[Andrew Evans is a graduate of Davidson College, where he studied Political Science and Philosophy. He is the recipient of Hertog and Publius fellowships, and currently works at National Affairs, a quarterly journal of domestic policy. He lives in Washington, DC.]
A few years ago I was attending a student Bible study at the University of Edinburgh in Scotland, and one of the study’s leaders, an Englishman, asked me why many Americans do not want universal health care. Britain’s National Health Service (NHS) enjoys broad support across the entire political spectrum, including from Christians. My friend, in fact, called himself a democratic-socialist, and I do not doubt the sincerity of his Christian faith in the least.
The experience of the NHS in Britain shows that Christians of good will can and will disagree on the proper role of the government in securing healthcare for its citizens. This disagreement has resurfaced with vigor in recent days with a debate over whether Americans should support the Affordable Care Act, popularly known as Obamacare. N.T. Wright and Michael Bird (based in Scotland and Australia, respectively) both contend that American Christians who object to Obamacare are failing to care for the poor and thus live out the true teachings of the faith. Michael Kruger and Bill Evans (who is, I should note, my father) have responded that Obamacare represents a unwarranted overreach of the federal government that will make healthcare in America worse and will expand the federal leviathan at the expense of local institutions and religious freedom.
I cannot claim to have the same quality or type of insights as the esteemed scholars and pastors above. I am an assistant editor for the public policy journal National Affairs in Washington, DC, and a former reporter for the Washington Free Beacon where I covered healthcare policy, and as a result my perspective is slightly different. I hope it is valuable, though.
Bird seems to think that the opponents of Obamacare do not want universal healthcare coverage. He wrote:
We are mystified as to how can good Christian men and women oppose – in some cases in the name of religion-providing healthcare for it citizens. Yes, I know there are some grey areas like the contraception mandate, and so forth, I understand the religious freedom objection, but the general principle of providing adequate healthcare for all should be championed by evangelical Christians who follow the teaching of Scripture.
The heart of Wright and Bird’s objection seems to be this: Obamacare is an effort to improve the status quo, to increase the number of people who have insurance coverage, and is that not a cause worth supporting? After all, is it not fundamentally unjust that in a society as wealthy as ours, the poor and sick should not be able to obtain health insurance? I myself have a pre-existing medical condition that would likely exclude me from getting health insurance on the individual market, and while treatment—funded in large part by my health insurance—keeps my condition in check and allows me to live a full, healthy life, going untreated could leave me permanently impaired. For other people, not having health insurance could mean death. In short, health insurance is a pretty basic necessity, given how healthcare is delivered in America, and certainly Christians should seek to extend coverage to everyone, right?
Why then do so many American Christians oppose Obamacare? Are they actually failing to live up to their creed? Or might there be a principled reason that goes beyond the pragmatic considerations that it simply won’t work as well as the private market? I think there is, grounded in the Bible’s teaching about human nature and needs.
The human being is a social creature. The only part of God’s creation that was not good was the fact that man was alone, so God made Adam a helper, Eve. Adam’s reaction to seeing Eve is one of overflowing joy: “This at last is bone of my bones and flesh of my flesh.” Adam’s song and the mysterious union of marriage demonstrate that man simply is not complete alone. We were made in the image of a triune God—God said, “Let us make man in our image, after our likeness”—and thus fundamentally need to relate to other people in order to be fully what God intended. The Mosaic law deals with social interactions, too, requiring that children honor their parents and that individuals not covet or steal from others. This emphasis on the value of personal relationships and community continues into the New Testament, where Christ teaches not just personal but communal morality (see Matthew 5 and 18, for example) and that Christ died not just for individual Christians, but for the Church. There is a stream of thought running throughout the Scriptures that we need other people in order to be fully human.
What exactly does this “social nature” entail? From Adam we learn that being social means being needy, because God gave Adam a helper in Eve. It means finding your needs met in other people, accepting help from them, as Adam did from Eve. It means respecting and honoring those who have cared for you, even after they have cared for you, as children should their parents. And in a fallen world, it means being vulnerable to other people. We see this not only in Matthew 18 but in the life and work of Christ himself, who came to earth and became close friends with many people, saw their sin, loved them and felt the pain of their loss (see John 11: 32-36), and ultimately reconciled them to himself through his death and resurrection.
In short, being social means knowing people and caring for them. It means being part of local networks of accountability.
This vision of people as social creatures is what the Bible teaches, but Christians are not the only ones to have this insight. Very early in the Politics, Aristotle says, “From these things it is evident, then, that the city belongs among those things that exist by nature, and that man is by nature a political animal.” There are certainly differences between what the Bible teaches and what Aristotle teaches, but the basic insight here is similar—people naturally are political, that is, they are by nature bound up with other people.
This understanding of humanity as social means that we need these connections to thrive. We need to be in a local network of accountability and responsibility in order to be fully and robustly happy. An isolated individual’s life is by definition deficient.
This understanding also stands in tension with other visions of human flourishing. Some say that people need to be totally free from all restraint, governmental and social. They should be free to live out their passions and desires regardless of how it impacts others and regardless of whether it fits into the value system of their local community. We see this vision in both the conservative “rugged individual” who strikes out on his own to blaze his own trail (think of John Stuart Mill’s On Liberty) and in the liberal autonomous self-actualizing individual.
