3.3 Greater Good Test Case (Health Care)

 We finish chapter 3 in the series, "What Would Jesus Vote?" Here is the series so far:

1. Would Jesus Even Vote?
2.1 (He would vote) As a Kingdom Citizen
2.2 We're citizens in two kingdoms
3.1 (He would vote) for love of neighbor and enemy
3.2 (He would vote) for the greater good

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Test Case: American Health Care
8. This discussion is all fine and good in the abstract. But where the rubber begins to hit the road is with specific issues. This is where our tribal sensibilities and gut assumptions begin to overwhelm our reason. It is also where our lack of expertise can begin to bite us. Things that seem obvious to us on a superficial level may become more complicated when we dig into the details.

Nevertheless, we need to explore the issues if we are going to make any progress toward a more Christlike approach to our political engagement. The question of health care seems like a good test case for the concept of the greatest good for the greatest number. So we gulp and step into deeper waters.

Let us start with the most general question. Would Jesus want as many as possible to have access to good health care whether they are believers or not? The answer seems pretty obvious to me. After all, healing and exorcisms stood at the very heart of his earthly mission. As far as we know, there wasn't a person he didn't heal if they sought him for healing.

To repeat some things we've already pointed out. God sends the much-needed rain on the righteous and unrighteous (Matt. 5:43-48). He sends the much-needed sun on both the righteous and the unrighteous. What would Jesus vote? At least at first glance, it sure seems like Jesus would vote for as many people as possible to have health care.

So what might prevent a Christian from supporting universal health care? Someone might try to show that it isn't economically feasible. Perhaps someone could argue that providing universal health care in some way lowers the overall average health care. Someone might argue that it is unconstitutional in some way, or a Christian might argue it is somehow unbiblical or unethical. 

Let's look at these counterarguments. Since the Affordable Care Act (ACA) is the current American option on the table, let's use it as our point of discussion. We can add that the United States is the only major Western country that does not provide universal health care in some configuration. Canada uses private providers funded by taxpayers to provide it. The United Kingdom has a government-run system funded by taxpayers. Germany and France have a mixture of providers funded by taxpayers, and the government oversees the system.

9. This is as good as any place to have an aside about the socialist boogie man. There is a fair amount of illogical rhetoric that says, "If you believe the government should run anything, you're a socialist." This is irrational on the merits. There is a spectrum of options from a government that runs practically everything to one that runs very little. Here is a spectrum:

• Truly Socialist: North Korea and Cuba would be examples of true socialism. North Korea currently allows no private enterprise and the government runs everything. It is a horrible place to live.
• Social Democracies: Sweden and Denmark have very high taxes to provide extensive governmental services, and their markets are heavily regulated. Nevertheless, they also allow significant economic freedom and have a vibrant private sector. They consistently score among the happiest nations in the world.
• Social market economies: Germany and France have less government regulation than Sweden but still have significant government-run services. The private sector still runs freely despite being a strong welfare state. They consistently score higher than the US on the World Happiness Report.
• Capitalist welfare states: Canada and the United Kingdom are capitalist countries that still provide significant social services based on taxes.
• Free Market Capitalism with some Welfare: The United States and Australia would have fewer taxes yet and fewer government services. Still, we have Social Security and Medicare. We have public education and a postal service, not to mention an army and police that are government-run.
• Libertarian Leaning States: Singapore and pre-2020 Hong Kong are/were examples of states with few government services and very limited government intervention in private enterprise. Nevertheless, Singapore does have some government services relating to housing and healthcare, and Hong Kong was returned to China's control in 2020. 
• Anarcho-Capitalist countries: There ain't any. Without any government, you would just have human chaos.

You can see that the US is nowhere near socialist, and no current candidates come anywhere close to socialist. Logically, you can't simply dismiss proposals by saying, "That's socialist." I call that "labelism," and it's a nothing burger. You need to have an argument as to why a specific proposal is good or bad.  The US currently has a number of government-run services that we will talk about throughout our journey. 

