Health Care Reform: Subsidiarity and Sphere Sovereignty

Christians have long taught that social issues are to be handled by the social institutions that are closest to the issue at hand. It’s what the Roman Catholics call “Subsidiarity.”

Also, for about a century (if not more), Protestant Christians have developed the principle of “Sphere Sovereignty,” which states that no single human institution should have absolute authority in society. Each institution is responsible directly to God for its particular area of sovereignty – families, educational institutions, businesses, trade unions, science, art, etc. No human institution owes its existence to the State, but rather to God. Government is not the superior institution, but simply has its own sphere of sovereignty. The key is this: The spheres of society are not subsidiaries of the state. Thus, in Christian social teaching, placing limitations on the power of government is a simple acknowledgement that only God has the right to absolute sovereign rule.

So, as I apply these Christian social teachings to the current health care issue, I wonder something: How is it that families and doctors are not given more responsibility for the decisions made concerning health care?

The most glaring reason that I see is this: The mode of payment has evolved into a third-party system, where employers pay heath insurance companies in order to cover the cost of health care.

The employer only has a stake here if health benefits for employees will also benefit the business (which more and more is not the case, so businesses are increasingly moving out of the sphere of being responsible for health).

The insurance companies’ most pressing issue is profits, not the health of those in their system, so they should not have responsibility for the sphere of health.

So, in our current system, families and doctors are not making decisions on what needs to be done, and at what cost.

My question for debate is this: How does replacing the third party of insurance companies with the third party of the federal government solve this problem? While Health Insurance Companies are definitely huge bureaucratic behemoths, replacing them with the huge bureaucratic behemoth of the Federal Government does not solve the issue that a third party that is very separated from the institutions needing to make the decisions will be making the decisions.


Byron Harvey said...

You answered your own question quite well, it seems to me.

The further answer is, in general, to move in the direction of introducing MORE, not less (a la Obamacare) market forces into the equation. Right now, if I have insurance, I don't care what the charge is; I only care about the deductible. Finding a way to make it matter to me what things actually cost would be ONE step in the right direction (along with tort reform, among others).

But the idea that giving government more power is, as you suggest, the wrong approach.

PamBG said...

I applaud the original post for pin-pointing the functional issue as the question: "What is the best and most efficient way to administer our healthcare system?"

Too much of the debate is conflating administration with ideology. That said, I'm with those who want to put at the center of American healthcare the ideology that "Healthcare is a right, not a privilege"

By allowing market forces to run our healthcare system we are saying that healthcare is a privilege for those who can afford it and that no one actually has a right to healthcare.

Insurance companies answer first and foremost to "their shareholders" and their goal is to maximize profit. If you are a patient, that means you will to get the least possible care at the highest cost that the market will bear. Furthermore, the modus operandi of insurance companies is incredibly opaque. (I'm confident whereof I speak on this as I was professional equity investor for over 20 years.)

Now, on the subject of "What is the best way to administer a healthcare system?" I don't personally have any ideas. I'm cynical about the government but I'm a LOT more cynical about the private sector running our healthcare system.

But I personally want to "get over" the rhetoric that suggests that the private sector is doing a fine job, thank you very much, and that they will provide the best possible healthcare. We need to make a conscious decision that healthcare is for everyone, not just those who can afford it.

(On a personal note, which has nothing to do with the debate, we are currently two middle-class, middle-aged, horribly underinsured individuals. We moved recently from the UK where we got quality medical care on demand with no bureaucracy. No worries about what the insurance company will or will not cover. No worries about if we go to the doctor will s/he discover something that the insurance company decides was a pre-existing condition and refuse to ever cover in our lifetime.)

Byron Harvey said...


Thanks for your thoughts. We're certainly on different sides of this one; I am fundamentally opposed to the notion that "healthcare is a right", believing as I do that rights revolve around our abilities to act in certain ways, not those (unenumerated in any relevant documents) things which government might, in this case, bestow upon us. As such, I would argue that the debate must be, at least in part, about ideology--as you've admitted, it seems to me.

That said, every American--and illegals as well, in some degree--already have a basic right to healthcare, at least in practice; if you arrive at a hospital with a life-threatening issue, no hospital can turn you away. Admittedly, this is not the same as high-quality healthcare, but the fact remains that we in practice treat at least certain types of treatment, in certain situations, as "rights".

I must disagree with your characterization of a free-market approach to healthcare. It might be true enough in one sense; insurance companies will seek to maximize profits, of course. But in a true free-market healthcare economy (which we do not have currently, it must be repeated), competition will produce superior "products" at reasonable prices. The company that is unconcerned about its customers, but only about its shareholders, will not long have customers; successful companies, regardless of field, have learned that satisfying customers leads to satisfying shareholders.

We also disagree on whom we trust more or less; I trust government in general, and an Obama administration more than any previous, to do about zero well. How many American examples of government incompetence do we need to prove this point? I like to ask, "can you name one thing that the U.S. government does both WELL and EFFICIENTLY?" I can't, but I'll proffer the question.

