Christian single-payer health care?

A First Things article by Matthew Loftus argues from an ostensibly “conservative Christian” perspective for “single-payer” health care in America.

According to the article, “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.”

Single-payer health care is “conservative” because 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.”

And single-payer health care is “Christian” because “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.”

The author argues that “charities are simply too irregular and unfocused to really give people in need what is owed to them by natural law.” And the “free market” doesn’t work in health care because “people are tremendously poor consumers” and “do not know what is good for their health or how to allocate their resources appropriately for it.”

Just as the state is obliged to protect against gun violence, he argues, so “it is the state’s prerogative to prevent both human and natural evils from taking us to the early grave.”

The author recalls that the earliest hospitals were Christian creations that got state help and were “public-private ventures between church and state.”

These assertions by the author are confusing. He almost implies U.S. health care now is a largely free market or charity run operation, with government standing at a distance. In 2021, government paid for at least 38% of health care in America. Private health insurance covered 28%. Ten percent was out of pocket. Other third-party payers were 14%. Over 90% have insurance whether government or private. 

There are over 700 religious hospitals in America, but the average hospital spends 1.4% of its budget on charity care. Religious hospitals no less than non-religious hospitals depend heavily on government funding plus private insurance, which is typically employer subsidized.

So it’s not accurate to imply that churches or private charities are carrying the major burden. Government is by far the largest payer of health costs in America, followed by private health insurance. The author thinks single-payer care would be more Christian because, apparently, it's more efficient. Instead of multiple sources, there would be a single source. And a centralized authority would direct health care instead of a decentralized hodgepodge. Individuals supposedly are not wise about their health care choices, so supposedly wise government would decide for them.

Maybe, but the author asserts that there is a form of health care delivery that is “Christian,” which is government controlled. What other areas of human life should the government also control? The author says the state “must provide” the “most basic, elemental needs of the human body.” Should the state therefore pay for and manage all housing? All food? All clothing? Wouldn’t society be much simpler if the government ran everything?

Taken to its logical conclusion, totalitarian North Korea is the most logical of societies, with the state as complete final arbiter of all human life. Obviously, the author does not want totalitarianism but a more Christian society. But state-control and Christian are not necessarily compatible. “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,” the author says.

But how many governments admit to and abide by being “only a small part of human flourishing?” Humans by nature, singularly or corporately, if unhindered and balanced by others, procure privilege and power for themselves at the expense of others. Governments, with their nearly unlimited coercive powers, are not easily restricted once expanded, with often catastrophic consequences for human dignity and liberty.

The author advocates for 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.” All of this is a lot to hope for. When does the author expect this conservative and Christian revolution to unfold in Western society? Should the complete state takeover of health care only occur after this revolution, or will the takeover precipitate the revolution for widespread virtue and Christian compassion?

Our neighbor Canada has single-payer health insurance, which may have virtues, but greater Christian compassion and justice have not necessarily been the fruits. Among other problems, last year Canada’s medical system facilitated 10,029 “medically assisted deaths” in 2021, a nearly 35% increase from the year before. Part of the “efficiency” of state-controlled health care is that killing the seriously ailing and terminally ill, not to mention the merely depressed, can be much cheaper than medically sustaining them for months or years.

The author tells us that “people are tremendously poor consumers” who consume useless nutritional supplements while becoming addicted to opioids. But individuals, however feckless, do generally seek their own best welfare. Governments at best seek the average best for many millions at the sacrifice of others. Resources are apportioned or rationed according to macro formulas rather than to serve the individual. The results are not always Christian or just.

Disdaining limited government and free markets is now fashionable across the political spectrum, including among some conservative Christians. Every human system, including free enterprise, is riddled with sin, frailty and unintended consequences. But further engorging government to micromanage human lives offers even more peril.

Some conservative Christians, including some Catholic Integralists and Calvinist “Christian Nationalists,” among others, now equate limited government with classical “liberalism” premised on individualism. Autonomous individualism divorced from transcendence can be calamitous. But the idea of the individual as a creature of God with freedom to choose is a uniquely biblical concept.

Christian influenced political insights across centuries determined that societies not respecting the individual in favor of the corporate are unjust and despotic. These insights have discerned that liberty, justice and dignity require limiting the state and safeguarding individual rights within civil society.

“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,” the author admits. But he does not really address this concern, instead wishing for a more Christian-infused society that will guard against Leviathan. This wish should contravene granting Leviathan more power and authority, especially over the most personal aspects of human life like health care.

A Christian-infused society should be especially aware of the dangers of concentrated powers, even for laudable purposes. Concupiscence and cupidity, intrinsic to human nature, are with us until the end of this age. How do we protect ourselves from overbearing and even tyrannical governance in defense of decency, dignity and liberty?

There is never a full-proof answer. But, generally, limiting government, and answering social challenges with other institutions, allows for better opportunities to safeguard the best of humanity. Totalizing political proposals, even if labeled as “Christian,” usually replace one set of problems with even worse problems.

Originally published at Juicy Ecumenism.