Would Jesus Heal Someone in a High Risk Pool? The Theology of Health Care Reform

Like many people I know, I was quite dismayed by the House’s recent passage of the abominable American Health Care Act, which seems to most fundamentally be about giving the rich a giant tax cut with the horrific side effect of making access to health care far more difficult for poor Americans in particular. (Don’t miss Michael Austin’s thoughts on this at BCC.) This one hits close to home—I was one of those who was uninsurable prior to Obamacare, due to having had the audacity to get treated for depression. I still remember the rejection letter I got from a health insurance company telling me that if I could manage to be symptom-free for seven years, they would maybe reconsider. The delicate question of how I was supposed to achieve the enviable status of being symptom-free for seven years with no insurance to pay for treatment was of course not addressed. I remember asking around about what to do, and people telling me that I should have just lied on the application and not mentioned the mental health care I’d gotten, especially given that it was paid for out-of-pocket; no one will ever know, they said. But possibly more out of neurotic paranoia that I would get found out than commitment to honesty, that didn’t feel like a real option to me, so I made my way forward with no insurance. I was lucky in that I was young and physically healthy, and yet every time I thought something be wrong with me, I would be sick with anxiety that it would turn out to be something serious and I would have no way to pay for treatment.

(I know, I know; the Republicans are going to take care of people in my situation by setting up high risk pools. Yes, California had those at the time; I remember getting a letter about it after I was turned down for regular insurance. I don’t remember the details, except that the premiums were crazy high, and even if you could afford them it was difficult to get in, as enrollment was capped and you got put on a waiting list. I didn’t even bother applying. Forgive me if I’m not holding my breath for that to be the magical answer for people like me. )

A few years after I was turned down for insurance, I was struck by good fortune in the form of my grad school partnering with Kaiser to offer affordable insurance to its students. I’ve heard from people who both loved and hated Kaiser, but my experiences were largely positive—they gave me a lot of high quality mental health care in particular. But above all, just knowing that if I got really sick or something else happened to me, I could afford to get treatment, felt like an almost unimaginable luxury. I could breathe again. And after I graduated and couldn’t find a job, the implementation of Obamacare meant that having received all that mental health care (and being diagnosed with several disorders in the process) didn’t exclude from me from continuing to get health insurance.

In reading many, many debates about health care over the years, I’ve perhaps predictably found myself particularly struck by the underlying theological ideas that seem to shape people’s thinking. There are a couple of related themes which I’ve seen come up again and again:

1) Freedom as All-Important

Repealing Obamacare has been regularly framed by the GOP as a move toward greater freedom. To give just one example, a Representative from Texas explained that he was proud of his vote for the AHCA as a move toward “restoring health care freedom in America.” I’ve been trying to tease out just what conservatives mean when they use the term. As far as I can tell, the particular kind of freedom they are usually talking about is freedom in the sense of not being told what to do in the context of certain issues. Highest on the list, it seems, is the freedom to do what you want with your money; taxation is regularly described as an assault on personal liberty. In the context of health care specifically, I also see a lot of resentment of the Obamacare mandate, which required people to buy health insurance or pay a fine. This is regularly derided by conservatives as government interference with personal freedom. In this vein, I saw a Facebook comment from a person celebrating the recently passed bill because it would allow him to “keep living as a free man who can make my own decisions without a government making them for me whether I lose my job or not.”

I don’t deny that there is a real sense in which you have greater freedom if the government doesn’t take any of your money, and you aren’t required to buy health insurance. But this strikes me as a very narrow understanding of freedom, one which leaves a lot out. For one thing, what about the freedom to pursue life opportunities (such as, say, a better job)—a freedom which is sustained and strengthened by having access to good health care? Something like chronic illness can take a real toll on that kind of freedom—especially if treatment isn’t a possibility. If we’re going to take away health insurance from millions in the name of protecting personal freedom, I think we should at least acknowledge that many are in fact losing freedom in the process.

For part of my dissertation, I explored the way in which the term “freedom” has been used in the history of Christian theology. And an observation made by a couple of theologians that really stayed with me was that “freedom” in the contemporary world has come to mean fundamentally consumer freedom. Not freedom from sin, or freedom to follow God, or even freedom to develop your human potential—but freedom to choose which breakfast cereal to buy. This model is blatantly apparent in Paul Ryan’s infamous tweet on the subject: “Freedom is the ability to buy what you want to fit what you need.” My first thought on seeing that was something like, “oh Paul, you need to do more time in Catholic school and learn some of the rich theology of your own tradition, because Thomas Aquinas is rolling in his grave.” And of course, not only is this view of freedom deeply impoverished in its scope, it’s really only relevant for those affluent enough to buy what they want (if only the pesky government would quit interfering with their consumerist dreams.)