There are certainly some problems with healthcare in the U.S., and the do-nothing Republicans are hardly without blame in this equation; 8 years of the Bush administration produced about zero to fix this problem. But I'm not interested in the least in having government wonks running our healthcare system, as inferior quality and rationed care seem inevitable. There are things that can be done to increase availability and portability, and to decrease costs, I believe, that involve free-market solutions--if the power-hungry people running this country will allow them to take place.

Byron Harvey said...

Ahem...I trust an Obama administration LESS than any previous.

PamBG said...

Hi Byron:

Thanks for your thoughts.

As a Christian, I'm particularly interested in how Christians who disagree with me see healthcare theologically. I'm baffled by a Christian theology that would be happy to leave some people to ill health or death simply because they can't afford healthcare. What is a theology, for instance, of the people who can't afford medication for diabetes and who therefore must expose themselves to the consequence of this condition?

I do have a theological problem with the concept of "rights". That is to say, theologically, I believe that everything we have is a grace and a blessing. But I do see secular "rights language" as a sort of secular translation of the concept of human worth. E.g. I'd see the concept that every human being has right to life, liberty and the pursuit of happiness as a secular way of saying "God is no respecter of persons".

So this would be my primary question to you. It does seem to me that the consequences of what you imply is that God has nothing to say to a society that has the ability to take care of its population but which chooses to ignore those who don't have the wherewithal to care for themselves. I assume that you wouldn't want to say that and that I'm missing something here?

Byron Harvey said...

Thanks, Pam, and good assumption: I certainly wouldn't put it the way you suggest (AS you suggest!). Further, I think that the differences between our ways of thinking have to do, as they so often do, not with differences in desired outcomes (contrary to what some of my conservative brethren seem to believe, I believe that HONEST liberals and HONEST conservatives--not those willing, for instance, to say anything to try to win elective office--are usually in general agreement about the ends sought, but differ on the means). We get into trouble when in our conversation we make assumptions about things like motives and "end games" of our "opponents". I too, for instance, am "baffled by a Christian theology that would be happy to leave some people to ill health or death simply because they can't afford healthcare." That is categorically not what I believe--nor, for that matter, is it what anybody I know would claim.

Speaking in general terms, my contentions would be that

1. The system does need fixing (don't make the mistake Obama has--willfully, in my opinion--made: "those who oppose my healthcare plan want to do nothing". That's a lie, and he knows it even as he tells it.).

2. Introducing true free-market reforms would preserve freedom, lower costs, and make quality healthcare more accessible than a government-run alternative.

3. Government screws up nearly everything it touches.

And so it's just really that simple: we share similar, if not identical, goals; you trust the ability of government to accomplish this, and I have far more trust in a truly unfettered market (such as we've not seen in healthcare) to accomplish the task.

PamBG said...

Thanks for that reply.

You said: you trust the ability of government to accomplish this

No, I don't "trust" the government.

For me, it's not a question of "Which one of these two entities - government or free market - do you trust to run a healthcare system?" For me, it's a question of "Who do you distrust more?" Personally, after 20+ years working in the markets, I distrust the markets. I especially do not believe in the idea that true competition will make everything alright. [Maybe my problem is that I don't know enough about government! ;-)]

There is a genius in your original post. Implicitly, I think, it's pointing out the extreme and exaggerated nature of the debate. Are our only two options for administering a healthcare system REALLY "100% administration by the federal government" or "100% administration by the private sector"? Clearly not.

It seems to me that the position of "I want our society to provide good healthcare for all its citizens, but I don't trust the government" is actually being clear about both the moral goal and the the way to (not) get there. What I'm hearing from the Right is more like "Since we don't trust the government, we can't be caring about those in our society who don't have healthcare". Which is understandable from a selfish or utilitarian perspective but baffling from a Christian perspective.

Byron Harvey said...

Point well-taken; "you trust the government to a higher degree than do I" would be better-put, which is easy enough to say, because my trust level is zero.

Yes, you're right about the "extremes", as well; I think that Obama's plan isn't 100% government control, of course, and thus if I gave that impression, that was overspeak. But the idea of a "public option" would seem likely to have the effect of putting insurance companies out of business in the long run. I just don't think that the two can likely operate on competitive footing.

As to your final point, though, I'm not sure that's what I'm hearing. One (or both) of us probably needs to listen more carefully!

Bob Robinson said...

Health Care is a "right" as much as food and shelter are "rights." However, few would agree to giving over to the federal government the responsibility for feeding and sheltering every American. That being said, the government does indeed have the responsibility of monitoring and regulating the food and housing industries so that the inevitable inequities and injustices of unfettered capitalism do not harm the common good.

So, PamBG, I think that we can agree that an unfettered capitalistic "answer" to this problem will only create even more problems.

