Healthcare is a problem, and not merely a sociopolitical one.  If we are to believe the media pundits, it’s also very much a religious question.  Nicholas Kristoff of the New York Times berates Paul Ryan for attempting to repeal the Affordable Care Act on the grounds that Ryans’s opposition to ObamaCare is a denial of the Gospel and therefore a violation of the Catholic faith that Ryan professes.  Jesus, apparently, was a socialist and would have voted Democrat.  Not so, says James Freeman in the Wall Street Journal: Ryan was right to push forward with the repeal of the ACA and can do so, as a Catholic in good conscience, because, well, Jesus was not a socialist.  Accusing Kristoff of casting “the federal bureaucracy in the role of Jesus,” Freeman defended Ryan’s efforts to dismantle Obama’s healthcare legacy.  Freeman asks what Jesus would say about big government and comes to the conclusion that He would agree with Freeman that it’s not a good thing.  During the 2016 presidential election campaign, in another article for the Wall Street Journal, Freeman had asked “how would Jesus vote?”  Contrary to the claims of Kristoff and the New York Times party, Freeman and the Wall Street Journal party insisted that Jesus was not a socialist, nor would He have voted for Bernie or Hillary; He was a fiscal conservative Who would have voted Republican.  To put the Wall Street Journal’s perspective in a nutshell, Jesus not only would have supported Ryan’s efforts to repeal ObamaCare, but would have voted for him to become president of the United States!

This ridiculous back and forth raises the curtain on the moral ramifications of ObamaCare and the ethical repercussions associated with its amendment or repeal.  It is certainly the case that aspects of Obama Care represent a tyrannical attack on religious freedom.  The ACA’s legal requirement for Christian employers to violate their consciences and commit a grave sin in paying for the provision of abortifacient drugs for their employees was an egregious example of Orwellian Big Government.  On the other hand, Christians, mindful of Christ’s Great Commandment that we love our neighbor as ourselves, are not at liberty to leave the weakest and poorest members of society without adequate care.  We cannot opt for what might be called the Scrooge Option, leaving the weak to die and, thus, “decrease the surplus population.”  This apparent dichotomy between the rights of the individual, on the one hand, and the responsibility of caring for the weak and the sick, on the other, is the palpable tension at the core of all good political philosophy.

In Catholic social teaching, the rights of the individual or family are enshrined in the principle of subsidiarity, whereas the responsibility of the individual toward the care of the weak and the sick—the duty to seek the common good—is encapsulated in the principle of solidarity.

Surprisingly, the definition of subsidiarity given by Wikipedia (not always the most reliable source) is entirely adequate:

social and political issues should be dealt with at the most immediate (or local) level that is consistent with their resolution.  The Oxford English Dictionary defines subsidiarity as, “the principle that a central authority should have a subsidiary function, performing only those tasks which cannot be performed at a more local level.”

More definitively, or, at any rate, more authoritatively, subsidiarity is defined in the following terms by Pope Pius XI in his encyclical Quadragesimo anno (1931):

Just as it is gravely wrong to take from individuals what they can accomplish by their own initiative and industry and give it to the community, so also it is an injustice and at the same time a grave evil and disturbance of right order to assign to a greater and higher association what lesser and subordinate organizations can do.  For every social activity ought of its very nature to furnish help to the members of the body social, and never destroy and absorb them.

Elsewhere in the same encyclical Pius XI described as a “fundamental principle of social philosophy” the fact “that one should not withdraw from individuals and commit to the community what they can accomplish by their own enterprise and industry.”

In the Catechism of the Catholic Church we are warned that

Excessive intervention by the state can threaten personal freedom and initiative.  The teaching of the Church has elaborated the principle of subsidiarity, according to which a community of a higher order should not interfere in the internal life of a community of a lower order, depriving the latter of its functions, but rather should support it in case of need and help to co-ordinate its activity with the activities of the rest of society, always with a view to the common good.

Put simply, the principle of subsidiarity rests on the assumption that the rights of small communities—families, neighborhoods, private associations, small businesses—should not be violated by the intervention of the state or centralized bureaucracies.  Thus, for instance, the rights of parents to educate their children without the imposition by the state of politically correct school curricula ought to be protected.  In terms of healthcare, it seems inescapable that a one-size-fits-all system, imposed by an oversized and overzealous central government and administered by an overweening bureaucracy, is a gross violation of the principle of subsidiarity.  In short, ObamaCare or any reincarnation of it in another guise, is unjust because it rides roughshod over the natural order.

Does this mean that Christians can be comfortable with the repeal of the Affordable Care Act and a return to the status quo ante?  Was the healthcare system in the United States fine and dandy until President Obama got his hands on it?

The answer is a resolute no.  Healthcare provision in the United States stank before the rise of Obama, though it might be conceded that it stank even worse after he added socialism to the mix.  We cannot be happy with the status quo ante because we cannot be happy with the better of two evils.  We need to strive for justice.  We need to find ways in which healthcare provision can serve the common good, ways in which it serves our neighbor, even our weakest and poorest neighbor, as well as serving ourselves.  In short, we need a healthcare solution that abides by the principle of solidarity as well as the principle of subsidiarity.  As the definition of subsidiarity in the above-quoted section of the Catechism stresses, subsidiarity must function “always with a view to the common good.”

