able to address well the overwhelming costs and complexities in our society today concerning public health. The individual, the religious community, the government and businesses must all play their parts for the well-being of our society.

We are all responsible, and we must move forward together. In view of the God who is three persons in eternal communion and who makes it possible for us to move beyond individualism and collectivism, we must continue to work together to account for personal responsibility and corporate solidarity. What will such responsibility and solidarity entail for healthcare?

Join me at The Institute for the Theology of Culture: New Wine, New Wineskins’ conference on Healthcare this Saturday, October 19 to further engage these issues.

No system is foolproof. Some people will seek to leech off of nationalized healthcare. When they don’t seek to contribute to the system but simply benefit from it, they injure their distinctive identity as well as harm the social health of the community. When individuals without enough money to pay into Obamacare but too much to benefit from Medicaid have to pay a penalty, the system robs them of benefiting from public health. When we leave it to the market to work it all out without imposing any constraints on human depravity and selfishness, the market will make it possible for the fittest to thrive; even so, a nagging question persists: who will ensure that the truly poor and those approaching poverty survive?

In the biblical world, the poor have a stake in society. What should we conclude about our society, if we were to run it completely like a market driven by shareholder concerns? However, if we approach consideration of the market more communally, we will find that the economic crisis does not have to result in a moral crisis that involves discounting the poor and those approaching poverty in our midst. Nor does it have to involve discounting people generally, reducing persons in communion to commodities in isolation. Trinitarian thought as espoused by this author views God as supremely personal and communal. The named God of Father, Son and Spirit in eternal communion does not allow the creation to be commodified: God has a longstanding stake in making sure that those created in the divine image are valued for their inherent worth as those loved by God rather than for how they benefit the free market’s shareholders.

This calls to mind a recent Economist article that explores the longstanding debate on whether firms should focus their attention on shareholders or stakeholders: “The economic crisis has revived the old debate about whether firms should focus most on their shareholders, their customers or their workers.”

In an article in a recent issue of the Harvard Business Review, Roger Martin, dean of the University of Toronto’s Rotman School of Management, charts the rise of what he calls the ‘tragically flawed premise’ that firms should focus on maximising shareholder value, and argues that ‘it is time we abandoned it.’ The obsession with shareholder value began in 1976, he says, when Michael Jensen and William Meckling, two economists, published an article, ‘Theory of the Firm: Managerial Behaviour, Agency Costs and Ownership Structure’, which argued that the owners of companies were getting short shift from professional managers. The most cited academic article about business to this day, it inspired a seemingly irresistible movement to get managers to focus on value for shareholders. Converts to the creed had little time for other ‘stakeholders’: customers, employees, suppliers, society at large and so forth. American and British value-maximisers reserved particular disdain for the ‘stakeholder capitalism’ practised in continental Europe. “A New Idolatry,” The Economist, April 22, 2010, (accessed on 1/20/2013).

Shareholders are stakeholders in corporations, but not all stakeholders are shareholders. While shareholders own portions of companies through owning stocks, stakeholders are concerned about the performance of companies based on various factors, not just the appreciation of stocks. Stakeholders can include employees, customers, suppliers, bondholders, and the general public. According to a May 8, 2009 entry at Investopedia,

The new field of corporate social responsibility (CSR) has encouraged companies to take the interests of all stakeholders into consideration during their decision-making processes instead of making choices based solely upon the interests of shareholders. The general public is one such stakeholder now considered under CSR governance. When a company carries out operations that could increase pollution or take away a green space within a community, for example, the general public is affected. Such decisions may be right for increasing shareholder profits, but stakeholders could be impacted negatively. Therefore, CSR creates a climate for corporations to make choices that protect social welfare, often using methods that reach far beyond legal and regulatory requirements (Reference, accessed on 2/9/2013). See the debate, “‘Stakeholders vs. Shareholders’: Haas faculty debate ‘Whom exactly should business serve?’”.

Whom exactly should businesses serve? Whom exactly should society serve—God or mammon? How should we approach public health? Healthcare providers must guard against raising premiums simply to make more profit. Pharmaceutical companies must concern themselves at every turn with making medicines that the sick really need rather than what won’t help and may even harm them. Injured patients must not seek to get rich on malpractice, raising malpractice insurance costs through the roof. Doctors should not approach their vocations from the vantage point of prestige and financial well-being, but from the vantage point of the Hippocratic Oath. Everyone has a stake in public health; no matter our stock portfolio or position, we all share in the consequences as participants in the greater public.

We must be willing to ask the various hard questions, not to paralyze discussion, but to advance the conversation. What is required is an open table, where we move beyond oversimplified ideology in search of complex solutions. The God who is triune moves forward not by advancing a platform position that is pushed down people’s throats. The God who is triune is not an ism; rather, this God is supremely personal and communal and makes it possible to share a meal at his open table and reason together.

This piece is cross-posted at The Institute for the Theology of Culture: New Wine, New Wineskins and at The Christian Post.