Libertarians like Byron want less regulation. (He is not in favor, when push comes to shove, for the fact that "if you arrive at a hospital with a life-threatening issue, no hospital can turn you away." This is governmental regulation, which is the ultimate anathema.) So, Byron wants to get rid of that law and any other law that regulates the health care industry - including those on insurance companies, pharmaceutical companies, and health care institutions. The idea is that the free market will work all this out. If enough people die of bad health care because of exorbitant pricing on drugs or because an insurance company turns down a pre-existing condition, people will stop buying drugs from those companies or their health coverage from those insurance companies.

This was the thinking when the industrial age started creating child labor and factories where people went to die. I'm a capitalist, but I do not favor unfettered capitalism. The role of government is to protect the common good, and often times, the common good gets ground up in the gears of capitalism. Just look at the recent unregulated mortgage industry and what it has done to the economy.

SOOOO... I think that what we'll end up with is some way for the free market to produce the kind of care that is in the best interest of the common good. This calls for the government to get its fingers into it through regulation.

My contention remains this, however: A free market solution that depends on the current way of paying (through third parties, ie the health insurance industry) will never get us to the kind of market force powers that Byron is advocating. Until health care is paid for based on providing quality long-term care and not on the number of patients seen or tests done, we will not see true reform. Until families and doctors are given responsibility, cost will continue to go up.

Byron Harvey said...

Nice to be told what I believe, Bob...except you've got it wrong on some points. Let me enumerate:

1. Did I ever suggest that I want people in need turned away at the hospital? Don't put words in my mouth. I said nothing of the sort, and don't assume that simply because I espouse many libertarian principles, I take a certain position on a given issue. You voted for the gentleman in the White House, but I don't assume you're the radical he is on most issues.

2. Libertarian thought--and sure, I'm pretty close to it--does not deny the appropriate role of government in setting up conditions in which free markets can operate under appropriate guidelines. Libertarians don't believe in no government; we believe in limiting it as much as is reasonable and allowing the market to do what it can uniquely do. But there is a role for government in establishing just rules which provide for fair competition. I'm just now reading The Road to Serfdom by Friedrich Hayek,. effectively a libertarian manifesto directed against Nazism and other forms of socialism, and Hayek is clear in saying that government must play a role; it's just a question of what that role might be.

Beyond that, your appeal to the need for child labor laws and the like might be true enough, but please recognize that we live in a significantly-different society today than we did back then. There are functions now which the private sector can effectively "police" which it could not back then; Consumer Reports is an excellent example of this, and with our ever-present media (of whichever flavor we desire) we are more than made aware of abuses such as you mention. I'm of the opinion that there are such a plethora of watchdog organizations that most of those issues are now moot.

But your last paragraph, Bob, I agree with, at least in principle: we have to find a way to make it work more in keeping with capitalist principles; i.e., the best system will make it matter how much drugs, etc., cost.

Bob Robinson said...

Just trying to keep the KoolAid drinking down to a minimum! ;-)
Just pointing out the logical conclusions that "libertarian" and "free market" ideologies lead. If we trust free markets, then why do we need the government mandating that hospitals must give emergency care to the poor? If we trust free markets, then let Consumer Reports make sure the spinach I buy at the grocery store doesn't contain botulism. No need for government.

There is another way - one that states that government has its sphere of sovereignty while other institutions have their spheres of sovereignty. This other way is what I'm advocating in this post.

PamBG said...

I thought I posted a post which seems to have got lost and is now somewhat redundant.

I'd be intrigued to hear a concrete illustration of how market forces might regulate the health-care industry.

At the moment I'm thinking that supply is not elastic because the barriers to entry for many healthcare fields are relatively high. And "consumers" are motivated mainly by fear. That's how I see it, anyway.

Byron Harvey said...

And I'm not sure that I disagree with your point, Bob; there is a role for government, as I've said, in making sure that laws enable the market to function as it ought. But I'm at the point of risking beating that horse to death...

To Pam, one of the big problems that we face in this country is a shortage of doctors; you're right about that (your "supply" statement). That would be a part of the fix, using market incentives to entice more young people to take up medicine. There are disincentives now (skyrocketing malpractice insurance being one--and tort reform, so strongly opposed by some who are in the hip pockets of the trial lawyers--should be a significant piece of the healthcare fix), and government stepping into the healthcare equation in a big way is likely to only add to the disincentives. I know of a husband and wife, doctors both, who are moving to New Zealand, because they're tired of dealing with the junk they deal with in practicing medicine in America, and only see it getting worse if Obamacare comes. My guess is that their move is a harbinger of things to come if we move in this direction.

I do think that there has been some work done, by minds far greater and more in tune with the issues than mine, on just how market-based reforms would go a long way toward fixing our current situation. I know Newt Gingrich (think of him what you will, he's a brilliant man) has been heavily involved in doing just this; try Googling "Newt Gingrich health care" and see what you come up with. As I recall, he and his group have a six-step plan (which they should have brought forth during the Bush administration!).