And here we get to man’s relationship to the state, where Bird explicitly and Wright implicitly go wrong. Let me quote Bird at length, as he expresses directly the mistake many make:
Kruger affirms, as I expect he would, that we should indeed help the poor (note, I’m not accusing Kruger of being unconcerned about people’s welfare). But he asks why it should be the government’s responsibility? Is this not a church responsibility? Well, yes, the church has a responsibility to care for the poor, and the best way to do that on a national level is to form a government that acts out of Christian values to help people and to help each other. I’m not buying into this Government vs. the People thing. Government is the representatives that the people elect. Correct me if I’m wrong but the first document of the first U.S. Government reads, “We the people …” Government is people, our people, well, at least until they replace politicians with robots.
Bird’s argument here is not novel in the American context. Various politicians (typically more liberal ones) throw out the “government is the people” line, and they allude to this idea when talking about the “American community” or “American family.” And Bird is not completely wrong—republican government exists so that the interests of the people are embodied in public policy. But he goes too far by simply collapsing the government and the people into one, and the consequences of this move are deeply problematic from a Christian anthropological view.
Government action can displace local community ties. Take the example of childbearing. Social Security (government support for the elderly) has displaced children as the primary support for many elderly people. According to Jonathan Last, in his recent book What to Expect When No One’s Expecting, Social Security has driven fertility down on average by about half a child. And this is to say nothing of frayed parent-child relationships that government policy enables, with elderly living in nursing homes with little support from or interaction with their children.
We also see this tendency in illegitimate births, where support for single mothers actually facilitates single-motherhood. The destruction of the two-parent household in the African-American community, where about 74 percent of children today are born to unmarried mothers, is devastating. It is no stretch to attribute this breakdown of the family to, at least in part, America’s welfare policies that make the support of fathers less necessary.
I am not saying that we need to get rid of these welfare policies. They address a legitimate need. But the way the programs have been structured has actually worsened the problems they seek to meet and allowed formerly necessary bonds to become optional.
Of course, what we see here as a problem might not be a problem to others. Do not these government policies empower the free expression of people’s desires? You don’t like your parents? That’s fine; the government will take care of them. You don’t want to marry the guy you’re sleeping with? That’s fine; the government will send you a check to help you care for your children as well as force him to send you a check. You don’t like your husband of twenty years? That’s fine; you can divorce for no reason and the government will send you a Social Security check when you start to miss your joint savings when you get older. You’re a free, self-realizing individual, empowered by the government to do whatever you want. Do your own thing!
But this statist vision of human life is fundamentally antithetical to the Christian vision. Christians of all types should want to see local communities—the very thing we need to be fully human—strengthened, not individuals empowered to spurn communities. It should not be government policy to promote anti-social behavior, either directly or indirectly.
Here lies my critique of an expansive federal government—it is not too communal, but rather too individualistic, in that it seeks to meet people’s needs apart from these all-important networks of accountability and support. A dominant federal government wants you and me to look only to it, and not to our neighbors, to meet our needs. Looking to others is too complicated, too messy, too compromised, and too limiting.
Alexis de Tocqueville wrote a haunting description of this towering central government in Democracy in America:
It willingly works for their happiness; but it wants to be the unique agent and sole arbiter of that; it provides for their security, foresees and secure their needs, facilitates their pleasures, conducts their principal affairs, directs their industry, regulates their estates, divides their inheritances; can it not take away from them entirely the trouble of thinking and the pain of living? (Univ. of Chicago Press: 2000, p. 663)
This vision of humanity—of atomized individuals drifting aimlessly around each other, dependent only on the central government, oblivious to the needs of each other—is positively dehumanizing. It is not one that Christians should be encouraging.
Both the British NHS and Obamacare are steps toward this vision. Obamacare differs from the NHS in that it tries to harness the market to bring down prices, and it gives people a measure of choice when selecting their insurance plans. But it does so through mandates and overregulation—witness the thousands who are losing their current insurance plans because their former plans were not deemed sufficient by the federal government. And Democrats have been pretty explicit that they would like to see Obamacare shifted to a single-payer system like the NHS.
Christians should support government policies that encourage communities to come together to meet individual needs, including health care. Of course, local communities are not a viable comprehensive solution in some cases. For example, only the biggest mega-churches would likely be able to cover fully the medical expenses of a baby born with a severe heart deformity. The cost of medical care is a systemic issue that dwarfs the resources of most local communities. But the government can provide families with basic access to our private healthcare system—by subsidizing private insurance premiums (which is the core of one conservative proposal)—but then it should let people make their own decisions and rely on one another for help navigating the system and covering excess expenses. Most families can’t pay the hundreds of thousands of dollars for a newborn’s multiple heart surgeries, but a community can come up with several thousand dollars to cover to out-of-pocket expenses that the insurance plan will not cover.
This approach is not novel. Republicans and Democrats have both pursued this vision of the role of government in society. But it does mean that government should not simply provide the basic necessities of life. It should create an environment where people—individuals living in communities—are capable of reaching the necessities of life themselves. For those who reflexively regard statist solutions such as a single-payer plan as reasonable, this vision may seem less rational, but it is formed around a robust conception of the matrix of human needs.
Wright and Bird’s goal of universal health insurance coverage is not a bad goal, as most Christians would acknowledge, but we must be careful how we achieve it. Obamacare’s vast regulation of the health insurance market begins to subvert both individual responsibility and community engagement with individual needs. What Wright and Bird and many liberal democrats really want is government-run universal healthcare, which is an even greater step toward the exclusion of responsibility and community ties. As Christians, we must oppose this system, not because of what it provides, but because of what it excludes. The vision of society that this system embodies is not what the Bible envisions for the true flourishing of humanity.