What Would Jesus Do?

Or, more precisely, what would Jesus want conservatives to do about health care for the poor?

I received a very thought-provoking request from a commenter about what proposals conservatives have to provide health care for those who are poor, disabled, otherwise honestly unable to work, and defenseless. Describing herself as a progressive and an orthodox Christian, she also challenged me, as the advisor to the Christian Legal Society how conservative Christians can “square modern [conservatism] with the commandments to care for the poor, weak, widowed, imprisoned, hungry, poorly clothed, and elderly regardless of Christian affiliation simply because to do so is to serve God.” I am paraphrasing a bit, but she believes that the proposed system (presumably a “public option” or more immediately complete government control of health insurance/care) is the only truly Christian one from those considerations.

Let me begin with the second point. Now, I am not a theologian, and there may be other, better arguments. As her claim of “commandments” are a mild source of perplexity for me, I have to assume that she is talking not of the Ten Commandments, but of, broadly speaking, Jesus’s teachings. First, I am loathe to conclude that the absence of a strong government role in the control of health care for the past two thousand years means that all of these societies and their people have not been truly Christian, even in this matter. Any observer of Western history over the past nearly two millennia must conclude that people in the West have taken their Christianity seriously. More seriously overall than societies in the radically secularized West do today. Not particular individuals, but societies. So if this were such an issue of religious significance, one would have expected Christian societies to make a stronger push for universal governmental health coverage long ago. Even if the point is merely protecting the poor, it is true that there were some governmental services for the poor through almshouses and orphanages more recently (as there is now). But even for them, health care and hospitals were provided historically mainly through private (religious) charity.

That concept of charity is crucial and brings me to my second point. I am not a Bible scholar, but I do not remember that Jesus at any time or anywhere called for government health insurance/care or, indeed, for any government program for the poor. He divided the loaves and fishes and, with the assistance of the disciples, fed the multitudes; He didn’t call for a welfare program from Herod. Jesus is charity and love.. He demonstrated it through His life of teaching and helping others. He gave freely and voluntarily of himself and called on his disciples to do likewise. Again, He didn’t pay Herod to do it for Him.

To be sacred, charity must be a gift, a voluntary action. Lacking that voluntariness, the lack of free will behind a forced exaction denudes it of any ethical meaning for the giver. The recipient, too, must perceive this as an act of sacrifice and love from the giver that reaches out to him. Otherwise, the recipient will begin to see this charity as a claim of right on the other that the giver is obliged to satisfy. That is exactly the problem as the issue of health care is often framed today. That replaces love with mutual resentment and destroys the holiness of the exchange. As Mark 14 points out, Jesus said (in a different context), “The poor you will always have with you, and you can help them any time you want.” Once more, the emphasis is on individual help, not on Herod’s tax collectors and administrators. The admonition is to “Love your neighbor as yourself,” not to “Pay the money Herod demands to provide for your neighbor as Herod does for you.”

So those supporters of government health care who appeal to Jesus’s authority are obliged to point out even one phrase in the Gospels where He says that it is the role of government to provide health insurance/care or, for that matter, any physical or emotional assistance. He may have said, “Render unto Caesar the things that are Caesar’s, and unto God the things that are God’s.” But He said that to underscore the difference between the spiritual authority of God’s love and the temporal authority based on force. Jesus was a teacher of salvation through God’s grace, not the State. To the extent that helping the poor could be considered faithful to His message, that had to come from individual acts freely chosen, not through state coercion. As Margaret Thatcher aptly put it, “Christianity is about spiritual redemption, not social reform.”

So, it seems that the focus for a Christian should be charity, giving of self to others. The extent of that must be left to individual capabilities and circumstances. Doctors, nurses, and others can and do meet their obligations, including doing so through contributions to charities whose income will suffer from the Obama administration’s planned restriction of the charitable contributions deduction for income tax purposes. Though this is only a very rough indicator, studies show that, adjusting for income differences, people in “red states” contribute more of their income to charity than those in “blue states.”

As for practical solutions, the problem of the poor will not go away. My interlocutor restricted her question to health care for the “deserving poor,” so as to avoid, I suppose, St. Paul’s message to the Thessalonians that “if anyone was unwilling to work, neither should that one eat.” There already are public programs for the “poor” through Medicare, Medicaid, and CHIP.

There are gaps in eligibility, to be sure. But if coverage for the poor is the issue, expand eligibility under Medicaid or apply Medicare to the poor. Or, to maximize choice, provide health care vouchers or cards for the poor and/or tax credits (including negative for those with no tax liability) for the somewhat less poor to spend on health services/insurance. But, unless the goal is some mindless equality to assure that the middle and upper classes (the politically-connected nomenklatura excepted, of course) only get the same quality of health care as the poor, there is no need to disrupt and destroy a rather well-functioning private system for the majority to change conditions for a minority. Why, then, expand the governmental health care inefficiencies that plague only a portion of the population to everyone?

The current system can use more competition among insurance providers. There is a need to reduce the power of large insurance companies in regulating the choice between doctors and patients. There is a need to reduce the tax advantages (and the government mandates) for non-catastrophic health insurance, combined with a tax-advantaged viable Health Savings Account policy. I buy home insurance policy against catastrophes like fire, not to protect against plumbing the kitchen sink. That power of insurance companies through tax-advantaged comprehensive insurance policies distorts the likely market discipline that would otherwise exist for all parties in the transaction. There are ways to deal with that problem, as I’ve posted before and as other conservatives have elaborated. Senator Corker of Tennessee has interesting proposals, some of which further such personal choice and insurance company competition. Beyond that there is the growth of pay-for-service retail clinics and the use of higher co-pays with lower insurance premiums to promote incentives for consumers to look carefully at what services they really need. But that is a larger policy matter for all of us, not for providing for the poor.

I have defective brakes on one car. I’ll replace those brakes. I don’t intend to replace the whole car. If I were to do the latter to deal with the problem of the brakes, people would think me insane. The government, on the other hand, might pay me to turn in an otherwise perfectly good car for them to destroy. Similarly, why have a radical change for most of us (and it will be a radical change in real life) to deal with the problems of a comparatively very few? (That 47 million uninsured figure is so bogus, even the President doesn’t use it any more.) Just deal with the problem that is really presented.

Oh, and by the way, would a concern about the inability of some of the poor to get food and shelter justify a government takeover of the means of distribution of those goods from profit-making enterprises like Von’s and Ralph’s, or farmers and apartment building owners?