Let me also say, "prove it" to those who think privatization is always better for the greater good. I would say it is often good, but we should consider each case individually. For example, having a centralized national defense surely works far better than if you had a host of competing mercenary and private military groups running around. Talk about a civil war waiting to happen! And don't like a particular conflict? Just quit.

Capitalism aims to maximize profit. Its intrinsic goal is to provide as little as it can get away with at minimum cost. When Bolivia privatized its water supply, it led to a disaster that ended with the government renationalizing it. A private company, without government regulation, will cut as many corners as it can to maximize profit. These dynamics suggest that when essential services are in view, the government may be better suited as the provider -- or else it had better regulate thoroughly.

Let's put a pin in that conversation and come back to it as we move through various topics. We'll take a case-by-case approach with the repeated dictum, "Prove it."

11. First with regard to cost. Because emergency care is regularly provided to individuals who cannot pay, both a thoroughly adopted ACA system or a single-payer system like Canada/Britain would lower or significantly lower the overall cost of health care in America. Healthcare costs in the US are significantly higher than those of Canada, Britain, Australia, Germany, France, etc. Meanwhile, our life expectancy is lower. On the merits, we have no bragging rights here. On the numbers, we are not providing a greater good to a greater number in the area of healthcare.

12. A second concern is health care quality and wait times. Because of those who aren't covered and because of the higher cost of health care, the US does not provide better health care for its population on average. It would rank lower on average among the countries we have been considering. Places like the UK emphasize primary care, so there can be wait times for elective care, but there is no extensive wait for essential care. 

In England, one can walk into an emergency room and get immediate service. When I was a student in England, I was a little shocked that we immediately went to the hospital when a Rugby player sprained his ankle. My family avoided the hospital like the plague because of the high cost of emergency room services. 

My father had some sort of heart event a few weeks before he finally died. They didn't go to the hospital even though Medicare would have paid. In my opinion, years of avoiding the emergency room were in play. My mother actually hung up on 911 when he died, thinking a twitch of his toe might mean he was still alive. I have another family member who eventually had a heart attack after failing to get proper medical care for diabetes. Again, in my opinion, none of the above would have happened in Canada or Great Britain where the mindset is just different.

Australia supplements its essential public care with private insurance options. In this way, it maintains a baseline of public health while providing options for those who can afford more for elective services. At least on the surface, a system like Australia seems to provide the best of both worlds. It seems to provide a greater good for a greater number than the American system, which largely caters to the privileged -- a differentiation that finds no basis in the Gospels. The Gospels give us every reason to think that Jesus would reject such a class differentiation.

The ACA of course was based on a Republican-designed system utilized in Massachusetts and involves a market-based approach based on competition between private insurance companies. In other words, it is a capitalism-based system. One has to wonder if it would have enjoyed widespread Republican support if it had been proposed by a Republican administration! Of course, then, it might face widespread Democratic opposition. One has to wonder the extent to which opposition to the ACA has been about partisanship rather than substance.

13. What, if any, opposition to it can be made on biblical or Christian principles? Wayne Grudem in his Politics According to the Bible has made several arguments against the ACA and similar health care proposals. [4] Probably the most serious concern he had was its provisions for contraceptive care and abortion. However, the Supreme Court decisions Burwell v. Hobby Lobby Stores, Inc. (2014) and Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania (2020) have mitigated those concerns. Similarly, the repeal of Roe v. Wade has changed that dynamic as well. It is really a side issue rather than an objection to universal health care per se.

Grudem is also concerned that it dulls personal responsibility. Rather than having to steward one's resources and count the cost for one's choices, one can take health care for granted. Healthcare becomes devalued because it is in such easy supply. Instead of reserving the emergency room for real crises, one now goes for a sprained ankle.

