A Biblical Perspective on the American Healthcare System

The obsession of the American psyche is that we should only get the health care we earn.

You should only get the healthcare you pay for.  That seems to explain why we have the healthcare system we have, and why health insurance is connected to work.  It’s a reflection of the Protestant work ethic, and reflects the belief that if you don’t work, you don’t eat.  We reap what we sow.  So obviously, if you won’t work, you shouldn’t get healthcare either.

There is no right to healthcare in the United States like there is in most other countries.  Americans have a right to attend public schools; receive government brokered public services such as utilities, mail, and police protection; and use public spaces such as parks and roadways. But healthcare is construed differently.  Like obtaining food, Americans get it in proportion to what they earn.  We are each pretty much on own when it comes to obtaining healthcare.

No individual can afford all the high costs that will eventually confront the average individual or family in a lifetime.  So healthcare insurance programs connected to work (or paid for by the individual from earned income) are the answer to this need.  Healthcare insurance shares the cost by spreading the risk over large groups of people who contribute to the fund over time and withdraw from it when needed.  Which insurance group a person gets to join is largely outside their control since that is determined by their employer’s business administrators and insurance agents.

If Americans don’t work they don’t eat, and they don’t get healthcare either.  It’s a straightforward system, and it even sounds biblical, since the Bible lays down these same principles.

Jesus as Interpreter of the Biblical Tradition

Unfortunately the traditional American approach to healthcare insurance is no longer consistent with biblical teaching, if it ever was.

One of the main reasons is that when Jesus said “the laborer is worthy of his wages” he seemed to ultimately suggest a principle that people should be paid what today would be called a “living wage“- the amount it takes to meet one’s basic survival needs, which would include such things as food, clothing, transportation, communications, education, and healthcare. 

Initially Jesus was just sending out disciples on a short term mission trip.  Only room and board was involved on that first trip.  But the early church understood the principle as the basis for a new category of paid leadership which would eventually evolve into the group we now call the clergy.

Wage earners were the “poor” in biblical society, although even within that group there could be those who were especially needy.  The people who owned real estate were the wealthy people, the ones who were given all those biblical warnings about paying their workers properly and promptly.  (It seems that eventually the nomads were crowded out by the settlers, and that the birthrights of the first born - who inherited the real estate - eventually resulted in many of the remaining males seeking their fortunes in other endeavors as land became scarcer.)

Businesses primarily serving the needs of property owners developed in towns and cities. Political leaders represented the needs of property owners and relied on militaries to protect and develop these emerging systems as larger political entities also emerged, degraded, and re-emerged.  With the post New Testament era rise of the clergy class, we recognize what came to be known as the “estates of the realm” in Middle Age Europe.

Jesus’ story known as “The Parable of the Workers in the Vineyard” seems to have had a particularly strong influence on popular discussion of American capitalist thought.  In it, workers hired at different times during the day are still paid the same amount at the end of the day.  Those who worked all day are offended that they received the same pay as those who only worked for an hour; but the owner is most remembered for saying, “Don’t I have the right to do what I want with my own money?”  He is less remembered for saying, “Didn’t you agree to work for a denarius?” and “Are you envious because I am generous?”

Many people have used this parable to defend the right to private property and to support both laissez-faire economic theory and libertarianism.

But this parable considers both the property owner and laborer as equal bargaining partners.  The key to the entire story is that the owner and laborers must agree to the terms of their service.  The terms are not forced on the laborers.  Furthermore, in this story, the owner is generous because Jesus wants him to model God’s character.  Extending the paradigm of this parable into economic theory, as tradition has already established, means that both owners and laborers may have representatives negotiate for them on a bi-partisan basis.  

When business leaders and politicians work together to obstruct negotiations with labor unions, they are not treating labor as equal partners. Likewise, when labor does not realistically consider the cost implications of their demands, they have no right to claim privileged bargaining status.  Owners may look elsewhere. The sticking point in all such negotiations is the degree of honesty involved and the willingness to put aside greed.  Goodwill is needed on both sides.  And both sides have mutual responsibilities.

Since there is no way to avoid dishonesty or sinful passions by legal means, care always needs to be taken to preserve the balance of power in these negotiations.  The traditional doctrine of the separation of powers has developed uniquely in the United States in a way that ebbs and flows to serve this need as long as the population (primarily through voting) responds to circumstances as they arise. Even political parties have tended to trend one way or the other in their tendencies to represent either labor or owners; but biblically speaking, both sides need to be fairly represented.   As long as the population consists of a healthy mix of both constituents, though, in theory, the electoral process should address this need.

The Rise of the Uninsured/Underinsured Working Class

Healthcare costs have now so skyrocketed that adequate health insurance is no longer available to a large number of working families and to individuals with previously existing health conditions ( 1 - 2 - 3 - 4 - 5 ).  This has created a dissonant situation in which we have some fairly well off families (especially in comparison to third world countries) yet because their healthcare needs are not met, they are significantly in need.  Their health is significantly endangered.  They do not receive preventive care or seek treatment when needed for financial reasons. In some cases they are dying for lack of treatment.

