The answer to the healthcare conundrum is not be found in Congress or in the White House, or in any draconian centre of usurped power; it is to be found on our own doorstep, in our own homes and in the homes of our neighbors…

Healthcare is a problem, and not apparently a merely sociopolitical problem. If one were to believe the media pundits, it is also very much a religious question. Nicholas Kristoff of the New York Times berates Paul Ryan for attempting to repeal the Affordable Care Act on the grounds that Speaker Ryan’s opposition to ObamaCare is a denial of the Gospel and therefore a violation of the Catholic faith that Speaker Ryan professes. Jesus, apparently, was a socialist and would have voted Democrat. Not so, says James Freeman in the Wall Street Journal, Speaker Ryan was right to push forward with the repeal of the Act and can do so, as a Catholic in good conscience, because, well, Jesus was not a socialist. Accusing Mr. Kristoff of casting “the federal bureaucracy in the role of Jesus,” Mr. Freeman defended Speaker Ryan’s efforts to dismantle President Obama’s healthcare legacy. Mr. Freeman asks what Jesus would say about big government and comes to the conclusion that he would agree with Mr. Freeman that it is not a good thing. During the Presidential election campaign, in another article for the Wall Street Journal, Mr. Freeman had asked “how would Jesus vote?” Contrary to the claims of Mr. Kristoff and the New York Times party, Mr. Freeman and the Wall Street Journal party insisted that Jesus was not a socialist, nor would he have voted for Bernie or Hillary; he was a fiscal conservative who would have voted Republican. To put the Wall Street Journal’s perspective in a nutshell (a good place to put nuts!), Jesus would not merely have supported Speaker Ryan’s efforts to repeal Obamacare, he would have voted for him to become President of the United States!

This preamble, somewhat ridiculous as it is, does at least raise the curtain on the moral ramifications of ObamaCare and the ethical repercussions associated with its amendment or repeal. It is certainly the case that aspects of ObamaCare represent a tyrannical attack on religious freedom. Its legal requirement for Christian employers to violate their consciences and commit a grave sin in paying for the provision of abortifacient drugs for their employees was an egregious example of Big Government metamorphosing into Orwell’s Big Brother. On the other hand, Christians, mindful of Christ’s great commandment that we love our neighbor, are not at liberty to leave the weakest and poorest members of society without adequate care. We cannot take what might be called the Scrooge option, leaving the weak to die “and decrease the surplus population.” This apparent dichotomy between the rights of the individual, on the one hand, and the responsibility of caring for the weak and the sick, on the other, is the palpable tension at the core of all good political philosophy.

In the political philosophy of the Catholic Church, more commonly called its social teaching or social doctrine, the rights of the individual or family are enshrined in the principle of subsidiarity, whereas the responsibility of the individual towards the care of the weak and the sick, or towards the common good, is enshrined in the principle of solidarity.

Surprisingly, the definition of subsidiarity given by Wikipedia (not always the most reliable source!) is entirely adequate:

Subsidiarity is an organizing principle that matters ought to be handled by the smallest, lowest, or least centralized competent authority. Political decisions should be taken at a local level if possible, rather than by a central authority. The Oxford English Dictionary defines subsidiarity as the idea that a central authority should have a subsidiary function, performing only those tasks which cannot be performed effectively at a more immediate or local level.

More definitively, or, at any rate, more authoritatively, subsidiarity is described in the following terms by Pope Pius XI in his encyclical Quadragesimo anno (1931):

Just as it is gravely wrong to take from individuals what they can accomplish by their own initiative and industry and give it to the community, so also it is an injustice and at the same time a grave evil and disturbance of right order to assign to a greater and higher association what lesser and subordinate organizations can do. For every social activity ought of its very nature to furnish help to the members of the body social, and never destroy and absorb them.

Elsewhere in the same encyclical Pius XI describes subsidiarity as a “fundamental principle” of political philosophy: “It is a fundamental principle of social philosophy, fixed and unchangeable, that one should not withdraw from individuals and commit to the community what they can accomplish by their own enterprise and industry.”