Latter-day Saints, of course, bring in their own narratives to this, sometimes pointing to the fact that the War in Heaven was fought over agency to assert that being required to help others (in the form of taxes) is nothing short of Satan’s plan. I find it telling, however, that when it comes to being “forced” to be moral citizens in other areas—for example, to pick something that maybe everyone can agree is a bad thing: drunk driving, which the government strongly discourages you from doing by imposing fines and jail time if you’re caught doing it—that restriction of freedom is generally seen in a positive light. (Even more bizarrely, I remember the argument going around during Prop 8 that the people who were pushing for greater freedom for gay people in the form of legal same-sex marriage were the ones advocating Satan’s plan.) Unless you are equating true freedom with total anarchy, I simply don’t think this idea that agency can be defined as the government not making any demands holds water. (I also dislike how framing the conversation this way pays more attention to the needs of the well-off to develop moral character through choosing to give than to the needs of the poor to have basic life necessities.) I think both the left and the right can be fairly accused of being out to legislate morality in some way; they just pick different issues.

2. Resistance to Grace

Many theologians have observed that one of the tensions in the Bible is between a worldview of exchange, in which people get what they deserve, are rewarded for their merits and condemned for their failures—and one of gift, in which what is offered by God isn’t attached to whether people have earned it. The former seems to be the view of Deuteronomy: people are straightforwardly blessed for being righteous, and punished for being wicked. The book of Job, by contrast, throws a monkey wrench into this neat system by telling the tale of someone who had terrible things happen to him despite his righteousness. (Though as an aside, the particular theological explanation of what happened to Job, as related in the cosmological narratives found in the introduction and conclusion—notably believed by scholars to be later additions to the work—is if possible even more troubling).

I’ll come back to the Deuteronomistic worldview in my fourth point. But I did want to note here that the concept of grace in Christianity turns any such system on its head. God offers things that are entirely unearned. I’ve been thinking and writing about grace for a decade and a half now, largely in an LDS context, and it’s been interesting to see the resistance to it. Grace is by any reckoning deeply unfair; people simply don’t merit what they get. I don’t know if I can draw a neat equation between the LDS works-oriented, grace-wary culture and the concern that people will be given something they didn’t earn (a “handout”), given that perhaps the loudest voice in contemporary American conservatism is that of white evangelicals, who vehemently emphasize salvation by grace alone with no works at all, but often still want to make sure the government isn’t giving anything to undeserving people. But I find it fascinating that many Mormons and evangelicals, despite their theological differences, seem to share a deep belief in salvation by works when it comes to the secular realm.

Obviously parallels between the theological economy and the secular one need to be made with some care, given the point that grace is abundant and presumably won’t run out; God can give and give, and the supply will remain the same. That, alas, cannot be said to be true of health care—there are limits, and as a society we have to grapple with those limits. I think raising that concern is perfectly legitimate. But I still flinch when I hear people—especially people who are very loud about their Christianity—talk at length about how important it is that people earn every single thing they get, so that we don’t reward irresponsibility. By those lights, it would seem that God is hugely mistaken in being in any way generous to us—doesn’t s/he know that if s/he gives us a salvation handout, we’ll inevitably be unprofitable servants? I’m especially flabbergasted to hear the sentiment that it’s worth denying badly need aid to 90 people if it means that we’ll manage to thereby block ten people who are just taking advantage of the system.

3. Radical Individualism

You’re likely familiar with Jimmy Kimmel’s plea, arising from his own experience as a parent of a son born with a heart defect, that we shouldn’t be a country that lets babies die of treatable conditions based on people’s income. Joe Walsh, a former Representative from Illinois who is known for making inflammatory comments, responded: “Sorry Jimmy Kimmel: your sad story doesn’t obligate me or anybody else to pay for somebody else’s health care.” This obviously is connected to my first point, about the way freedom is understood as freedom from any obligation to others. It also reflects a commitment to a kind of radical individualism which lacks any sense of what I would call social goods. I see things like public education, roads, libraries, and yes, health care, as social goods. They benefit everyone. (For this reason, for example, I don’t resent paying taxes for education even though I have no children of my own, because I think educating everyone is hugely beneficial to society as a whole.)

Ralph Hancock recently wrote an editorial  arguing that LDS progressives fundamentally diverge from LDS teachings—he is specifically concerned about what he calls “borderless globalism” and “free ‘sexual expression.'” (His concern about the latter is particularly interesting in view of my earlier comments about the worship of freedom—evidently freedom is virtuous when applied to your getting to do what you want with your money, but of dubious value when applied to your getting to do what you want with your body.) Even setting aside the question of whether he is accurately representing progressives, I am struck by his argument that these values are problematic because they “are part of the same ethic that seeks to emancipate the individual from the needs and norms of all real, concrete national and religious communities.” This comment genuinely surprised me, because I see conservatives as having largely abandoned commitment to the good of communities in favor of the all-important right of the individual to accumulate as much as she or he can. To be fair, I may be as guilty here of caricaturing conservatives as Hancock is of caricaturing liberals. But I do wish that the idea of a social good played more of a role in our national discourse.