This means that capitalism as we know it has created a new category of “poor” people in our country - people who do not have their basic needs met even though they work for a living - the uninsured/underinsured working class.  Some are part of the group whose healthcare benefits have been decreased.  Others who had coverage at work have lost healthcare benefits even though they still work. Many have remained continuously uninsured for long periods of time for various reasons. I believe this class is directly analogous to the working poor so frequently referred to in the Old Testament prophets.

These uninsured people may well earn reasonably high incomes based on a minimal poverty scale.  But that does not mean their basic needs are met.  The American poverty scale is not the biblical standard of living from which traditional work ethics are derived.  The biblical standard expects that a worker will be able to fully support his family if he works, and that the rich will share with him when he is needy.  So often the American standard of need expects the person or family to be without a job before really thinking of them as needy.

Just as the rich promote their own interests, they also need to work with the state to address the healthcare needs of the working class.  It is in America’s interest to have a working class that can go to where the jobs are, and that is not anchored to dead-end markets because of the current draconian healthcare system that drains personal resources to pay healthcare costs and then ties welfare to residency, creating a non-productive, overly conservative labor force, afraid to take risks. 

It is no wonder that illegal immigrants are able to come in with a degree of flexibility not seen in the average American worker, although for many of them, it must be kept in mind that their home base is not in America, since their primary function in coming here is to send money “back home” and they simply go to wherever they can obtain jobs.  If Americans had universal healthcare, it seems reasonable to suppose that they could more easily move to wherever the jobs were, as well, and they would be in much better position to accept jobs at the lower end of the pay scale.

Recognizing the Uninsured/Underinsured as “Poor and Needy”

We should include the uninsured/underinsured working people when we think of what the Bible calls the “poor and needy” because although they work (just as those in the Bible did), they do not have their basic needs met by means of that work.  Society needs them to perform their work and takes advantage of their services, but does not adequately compensate them. 

Jeremiah spoke to the problem of disproportionate distribution of wealth, where those who own the major capital assets use various excuses to justify inadequate remuneration for laborers.  The situation he describes is easy enough to discern and the principles he enunciates are still applicable (Jeremiah 22:13-17).

Although there are many reasons for why we are in our current economic situation, and why so many are without healthcare, the disproportionate income distribution in the corporate workforce, in which the top executives get so much more than the first line workers, testifies that the moral corruption of Jeremiah’s day still continues.  Although many of these corporations provide healthcare insurance for all the employees on their books, many of them also contract out many functions to avoid paying these benefits, and have also transferred many manufacturing jobs oversees where  the issue of employee benefits is dwarfed by such concerns as use of child labor.  And as already noted, many employers are also cutting back on the health insurance benefits that they do offer.

We do not know how to recognize these neuvo poor people due to inadequate healthcare in our country because they look like us and we mainly think of the poor as street beggars.  The traditional image of the poor as visibly “different’ has been true since ancient times, as witnessed by this passage from the New Testament book of James….

My brothers, as believers in our glorious Lord Jesus Christ, don’t show favoritism. Suppose a man comes into your meeting wearing a gold ring and fine clothes, and a poor man in shabby clothes also comes in. If you show special attention to the man wearing fine clothes and say, “Here’s a good seat for you,” but say to the poor man, “You stand there” or “Sit on the floor by my feet,” have you not discriminated among yourselves and become judges with evil thoughts? (James 2:1-4)

For us, Charles Dickens, among others, was so successful in communicating the social conditions of the 19^th century slums that we are not able to imagine what impoverishment due to the lack of healthcare in America looks like in the 21^st century. 

But those without medical insurance (or with inadequate insurance) in our day may look like most other people in our neighborhoods, except for that one major deficit.  One free clinic, for example, reported: “The clinic staff was surprised at some of the people who have no health insurance, including many part-time nurses and part-time postal workers.”  Another clinic reports that “Frustration comes in and patients give up” - many primarily need medical guidance and assistance navigating through the maize of government programs.

Most of us may only learn of their situation if a noticeable problem arises, and then there may be some sort of raffle or other fund raising event to try to help them out.  This kind of local support is meaningful; but it is also fairly frustrating since it can’t usually come near to meeting the total need, and we know that this person is only one of many other needy ones who have no friends to solicit for them.

For those who have seen it, Michael Moore’s Sicko has helped raise awareness of how the American healthcare system is adversely affecting people’s lives, and has even been complimented for this by his critics.

Does the rise of this new impoverished class mean capitalism is suspect or that America is inherently flawed?  Not necessarily.  Everything depends on our response to the situation.

Jesus said, “The poor you will always have with you….” (Mark 14:7; cf. Deut 15:11)

I take this to suggest that the human social condition apart from divine intervention will always result in some deprived social class.  And based on God’s revelation in the Old Testament, we know that God identifies with the poor in a particularly emphatic way and expects his people to do the same, to help them and to meet their needs.  As modeled in the Bible, this has meant not only individual actions of charity, but also national laws when appropriate for the time and place.  God has shown us what is good and expects us to continue with him in his ways.

When Jesus said that he came to bring “good news to the poor … and recovery of sight for the blind” perhaps some kind of universal healthcare insurance was eventually going to be part of that plan.  The church has always included medical ministries as part of the Christian mission since they are so directly related to Christ’s healing ministry. It is not a big stretch to now support universal health insurance.

It is time to think more comprehensively and accept responsibility to use wealth for the common good.