In the Catechism of the Catholic Church subsidiarity is discussed in the context of the dangers inherent in too much power being centralized in the hands of the state:

Excessive intervention by the state can threaten personal freedom and initiative. The teaching of the Church has elaborated the principle of subsidiarity, according to which a community of a higher order should not interfere in the internal life of a community of a lower order, depriving the latter of its functions, but rather should support it in case of need and help to co-ordinate its activity with the activities of the rest of society, always with a view to the common good.

Put simply, the principle of subsidiarity rests on the assumption that the rights of small communities—e.g., families, neighbourhoods, private associations, small businesses —should not be violated by the intervention of larger communities—e.g., the state or centralized bureaucracies. Thus, for instance, in practical terms, the rights of parents to educate their children without the imposition by the state of “politically correct” school curricula would be enshrined by the principle of subsidiarity. Parental influence in schools is subsidiarist; state influence is anti-subsidiarist. In terms of healthcare provision, it seems inescapable that a one-size-fits-all healthcare system, imposed by an over-sized and over-zealous central government and administered by an over-sized and therefore inevitably inefficient bureaucracy, is a gross violation of the principle of subsidiarity. In short, ObamaCare, or any reincarnation of it in another guise, is unjust because of its riding roughshod over the justice inherent in subsidiarity.

Does this mean that Christians can be comfortable with the repeal of the Affordable Care Act and a return to the status quo ante? Was everything fine and dandy until President Obama got his hands on it?

The answer is a resolute “no.” Healthcare provision in the United States stank before the rise of President Obama, though it might be conceded that it stank even worse after he added socialism to the mix. We cannot be happy with the status quo ante because we cannot be happy with the better of two evils. We need to strive for justice. We need to find ways in which healthcare provision can serve the common good, ways in which it serves our neighbor, even our weakest and poorest neighbor, as well as serving ourselves. In short, we need a healthcare solution that abides by the principle of solidarity as well as the principle of subsidiarity. As the definition of subsidiarity in the above-quoted section of the Catechism stresses, subsidiarity must function “always with a view to the common good”.

From a libertarian perspective, this subclause to the Catholic Church’s definition of subsidiarity represents the “devil in the detail;” it is the back door by which the bogeyman of socialism enters the scene. From a Christian perspective, however, it is the place where the rights of the individual or the family are circumscribed by their responsibility towards the needs of their neighbours, the door of welcome by which our neighbours are invited to join us in a spirit of solidarity.

Perhaps a practical example might help, indeed a personal one.

We have two easements running through our property. One conveys gas pipelines; the other, telephone wires. I accept a limitation on my rights as an owner of private property due to my responsibility towards the common good. My property rights (protected by laws based on subsidiarity) are circumscribed by my responsibility towards my neighbor (protected by laws based on solidarity). At the heart of such a healthy balance is the recognition that rights always presuppose responsibility; one cannot and should not exist in isolation from the other.

“Many people today would claim that they owe nothing to anyone, except to themselves,” wrote Pope Benedict XVI. “They are concerned only with their rights, and they often have great difficulty in taking responsibility for their own and other people’s integral development. Hence it is important to call for a renewed reflection on how rights presuppose duties, if they are not to become mere licence.”

Solidarity, writes St. John Paul II, “is not a feeling of vague compassion or shallow distress at the misfortunes of so many people, both near and far. On the contrary, it is a firm and persevering determination to commit oneself to the common good; that is to say to the good of all and of each individual, because we are all really responsible for all.”

Solidarity is, therefore, not a mechanistic thing that can be brought about solely by the passing of laws or by government intervention. Such mechanistic solutions, of which the Affordable Care Act is a case in point, always become coercive, trampling on legitimate rights, even religious rights and the rights of conscience, in order to bring about an elusive (because illusory) “justice.” Mahatma Gandhi spoke disparagingly about “dreaming of systems so perfect that no one will need to be good.” Justice is impossible without the widespread practice of virtue, specifically the virtue of charity (caritas), the love without which nothing is possible except the moral decay that leads to chaos. This bedrock reality was summarized with succinctness by Benedict XVI:

On the one hand, charity demands justice: recognition and respect for the legitimate rights of individuals and peoples. It strives to build the earthly city according to law and justice. On the other hand, charity transcends justice and completes it in the logic of giving and forgiving. The earthly city is promoted not merely by relationships of rights and duties, but to an even greater and more fundamental extent by relationships of gratuitousness, mercy and communion. Charity always manifests God’s love in human relationships as well, it gives theological and salvific value to all commitment for justice in the world.

