Evangelicals and Health Care (Updated)

I have to confess to always being perplexed not only by American opposition to universal healthcare, but to opposition to universal healthcare by evangelicals on purportedly theological grounds. I was simultaneously amused and confused by the image on TV of two pastors prostrating themselves before the Supreme Court and praying that Obamacare would be thrown out. Did they really think that God would be opposed to everyone in America having access to healthcare (even if legally required to purchase it)? I thought Jesus went around healing the sick, the blind, and the lame … for free? Didn’t Christians set up the first hospitals in the world? Has anyone heard of the Leprosy Mission and the work they do around the world without asking for a person’s insurance number? So the question is why the opposition to universal healthcare and why is the conservative evangelical constituency among the most vocal in opposition to it?

I have always lived in a country with universal healthcare, both in Australia and the United Kingdom, and though those systems have many flaws, they are eminently superior to a system where millions of citizens do not have access to healthcare because they cannot afford it or are discriminated against. I have been blessed with a good measure of health for the most part, but myself and my family have spasmodically relied on government provided health care to get us through serious injury and illness. I experienced first class care when I took ill with a bout of viral meningitis in the UK several years ago. My youngest daughter also receives very good assistance with hearing and learning difficulties through government programs in Australia. So I am a big supporter of universal healthcare.  Again, it’s not perfect, but it’s better than what people get in Africa and America.

I am also fairly well aware of the American system with HMOs, Medicare, Medicaid, and the furor surrounding Obamacare. I travel to America often, converse with Americans about healthcare whenever I can, and I’ve done some research with health professionals on the healthcare system in several countries. So I feel competent enough to offer some commentary on universal healthcare and the American evangelical objection to it.

Wayne Grudem’s book God and Politics speaks for many in its opposition to universal health care. I have a tremendous respect for Grudem (I once had breakfast with him at the Tyndale Fellowship) and I concur with his stances on same-sex marriage, euthanasia, and abortion, etc. However, it looks in many places like Grudem has already made his mind up on politics and seeks to give his political perspectives biblical sanction (see in particular the critique of Grudem’s theological method by Kevin J. Vanhoozer, “The Voice and the Actor,” 62-63 in J. Stackhouse, Evangelical Futures). Grudem gives several reasons for rejecting universal healthcare.

1. Inefficiency. The absence of incentives from a competitive free market will lead to inefficient practices and,therefore, result in spiraling costs and reduction in services.  My response is that the free market is driven by profit and not by concern for its citizens’ welfare. Insurance providers make money by charging the maximum amount they can while providing the least service they can and by marketing themselves better than other insurance providers. But consider this: while it may be cheaper and more efficient to sub-contract out our border security, the liberation of Kuwait, and eliminating Al Qaeda terrorists to a mercenary organization of ex-US Marines, we don’t do that because we only trust an organization with accountability to the people to protect us from harm and to prosecute our strategic interests. I could give the same example with environmental protection, education, and banking regulation. The same applies to healthcare. We trust ourselves, i.e. the officials we elect, rather than CEOs, hedge funds, market forces and profit incentive to be the guardians of our standard of health and medical care. What is more, inefficiency can be curtailed if you have a health system that is heavily reviewed by independent agencies (i.e., an ombudsman) and if government control of healthcare is held accountable by a free media who report on waiting lists and funding levels and a good political opposition who aim to eliminate waste and provide better system than the current government.

2. Rationing. Grudem complains that a government funded health scheme will lead to a rationing of healthcare and government then decides who gets treated and who does not.  At a certain level this is true, but it is not called “rationing,” it is called “triage.” Every waiting room in every hospital has to prioritize on who needs the most urgent care based on the severity of the case and the resources available. The problem I have with Grudem’s model is that the delivery of health care is not determined by the person with the most critical need, but by the person who has the most money (or best policy). So Grudem is right at one point, America does have the best healthcare in the world … but only for those who can afford it, that’s the problem. This system encourages doctors to discriminate against persons on Medicare and Medicaid because it is less lucrative for them to treat them. The solution is not the abolishment of medicare and medicaid, but the integration of private and public health so doctors can work in both streams effectively without huge disparities in fees received – again, this happens in Australia quite well.