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About Paul Louis Metzger

Dr. Paul Louis Metzger is the Founder and Director of The Institute for the Theology of Culture: New Wine, New Wineskins and Professor at Multnomah Biblical Seminary/Multnomah University. He is the author of numerous works, including "Connecting Christ: How to Discuss Jesus in a World of Diverse Paths" and "Consuming Jesus: Beyond Race and Class Divisions in a Consumer Church." These volumes and his others can be found wherever fine books are sold.

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  • BrianJConsidine

    Paul, I think you reason this out well and present something good to think
    about. I would be all for a single-payer healthcare system, I’m not
    saying that is your position, but for one thing – our government.

    You don’t mention the government, except to say they need to play a part in healthcare administration, while addressing the sin of corporate greed that drives the market price of healthcare upward. Therefore, I will… :-)

    As but one example, I would point out that the government recently released a new $634 million dollar website, although some reports now indicate that number is overstated. Regardless the cost, this new system still isn’t working well. Worse, people are realizing the costs of the plans being offered through this new government website are higher than they were for many prior to the ACA healthcare mandate. This government has been wrought with issues since launching, so much so to quote the a recent Huffington Post article: “failure of this magnitude would discredit a core premise of this presidency, that government can do big things to improve Americans’ lives.”

    Americans were told that premiums would come done, be more affordable, with the implied name “Affordable Care Act.” That served to get this current administration elected twice. The economics of the mandate and removal of the preexisting condition clause weren’t well presented to the American people. Naturally absorbing more sick people into the risk pool for insurance carriers must drive costs upward. Some have been citing this as the case all along. The IRS is now projecting that the premium costs for a family of four will exceed $20,000 per year by 2016. How many American families can afford that kind of added expense?

    Complicating the rising cost issue is the approach taken didn’t allow for catastrophic plans with lower premiums. Rather an ideologically driven mandate, supported only by a single party, was expeditiously issued (“we need to pass it to find out what’s in it”) that required the same level of basic care for everyone. It wasn’t a solution that considered real world market factors. It does often seem that good intentions do not overcome government ineptness when it comes to involvement in what should otherwise be self-correcting competitive free markets. And, there were ways to make it more competitive that were not considered, or if they were, were too easily dismissed. Why?

    While some corporations may be guilty of greed for a profit motive, governments (which also have their own motives because they are run by people who have a sin nature, which historically often puts them at odds with the common good), is often guilty of another form of greed – ideologically driven power. Such ideological power grabs have the potential to upset markets that would otherwise work to keep costs down.

    The ACA was sold to the America people on the basis of the 40 million who were uninsured. Certainly in a society concerned with the common good, it is not acceptable to exclude anyone from access to healthcare. The fact is no can be in emergency situations in this country. Two things more to consider here. First, there was already a safety net in place for the poorest Americans – Medicaid, and Medicare is available for our seniors. Second, many of the uninsured are uninsured by choice. Many are young healthy people who chose to remain uninsured. Many work part-time and don’t have the means to purchase health insurance. Many will remain uninsured and now chose to pay a minimal penalty rather than be forced to purchase an unaffordable plan.

    Could we “progress” to a single-payer system like Canada, Australia or the UK? Perhaps we will but we also need to be honest about how their systems are working. Just because the majority of the Developed world has such plans in place is not necessarily reason for this nation to follow suit. Is single-payer superior to ours? That needs honest debate with our government leaders willing to listen to one another.

    Ultimately, you are correct that “Everyone has a stake in public health; no matter our stock portfolio or position, we all share in the consequences as participants in the greater public.” But when a government is driven by ideology, as this one is in my humble opinion, civil discourse is very difficult at best and that doesn’t foster an environment of trust. We need an honest dialogue about a very complex issue, which has been largely lacking from this national debate.

    In closing, to your second to last paragraph I would add: government leaders must seek to serve honestly the public good first, not special interests, their political base, or ideological derived visions of grandeur. I point this out to perhaps bring some additional balance to your very thoughtful article.

    Praise God that one day, hopefully sooner than later, we will see the “healing of the nations,” as our Trinitarian God brings wholeness to his creation.

    I always enjoy reading your posts. Blessings, brother.

  • Y. A. Warren

    Religions are ways of bonding the spirit, whether sacred or non-sacred in each individual to the spirit in each other in committed community. When we take the personal connection away from common commitments, we take away the accountability to one another that is necessary to “Christian” community.

    This is the loophole in assuming that we are all responsible for each person who shares in the “community” of our country. The taxpayers are given the burden of responsibility with no commensurate accountability coming from those who take from the system. I didn’t pay my own children to simply breathe and breed, but I am forced to pay for many others, who by choice, live in the ways of the lowest animals.

    Responsibility without authority is a lose-lose scenario for all concerned. I resent the magical thinking that so many religious people put forth, “God will provide.” The Sacred Spirit is encased in flesh for a reason that I don’t pretend to understand. What I do understand is that flesh and blood ministers to flesh and blood. I believe the test of whether the spirit that energized the flesh and blood is The Sacred Spirit is not religion, but responsible, committed compassion for all the physical manifestations of The Sacred Spirit on earth.