I feel this one a little bit. But I feel this one as someone who has health insurance. Is it better for everyone to have access to healthcare, or is it better for those of us with healthcare to grow from having to make careful choices about using what we have? It seems like an argument for the privileged rather than one that is concerned for the greater good of all. 

Again, knowing what I know of the Gospels, Jesus seemed more concerned that the crippled beggar (without health care) be healed than that the Pharisee grow in personal responsibility by making disciplined choices (can't even think of a story like this). In the end, I believe Wayne Grudem and others are unable to see beyond their Western glasses to read the Bible on Jesus' terms.

I will set aside for a later chapter the argument of Grudem and others that Romans 13 does not allow the government to provide services to its people like healthcare. In my opinion, this takes Paul's comments way beyond anything he was saying. Paul is not giving a comprehensive view of the state in Romans 13. 

And, even then, he calls the state a servant for the Romans' good. If the Roman government had decided to use the tax money it collected to provide healthcare for its citizens, I have to think that Paul would have approved. More on this question in chapter 6.

14. That leaves us with one last objection, and that is the individual mandate. The way the ACA was meant to work financially was that everyone was required to have health insurance or else to pay a fine. After all, the way insurance works is that there are enough healthy people paying for insurance to offset those who need health services. By requiring young people who are not as likely to need health services to pay toward it, the system became financially viable.

Suffice it to say, the Republican-controlled Congress in 2017 kiboshed the individual mandate. Interestingly, premiums for the ACA have still remained relatively stable. Only about 8% of Americans are not covered with some sort of health insurance at the moment, down from 16% before the ACA. All in all, the ACA would seem to be somewhat of a success, although it arguably would have even greater success if it had bipartisan support.

It does raise a bigger question of whether it is biblical for me to have to pay for someone else. Some would view the individual mandate as tantamount to stealing. You are taking my money to pay for someone else.

But this is a pretty Western cultural way of thinking -- hyperindividualistic. It's not biblical thinking. After all, what are taxes but a way of collecting money to provide services to everyone as needed? And the Bible unanimously says to pay taxes. And the collection could be for you. You don't know when you'll need medical help.

In the end, this all strikes me as a self-centered way of thinking, not a biblical one. The spirit of Scripture is rather, "Whoever has the life of the world and sees a brother in need and withholds his compassion from him, how can the love of God abide in him?" (1 John 3:17). Isn't this also part of the message of the Parable of the Good Samaritan in Luke 10? In other words, it seems more like the selfish mindset of the world to resist giving to those in need. Shouldn't a person with a biblical, Christlike heart gladly give -- even sacrifice -- for the good of others? It's God's money in the end anyway, not mine. [5]

We will return to some of these questions more extensively in the chapters that follow. I will make the case that the American capitalistic system makes money something different from something concrete like a hammer. If you come into my garage and take my hammer, that's stealing. But the system of money in a country like America is a little different. The Gross Domestic Product (GDP) isn't even tied to something concrete like a gold standard. Its value is much more abstract. More to come.

15. In the end, it seems fairly clear to me that -- on this one issue -- Jesus would vote for as many people to have healthcare as is practically possible. If you think of it, giving away free healthcare was a major theme of Jesus' earthly ministry. He did not cater to the wealthy and privileged who could pay for his services. He targeted "the uncovered," so to speak.

In the end, objections to something like the ACA seem to me almost entirely based on tribalism. In some cases, it is based on what I would see as extreme ideology. But in general, one side suggests a solution so the other side opposes it. It could have been flipped, and it might be the opposite. Mitt Romney could have become president and proposed something like the ACA, and maybe Democrats would have staunchly opposed it.

What would Jesus vote? On this one issue, I think he would vote for as many people to have healthcare as possible.

[4] Wayne Grudem, Politics According to the Bible (Zondervan, 2010).

[5] Ron Blue, God Owns It All: Finding Contentment and Confidence in Your Finances (Lifeway, 2016).