I would actually endorse some of Grudem’s approaches to the healthcare crsis such as tax credits for those who take out private insurance because it it encourages people to take out private health cover and thus takes the pressure off the public system, establish health insurance collectives to help people gain private insurance at discounted rates, capping medical liability insurance, and allowing people to purchase insurance from companies interstate. The question of treating people with a pre-existing condition is more complex and I confess that I simply need to think further about a solution esp. in respect to the American system. But not giving such people insurance or else forcing companies to insure them is certainly problematic on either account. But when Grudem says: “Some provision should be made to care for those who cannot truly afford medical insurance … some kind of fund that would enable the truly poor to obtain a basic health insurance policy,” I think he makes a noble concession, yet one that undermines the entire thesis for a strictly private approach to healthcare. A good private system that is regulated and competitive is indeed good, but it does not obviate the need to establish a safety net so that every citizen in our country has access to the best health care that can be provided, even if at government expense.

I should also point out that there is nothing biblical or even theological in Grudem’s arguments. It is a fairly standard GOP perspective on healthcare. But what if we were to bring Jesus into the healthcare debate, what would it look like? Well, I want to point out several things to my American friends about healthcare, government, and Christian faith:

1. Beware of The Cult of the Individual and the Idolatry of Greed. American and evangelical opposition to universal healthcare has nothing to do with the Bible or Theology, but is driven purely by a cultural and economic ideological bias; a bias (or at least a disposition) of which very few are even aware that they possess. The American emphasis on freedom, civil liberties, individualism, low taxes, laissez-faire economics, and small government has always predisposed them against too much government regulation and intervention in the life of the individual.So it goes: Why take my money and redistribute it to someone else who is too lazy to work? Tell’em to get a hair cut, a real job, and then get their own healthcare! I get the point, I enjoy freedom, I benefit from a free market, I don’t like taxes either, and I don’t want my country to turn into the next Eurozone catastrophe where there is low productivity and a culture of entitlement. But it seems to me that this emphasis on individual liberty is advocated at the expense of commitment to and compassion for our wider community. There is no mitigation of economic opportunity and no disparagement of individual responsibility to think of ourselves as socially responsible for each other, working in and for our wider society to achieve a collective good that we cannot otherwise achieve individually. What is more, the libertarian approach is really a form of social Darwinianism, namely, every man for himself and survival of the fittest. To an outsider looking in, the American mythology of freedom is the cult of the individual. The libertarian view of “leave me and my money alone” owes more to Darwin and Nietzsche than it does to Jesus or Moses. Our treasure is in heaven with our good deeds, not in the Bank of America. In Jesus’ parable of the Good Samaritan, the Samaritan did not baulk at the cost of paying for the healing for the wounded stranger, an action that is irreconciliable with certain tenets of conservative American economics. So I don’t mind paying taxes, especially if it means that no child will ever go without needed medical attention, and to prevent any person from having to choose between financial ruin and seeking medical attention. The challenge I have for my American friends is to see their history and culture as things not to be baptized with Christianity, but to be weighed and measured against the biblical worldview and its ethical corollaries. American is a truly great nation (they saved Australia’s butt in WWII!). You guys have the best and worst of everything: great prosperity and great inequality; Chik-Fil-A and White Castle; Billy Graham and Benny Hinn, Jim Hamilton and Denny Burk (or is it Denny Burk and Jim Hamilton – I forget which one is the bad guy!), but it is not perfect as ya’ll know, and among its imperfections I think are the cult of the individual, a near-worship of economic prosperity, and a cultural inclination on reneging on moral obligations to anyone other than ourselves. The opposition to universal healthcare can only be given religious currency by either repeating the words of Cain, “Am I my brother’s keeper?” or by quoting the apocryphal saying, “God helps those who help them themselves!” It has no traction in the Judeao-Christian ethic, nor in the teaching of Jesus, the instruction of Paul, and has no place in the testimony of the Christian tradition.

