Caring for one another’s bodies, particularly the bodies of the vulnerable, is one of the most profound ways we can fulfill our duty to each other. The simple fact of a person’s existence obligates others to care for that person; this ethic underlies our commitment to protecting the unborn. The Westminster Larger Catechism interprets the Sixth Commandment as a call to “all careful studies, and lawful endeavors, to preserve the life of ourselves and others,” and the Catechism of the Catholic Church enumerates that society is required to help others attain “health care.”
Despite what some may believe, there is such a thing as a conservative Christian case for single-payer healthcare. By “conservative,” I mean someone who wishes to conserve the institutions, structures, and communities of human life, which have been given to us by God and maintained in our common traditions—in particular, families, religious communities, and local networks of care that provide for the most vulnerable among us. By “Christian,” I mean that the principles found in Scripture and church teaching guide how we reason about politics and common life together. Christian love is not directly imported into politics with chapter-and-verse correspondence, but it is made manifest in various ways through political judgments that prevent harm, reward good, and punish evil. As Oliver O’Donovan puts it in The Ways of Judgment: “Wrong, and nothing else, is the necessary condition, but also the sufficient condition, for governmental intervention.”
The deracinating power of the state is probably the concern that engenders the most skepticism when raising the question of a single-payer healthcare system. “Health” is an extraordinarily difficult concept to pin down, and if unchecked, it will expand to encompass anything and everything as Leviathan's vanguard and advance scout.
Christian conceptions of “holistic health”—the flourishing of our minds, bodies, and souls—can help us understand that communities, familial and religious, are critical to our health. But the healthcare system qua healthcare system that we wish to fund through the state is not meant to be holistic because it never can be. One need only look at those who receive the most intervention by the state to see how awful it is at providing holistic care. Every healthcare professional encounters people who are not only personally miserable but are also usually inflicting misery on others despite having state-provided housing, food, and healthcare. These people, many of them victims of significant trauma, are just as deserving of love and care as any hard-working pillar of the community or saintly grandmother. We should not, however, expect that simply meeting their material needs will suddenly change them for the better; rather, we should ensure that they are getting what the state ought to give them as citizens and children of God. We must then be working in and through all institutions of human care to help them live better lives.
A conservative “healthcare system” is one that protects life and prevents disability. Modern medicine is good at resuscitation, reducing the risk of severe yet preventable incidents such as heart attacks and strokes, catching cancers when they can still be treated, and managing chronic illnesses such as asthma and depression. Caring for illnesses both catastrophic and chronic is what a healthcare system is for, and only when there is a strong focus on applying the technical power of medicine to prevent or treat disease, rather than an all-encompassing quest for health, can we speak coherently of a healthcare system worth funding.
Christian tradition has long held that those who lack material resources should receive what they need to survive, and we are blessed today to have medicines, tests, and procedures that our forefathers in the faith would have been eager to share with the poor. Thomas Aquinas makes a similar case according to natural law in the Summa Theologica: “whatever certain people have in superabundance is due, by natural law, to the purpose of succoring the poor.” We cannot argue that the poor do not deserve what they need to live and call ourselves Christians.
It is the state that must provide (or at least pay for) the most basic, elemental needs of the human body—not private charities or the free market. The particularities of healthcare are amenable to neither. Charities are simply too irregular and unfocused to really give people in need what is owed to them by natural law. As for the free market: Firstly, people are tremendously poor consumers. They do not know what is good for their health or how to allocate their resources appropriately for it. There is virtually no evidence that nutritional supplements, for example, make us live longer or happier, and yet supplements are a multi-billion-dollar industry. The opioid crisis and the antibiotic resistance crisis are prime examples of what happens when patients are given what they demand and doctors (because of laziness, ignorance, or cowardice) go along with it. Part of why our current healthcare spending is unsustainable is that countless unnecessary procedures, tests, and medications are paid for (and advertised by hospitals) in this vortex of supply and demand.
Secondly, what people need from any healthcare system for their physical health is a complex mixture of screening, advice, investigation, and treatment. There are some things that virtually everyone should receive, and things that other people need at various times. Health insurance exists because no one can reasonably budget, comparison-shop, or save up for the wide variety of doctors, tests, medications, hospital stays, or adjunctive therapies that they will need—especially not in an emergency. None of us knows whether or not we’ll develop an expensive and debilitating condition, so that risk has to be distributed across the population. Deciding between health insurance plans in the market is as pleasant as receiving a colonoscopy and almost as easy for the average person to do by themselves.
Thirdly, the market introduces unavoidable inefficiencies. Multiple drug companies making similar products cut deals with insurance companies who reimburse differing amounts to doctors who prescribe in idiosyncratic patterns, creating a bureaucratic nightmare that has been estimated to increase costs by as much as 400 percent in the U.S. compared to more centralized and streamlined systems like Canada's. When conservatives try to praise more “free market” systems like Singapore or Germany, they leave out the fact that these markets are both highly subsidized and regulated in ways that Americans have resisted, often because of the rent-seeking monopolists that control various sectors of the business and lobby for their own interests so that they can hold onto their own share of the exponentially increasing pie.
It is simply unjust to allow fellow citizens to be wiped out financially by an accident or killed decades too early by a preventable or treatable disease simply because they could not afford good insurance (especially if they work, as many uninsured people do). If that cancer were a man with a gun or a fire, we would say without hesitation that it is the state's duty to prevent his injury; it is the state's prerogative to prevent both human and natural evils from taking us to the early grave.
As for the Church, there will always be needs that she meets in her charity, but the cost of healthcare for the poor is too great a burden to ask her to bear. Indeed, the earliest hospitals were what we might call public-private ventures between church and state. As the Roman Empire Christianized, the hospital as we know it was born out of the private initiative of churches seeking to care for the disabled and the generous financing of newly converted public leaders. There is shockingly little record of Christians objecting to the state funding of their charitable works. For Christians whose conservatism begins and ends at the size of government, we must look back throughout history for a more robust view of health and the state.
What is conservative about single-payer healthcare? It gives people what they justly deserve in order to live, protected from preventable natural evil, and it does so in a way that is efficient and stewards the limited resources we have at hand carefully. What is Christian about single-payer healthcare? It takes the gift of modern medicine that God has given us and uses it to help our neighbors live in the bodies he created according to the laws of nature. A healthcare system that acknowledges its limits deserves to be funded by a state that admits it can only be a small part of human flourishing. Accompanied by a conservative revolution against the modern spirit that puts character and virtue at the heart of justice in society, and a Christian revolution in care that zealously defends our mutual obligations to one another and especially those whose health is most fragile, we can use the resources of the state for the prudent care of our created flesh.
Matthew Loftus writes from Kenya, where he teaches and practices Family Medicine.
First Things depends on its subscribers and supporters. Join the conversation and make a contribution today.
Click here to make a donation.
Click here to subscribe to First Things.
Image by Tima Miroshnichenko licensed via Creative Commons. Images combined and cropped.