From a libertarian perspective, this subclause to the Church’s definition of subsidiarity represents the “devil in the detail”; it’s the back door by which the bogeyman of socialism enters the scene.  From a Christian perspective, however, it’s the place where the rights of the individual or the family are circumscribed by their responsibility toward the needs of their neighbors, the door of welcome by which our neighbors are invited to join us in a spirit of solidarity.

Perhaps a practical example might help.  We have two easements running through our property.  One conveys gas pipelines; the other, telephone wires.  I accept a limitation on my rights as an owner of private property because of my responsibility toward the common good.  My property rights (protected by laws that reflect subsidiarity) are circumscribed by my responsibility toward my neighbor (protected by laws that reflect solidarity).  At the heart of such a healthy balance is the recognition that rights always presuppose responsibility; one cannot and should not exist in isolation from the other.

“Many people today would claim that they owe nothing to anyone, except to themselves,” wrote Pope Benedict XVI. 

They are concerned only with their rights, and they often have great difficulty in taking responsibility for their own and other people’s integral development.  Hence it is important to call for a renewed reflection on how rights presuppose duties, if they are not to become mere licence.

Solidarity, writes St. John Paul II,

is not a feeling of vague compassion or shallow distress at the misfortunes of so many people, both near and far.  On the contrary, it is a firm and persevering determination to commit oneself to the common good; that is to say to the good of all and of each individual, because we are all really responsible for all.

Solidarity is, therefore, not a mechanistic thing that can be brought about solely by the passing of laws or by government intervention.  Such mechanistic solutions, of which the Affordable Care Act is a case in point, always become coercive, trampling on legitimate rights, even religious rights and the rights of conscience, in order to bring about an elusive (because illusory) “justice.”  (Mahatma Gandhi spoke disparagingly about “dreaming of systems so perfect that no one will need to be good.”)  Justice is impossible without the widespread practice of virtue—specifically, the virtue of charity (caritas), the love without which nothing is possible except the moral decay that leads to chaos.  This bedrock reality was summarized with succinctness by Benedict XVI:

On the one hand, charity demands justice: recognition and respect for the legitimate rights of individuals and peoples.  It strives to build the earthly city according to law and justice.  On the other hand, charity transcends justice and completes it in the logic of giving and forgiving.  The earthly city is promoted not merely by relationships of rights and duties, but to an even greater and more fundamental extent by relationships of gratuitousness, mercy and communion.  Charity always manifests God’s love in human relationships as well, it gives theological and salvific value to all commitment for justice in the world.

There will be no justice, in the area of healthcare or anywhere else, unless we have a society that recognizes the necessity of Christian virtue.  A society that refuses even to discuss virtue, on the relativistic assumption that what is called virtue is a matter of personal choice, is doomed to descend into tyranny.

In the meantime, what should Christians do?  Should we wait in passive submission until the politicians come to their senses?  Of course not!  We should move from preaching what should be practiced to practicing what we preach.  We can build radical new healthcare solutions from the grass roots, evangelizing the culture with healthy answers to the unhealthy mess in which we find ourselves.  One way of keeping subsidiarity and solidarity in harmony is by joining Christian initiatives, such as the new medical sharing groups, or medical cooperatives, which bypass the healthcare juggernaut by connecting Christians in medical need with those who might be in need in the future.  My own family has joined Samaritan Ministries: Every month we send a check directly to a family in medical need—except for one month per year, when the check is sent to Samaritan Ministries to cover its administrative costs.  As members of this ministry, we will receive direct help from other families if a medical emergency strikes our family.

Dale Ahlquist, president of the American Chesterton Society, is a great advocate of these innovative initiatives.  “Insurance is a bet where the only way to win is to lose,” he writes.  “In other words, it only pays off when something goes wrong.”  Ahlquist continues,

When I had health insurance, I was paying a ridiculously high premium, with an even ridiculously higher deductible, to help pay for a ridiculously high glass skyscraper that bore the name of my “provider.”  Now I belong to a Christian medical cooperative.  There are over 40,000 members.  The idea is that everyone pays his own basic medical costs, and then when a major medical need arises for a member, that person gets help from the cooperative. . . . The amount I send is based on my family status.  So, I know that I’m not paying for abortions or hair replacement, but for the known needs of a person with a name and address, to whom I am also asked to write a letter of encouragement and spiritual support.  The cooperative sends out a monthly newsletter with advice on cutting medical expenses and finding affordable doctors and clinics.  I pay my basic medical bills from a tax deductible health savings account.  Bottom line: I pay half of what I used to pay for insurance.  And I’m not giving money to a huge corporation that is interested more in profits than in providing healthcare.  And I’m connected to the people who benefit from my payments.  Lord willing, I will never have to make a claim, in which case, I haven’t wasted any money in lost premiums: I’ve helped my neighbor.

In other words, this Christian medical cooperative incorporates both subsidiarity (removing all government intervention from the equation, in conformity with “an organizing principle that matters ought to be handled by the smallest, lowest or least centralized competent authority”) and solidarity: Helping myself and my own family, I am also providing for my neighbor in need.

The answer to the healthcare problem is not to be found in Congress or in the White House, or in any institutional center of usurped power.  It is to be found on our own doorsteps, in our own homes and in the homes of our neighbors.