2. Varieties of Universal Healthcare. A big problem is that Americans simply do not understand universal healthcare (hence the talk of these “death panels,” which incidentally do not exist). Universal healthcare is not necessarily socialism since Australia is not a European socialist state, nor is New Zealand where much cost for public health care is still borne by the individual. Note also that there are a variety of models. The UK and Australian models are very different. In Australia we have a two tier system with public health and private health sectors. In fact, just today, I visited my step father in a public hospital where he was in intensive care suffering with a severe breathing condition, and was very well looked after. But I also booked a physio appointment for my daughter to be partially paid with private health cover. Yet in the UK there is virtually no private healthcare with only a few private hospitals. Governments subsidize health care and insurance to different extents depending on the country. In addition, not every country with universal healthcare provides government funded abortions. I know this is a major concern for American evangelicals, but government does not have to do this. In fact, in Australia, it was only very recently that government provided a partial refund on abortions and that may be reversed at our next federal election.

3. Christian Advocacy for Healthcare. Every western democracy from Norway to New Zealand has universal healthcare for its citizens except for the most prosperous nation on earth. Across the world this move to care for the sick has been driven by a Christian ethic of compassion and not by the pursuit of economic again. Now as any mission organization will tell you, there is no mission without margin, so you have to pay for it. But the purposes of taxation is not a re-distribution of wealth, but to do together what we cannot do individually, airports, defence, environment, education, commerce, etc. and to help the poor and the vulnerable. Universal health care is not a ponzi scheme any more than the USAF is a ponzi scheme. It is something that is needed and in the national interest of our citizens to have.

4. The Testimony of Americans Who Have Shifted Their Views. My good friend Dr. Jason Sexton, a recent graduate of St. Andrews University in Scotland, graduate also of the Masters Seminary in California, and current post-doc at Ridley Hall in Cambridge, England, told me of some of his experiences in Europe of universal healthcare. While in France doing a language course, his daughter Kara became critically ill with a cavernoma vascular malformation that had hemorrhaged on the left lobe of her brain. Jason told me:

When we were in Paris last summer, the leading pediatric neurosurgeon who performed my daughter’s emergency brain surgery, who trained under the leading neurosurgeon in Great Ormond Street, London, saw me editing my thesis beside my daughter’s bed in the Parisian ICU, and asked, “Are you a student?” I replied that I was finishing my PhD at St Andrews in theology. After this, he asked if we had spoken to the social worker (who were somewhat reluctant to acknowledge the fact that we were Americans in Paris on a language course with the Catholic University of Paris who had virtually “no money”). I had a date to speak with the social worker the next day, at which point the world-class and leading neurosurgeon at L’hopital Necker, the oldest children’s hospital in the world, told me: “The doctors in Paris, we’re not rich, and don’t make a lot of money. We’re not like the States – we don’t like to take the money from the families.” He was obviously aware of the inflated medical and insurance costs in the US, and wanted to encourage us in this moment. We expected the surgery and hospital costs to be outrageous, of course. But after hearing this from Kara’s surgeon, and also learning around this time that the British NHS was willing to fully reimburse our somewhat nominal hospital costs in Paris (after three weeks in Paris). We, of course, had some extra unexpected travel, lodging, and living costs, which prompted believers from all around the world to assist us financially. But after hearing this from the neurosurgeon, my wife and I breathed a sigh of relief, knowing we were cared for by some of the world’s most skilled specialist hands and minds, and that the French (and British) somehow were caring for us in profound ways that cost them something. And in this moment, we knew God was caring for us and our little girl in the very best means possible.