As the foregoing demonstrates all too clearly, there will be no justice in society, in the area of healthcare or anywhere else, unless we have a society that recognizes the necessity of Christian virtue. A society which refuses to even discuss virtue, on the relativistic assumption that what is called “virtue” is a matter of personal choice, is doomed to descend into tyranny, via the anarchy which is always and only a stepping stone to the rule of the tyrant.

But what should Christians do in the meantime? Should we wait in passive submission until the politicians come to their senses? Of course not! We should move from preaching what should be practiced to practicing what we preach. We can build radical new healthcare solutions from the grassroots up, evangelizing the culture with healthy answers to the unhealthy mess in which it finds itself. One such way of practicing what we preach in terms of keeping subsidiarity and solidarity in harmony is by joining Christian initiatives, such as the new medical sharing groups, or medical cooperatives, which bypass the healthcare juggernaut by connecting Christians in medical need with those who might be in need in the future. My own family has joined Samaritan Ministries, one of these new initiatives. Every month we send a check directly to a family in medical need, except for one month a year when the check is sent to Samaritan Ministries to cover its administrative costs. As members of this ministry, we will receive direct help from other families if and when (and heaven forbid!) a medical emergency strikes our family.

Dale Ahlquist, President of the American Chesterton Society, is a great advocate of these new and exciting healthcare initiatives. “Insurance is a bet where the only way to win is to lose,” he writes. “In other words, it only pays off when something goes wrong.” He continues:

When I had health insurance, I was paying a ridiculously high premium, with an even ridiculously higher deductible, to help pay for a ridiculously high glass skyscraper that bore the name of my “provider.” Now I belong to a Christian medical cooperative. There are over 40,000 members. The idea is that everyone pays his own basic medical costs, and then when a major medical need arises for a member, that person gets help from the cooperative. Each month I send a check to another member, and one month a year, I send a check to cover the administrative costs of the cooperative. The amount I send is based on my family status. So, I know that I’m not paying for abortions or hair replacement, but for the known needs of a person with a name and address, to whom I am also asked to write a letter of encouragement and spiritual support. The cooperative sends out a monthly newsletter with advice on cutting medical expenses and finding affordable doctors and clinics. I pay my basic medical bills from a tax deductible health savings account. Bottom line: I pay half of what I used to pay for insurance. And I’m not giving money to a huge corporation that is more interested in profits than in providing health care. And I’m connected to the people who benefit from my payments. Lord willing, I will never have to make a claim, in which case, I haven’t wasted any money in lost premiums: I’ve helped my neighbor.

There seems little to add to Mr. Ahlquist’s eloquent advocacy of this radical new approach to healthcare, except to say that it conforms with subsidiarity by removing all government intervention from the equation in conformity with “an organizing principle that matters ought to be handled by the smallest, lowest, or least centralized competent authority,” and that it conforms with solidarity in the sense that in helping myself and my own family I am also, at one and the same time, helping my neighbor in need.

The answer to the healthcare conundrum is not be found in Congress or in the White House, or in any draconian centre of usurped power; it is to be found on our own doorstep, in our own homes and in the homes of our neighbors.

Books on the topic of this essay may be found in The Imaginative Conservative Bookstore. Republished with gracious permission from the author. This essay originally appeared in Chronicles (May 2017). The Imaginative Conservative applies the principle of appreciation to the discussion of culture and politics—we approach dialogue with magnanimity rather than with mere civility. Will you help us remain a refreshing oasis in the increasingly contentious arena of modern discourse? Please consider donating now.

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