4. Prosperity Gospel

In a recent Atlantic article, Vann R. Newkirk suggests that underlying the Republican approach to health care is a familiar theme: the prosperity gospel. If you’re not familiar with the term, it’s the Deuteronomistic worldview mentioned earlier in which the righteous are blessed, and the wicked are punished. (Social scientists call this the “just world hypothesis.”) Some Christians have gone pretty wild with this, arguing that God actually wants you to be rich, and will reward you with material blessings if you do the right things. See for example Paula White, one of the pastors invited to pray at the inauguration, who is described as an influential spiritual adviser to Trump. According to White’s website, you need to give God your “first fruits”, and in response, “He gives you the power to acquire wealth to establish His covenant.” (If you’re wondering just how to get this first fruits offering to God, clicking on the provided link will send you to a page where you can—surprise! —donate to White’s ministry.) This is of course nothing new; prosperity theology in its current form dates back to at least the 1950s, and has its roots in earlier movements.

While I am generally hesitant to draw hard and fast lines about who gets to use the label “Christian,” I find it frustrating that this nonsense is usually packaged in a Christian form. (I should mention that the prosperity gospel has been widely denounced by Christians of all stripes, including evangelicals.) I find the worldview troubling for many reasons, including the way it preys on the vulnerable, but I think perhaps the most insidiously toxic aspect of seeing wealth as a reward for righteousness is the obvious corollary that if you’re not rich, it’s your own fault—the poor have only themselves to blame. But as Newkirk points out in the aforementioned Atlantic article, “The prosperity gospel sold by televangelists fit—and fits—so well in many American homes because it mirrors the established national secular ethos. ” And, relevant to the health care debate, the prosperity gospel teaches that not only wealth but also physical health is a divine blessing bestowed on those who do the right things. The recent CNN interview with Alabama Representative Mo Brooks was especially revealing. Brooks spoke of “those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy” as ones who needed protection from the costs brought about by sick people. The equation here is pretty clear: those who are sick are those who made poor choices. Yet, as Newkirk notes, along with race (blacks having been historically excluded from health care), “perhaps the most direct societal predictor of health is still wealth.”

Mormons, in my experience, have little love for televangelists like Paula White. But the prosperity gospel is not alien to Mormonism, either; I can’t count the number of Sunday School lessons I’ve sat through on the subject of the warnings about riches laid out in Jacob 2 which have turned into full-throated defenses of wealth, which is not uncommonly described using the language of divine favor. (When my Catholic friends first told me about the idea of the “preferential option for the poor,” which draws on biblical injunctions to care for the poor and the oppressed to argue that God has special concern for those in poverty and on the margins of society, I only half-jokingly responded that Mormonism has a “preferential option for the rich.”) Code words like “self-reliance” and “personal responsibility” are tossed around to indicate that the poor have brought their unfortunate situation on themselves. Consider Utah Representative Jason Chaffetz’s much-derided comment that people need to save money for their own health care “rather than getting that new iPhone that they just love.” In addition to indicating so much obliviousness about the actual cost of health care that I strongly suspect that Chaffetz has never had to pay for it himself, this statement suggests that the core problem is irresponsibility. The poor would not be struggling to afford health care if they would just spend their money more responsibly. The prosperity gospel is lurking here somewhere.

One last point. A health care system that truly covered everyone wouldn’t actually be fair. Paul Ryan complained that “the idea of Obamacare is . . . that the people who are healthy pay for the people who are sick.” But that’s the reality of how insurance works—it spreads the costs around, and healthy people pay more so that sick people can pay less. That’s a bad financial deal for the healthy people; I don’t deny it. But framing it in just those terms leaves out some things—even if you are generally healthy, surely there is something to be said for knowing that if your health does fail you at some point, or perhaps even more significantly, if someone you love needs help, it will be accessible. (Of course, this does mean abandoning the untenable idea that health is so closely tied to morality that if you are sufficiently righteous, you’ll never need health care, so there is no need to worry.) And even if this set-up means that some people run the risk of over the course of their lifetime paying more into the system than they get out of it, that doesn’t sound like a terrible outcome to me (if that’s the worst that happens to you, in fact, I would say that you led a pretty fortunate life.) Additionally, as I said earlier, I think the idea of a “social good” should play some role in the discussion, if even for purely selfish reasons on the part of individuals—everyone benefits from living in a society in which people can get health care when they need it. (To give just one example, if other people can get treated for communicable diseases before they spread them to you, that’s good for you, too.)

I’m not an economist, a health care professional, a politician, or really an expert on anything practical, and I realize there is a lot to be worked out in the health care debate, and that compromises will likely be required. But I would like to at least challenge the problematic theological ideas I see getting a lot of airtime, including freedom (and freedom defined in a certain way) being worshiped as the highest good, “morality” being equated to making sure no one gets anything s/he didn’t earn or deserve, a belief in a kind of radical individualism which is disconnected to larger social goods, and prosperity theology.