Dr. Christopher Hays is an American with a Ph.D from Oxford who has done post-doctoral work in the UK and Germany. Listen to his story:

Since most testimonials in this blog-entry will probably focus on the UK, let me comment on Germany, where I lived and worked for two years. German UHC requires everyone to purchase health insurance. Since I was a low-income student with a wife and two children, I paid 45 Euro a month for the state-backed insurance. This got me full medical and dental coverage (best dental care we ever received). There were co-pays: 10 Euro per quarter covers your contribution for all medical and dental fees. And when my wife got pneumonia and had to be hospitalized for 10 days, we spent a grand total of 100 Euro. When Michelle was hospitalized, even though I knew we were well-insured, I still thought that we’d be in financial trouble; after all, I’d have to take a lot of time off of my non-salaried work to watch our boys and help Michelle recover. But I shouldn’t have worried: my insurance paid 90% of my wages. And if I couldn’t have left work for other reasons, then insurance would have paid to hire someone to come watch the boys, cook, clean, and buy groceries. So when Michelle got sick, instead of worrying about money, all I had to worry about was helping her get better.  Of course, someone had to pay for that. The German people and my tax-dollars paid for it. But nobody begrudged the fact that a foreigner in a low tax-bracket was getting proper medical care. Why? Because in Europe and the Commonwealth people have a much broader understanding of human rights. Since most testimonials in this blog-entry will probably focus on the UK, let me comment on Germany, where I lived and worked for two years. German UHC requires everyone to purchase health insurance. Since I was a low-income student with a wife and two children, I paid 45 Euro a month for the state-backed insurance. This got me full medical and dental coverage (best dental care we ever received). There were co-pays: 10 Euro per quarter covers your contribution for all medical and dental fees. And when my wife got pneumonia and had to be hospitalized for 10 days, we spent a grand total of 100 Euro. When Michelle was hospitalized, even though I knew we were well-insured, I still thought that we’d be in financial trouble; after all, I’d have to take a lot of time off of my non-salaried work to watch our boys and help Michelle recover. But I shouldn’t have worried: my insurance paid 90% of my wages. And if I couldn’t have left work for other reasons, then insurance would have paid to hire someone to come watch the boys, cook, clean, and buy groceries. So when Michelle got sick, instead of worrying about money, all I had to worry about was helping her get better. Of course, someone had to pay for that. The German people and my tax-dollars paid for it. But nobody begrudged the fact that a foreigner in a low tax-bracket was getting proper medical care. Why? Because in Europe and the Commonwealth people have a much broader understanding of human rights.

5. The Example of Jesus. As we reads the Gospels one cannot help but notice that a central characteristic of Jesus’ ministry was offering healing for the sick and injured. He was no physician or witch-doctor who charged money for his actions, but did them as demonstrations of the here-and-now-saving-power of the kingdom of God. Jesus’ healings were proof that the Lord “took-up our infirmities,” Israel’s new exodus was happening, the day of liberation had arrived, and God was showing his kingly power for Israel and also the nations. Indeed, praying for the sick, anointing with oil, laying on hands, and caring for the ill were characteristics of the early church (see Rodney Stark on this who makes some amazing conclusions about this vis-a-vis immunology and Christian growth!). If we see ourselves as continuing the ministry of Jesus in some senses (obviously not in every sense) then seeking to care for the sick should be part of our kingdom vision. It was this kingdom vision that led and continues to lead Christians to set up medical centers around the world, hospitals, and clinics. If we are gonna do that in New Guinea why not in New York as well?

Conclusion

Let me acknowledge that opponents of universal healthcare are not merciless and greedy persons who delight in the plight of the poor and the sick. They want a system of healthcare that is responsible, affordable, compassionate, and does not interfere with their liberties. I can respect that. Also, I’m not saying universal healthcare is flawless, nor am I endorsing every aspect of Obamacare. But many opponents of universal healthcare are constrained by the myopia of their own cultural context, especially concerning individual liberty over social responsibility, economic prosperity over social security, and have wrongfully tried to give religious sanction to a very human set of beliefs. What is more, I find opponents mostly uninformed as to how universal health care works and the rhetoric of “death panels” and the like illustrates this all the more.