Health Care: A Moral Imperative

Too often our knowledge of health care is based on myths, misconceptions, and partial truths.

The political culture in North America is often at odds with our religious faith. Particularly in the United States, our emphasis on rugged individualism at times makes us forget the Old Testament admonitions for justice and the New Testament teachings of Jesus Christ. One of the places where this excessive individualism plays out is in the arena of health care.

Hard-working, middle-class Americans—including a substantial number of Banner readers—are but a single illness away from bankruptcy. Those who have lost their jobs, whose hours have been cut to part-time, or who have gone into business for themselves are especially vulnerable. This vulnerability is inconsistent with the values found in Scripture, which seems to suggest access to health care for all people, regardless of income.

Too often our knowledge of health care is based on myths, misconceptions, and partial truths about the American and Canadian systems. These myths include the notion that the U.S. has the finest health care system in the world. In fact, the World Health Organization states that the U.S. is behind 30 other countries in quality of health care.

Another misconception is that change would be too expensive. There is ample evidence that it would, in fact, cost less. Presently the U.S. health care system costs about double that of other industrialized countries, all of whom provide better care. One primary reason for this is administrative costs. Currently over 31 percent of every health care dollar in the U.S. is spent on paperwork and overhead, far more than in other industrialized countries. A national one-payer health care system could save enough on administration costs to ensure access to care for all Americans.

People also express the fear that with national health insurance the government would make people’s medical decisions. But experience shows that in a publicly financed health care system, medical decisions are, as they should be, left to the doctor and the patient.

A Moral Imperative
The debate over health care reform has not been treated as the great moral crusade that it is, according to renowned ethicist David Gushee. A strong case can be made to extend quality health care to 50 million Americans who do not currently have it. Why a moral imperative? In the U.S., an estimated 50,000 people die of treatable diseases each year because they did not have health insurance. Gushee suggests that Jesus’ call to love our neighbor as ourselves means we need to care about these people.

And what does the Lord require of us? “To act justly and to love mercy and to walk humbly with [our] God,” says the prophet Micah. In addition, Proverbs 31:8 instructs us to “speak up for those who cannot speak for themselves, for the rights of all who are destitute.” Think how much time Jesus spent healing the sick. Health care reform must rest on a foundation of biblical values that affirm each person’s life as a sacred gift from the Creator.

The government’s God-given task is to correct and prevent injustice (Ps. 72). It is immoral for the government, the church, or individuals to look the other way when there is injustice. Would God be pleased with us allowing his children to suffer because of an ideological struggle about who has responsibility for caring for the needy?

As Steven Brill reported in Time magazine, the system of paying for health care in the U.S. is broken (“Bitter Pill: Why Medical Bills Are Killing Us,” March 4, 2013). Health care costs in the U.S. have grown at a rate five times that of the gross national product (GNP). Sixty-two percent of bankruptcies are caused by or are related to medical bills. Drug prices in the U.S are, on average, 50 percent higher than in other developed nations. So we need to control drug costs. The U.S. can lower the qualifying age for Medicare, which is far more efficient than private insurance. We need to insist that hospital managers be paid a more reasonable salary, and that hospitals make a more reasonable profit. The evidence is that a single-payer publicly funded system can provide quality care for all at half the price of private insurance companies.

The Role of the Government
John Calvin freely spoke of the government’s obligation to ensure that the basic needs (he called them “rights”) of the poor are met, both in terms of basic provisions and in terms of basic health care. Calvin argued that the diaconate of the church should work closely with the civil government in these areas, and he insisted that the government of Geneva should establish a governmentally supported hospital for the poor.

The legislators, the president of the U.S., and the judges who created the Affordable Care Act do not fall under the category of “the principalities and powers of darkness.” They are the authorities ordained by God to govern, the ones to whom citizens owe obedience, love, and service. When Christians need to oppose civil authority, we need to do so in obedience to the Word of God, exemplifying the sacrificial service of Christ toward our neighbor in all that we do, and so witnessing in word and deed to the gospel. That does not mean we need to compromise our convictions about what is best for the country we live in with respect to health care or any other issue, nor does it mean we should submit to the government when it commands us to disobey God. But it does suggest that we do these things in a spirit of love and humility, not in a spirit of cultural warfare.

In contrast with the U.S. health care system, the Canadian system is based on the belief that all “necessary hospital and physician services” will be provided to the citizens by the government. The majority of Canadian citizens take out supplementary insurance policies, comparable to persons on Medicare in the U.S. Physicians in Canada are usually reimbursed by the government at a negotiated fee-for-services rate. Canada spends about 12 percent of its gross domestic product (GDP) on health care. A 2010 Health Affairs study found that doctors in Ontario spent $22,000 each year dealing with the single-payer agency, compared to the $83,000 doctors in the U.S. spent dealing with multiple insurance companies.

Whatever its shortcomings, the Affordable Care Act in the U.S. is an attempt to provide health care to the poor. Those who oppose it should turn their attention to providing an alternative that provides access to health care for all, regardless of income. Meanwhile, the private, for-profit health insurance companies continue to divert funds to drug ads, salespersons, lobbyists, and huge executive salaries. In addition, they distribute more than $12 billion a year to shareholders. The U.S. General Accounting Office has concluded that a single-payer health care system would save the U.S. about $400 billion a year. Those funds would cover the cost of providing access to health care for most of the people who are currently uninsured, and thereby save thousands of lives.

There is no doubt that many Christians in the U.S. and Canada obtain superb medical care. The question is, can we have a system in which that superb medical care is available to all? As Christians, we’re always called to care about what is best for all people, not just what’s best for ourselves.

Related link:

The Complexities of Health Care (The Banner)

Health Care Reform (Office of Social Justice)

Web Questions:

  1. The authors assert that Scripture seems to suggest access to health care for all people, regardless of income. What passages/biblical teachings might lead us to that conclusion? Do you find them persuasive?
  2. What are some of the “myths” about U.S. health care, according to the authors? Do you believe they are myths?
  3. Do people have the right to quality health care? Is it a moral imperative for us to extend health care to all, regardless of their ability to pay for it? If so, how should we go about doing that?
  4. What should the government’s role be in seeing that health care is distributed equitably? Is “Obamacare” an acceptable way of doing so? Why or why not?
  5. Should we, our congregations, and/or our denomination involve ourselves in this issue? Why or why not? If so, how?

About the Authors


Henry Holstege is emeritus professor of sociology at Calvin College, Grand Rapids, Mich., and a member of Eastern Avenue Christian Reformed Church, Grand Rapids.


Bob Ritsema is a member of Eastern Avenue CRC and of the Micah Center, which seeks to be a voice for those without a voice. He taught at Calvin Christian High School and in China.

See comments (11)


One of the best articles about the ACA I have read.

This article's claims of existing myths and misconceptions are themselves myths and misconceptions.

Contrary to the claim of this article, few Americans believe the US has the "finest health care system in the world" in all respects (eg., almost everyone hates US medical insurance companies), although the US probably does lead the world in medical device technology, pharmaceutical technology, and medical training.  Pretty much everyone believes the system costs way too much.

And who believes, as this article suggests, that "change would be too expensive"?  Undoubtedly, some change would cause the "system" to be more expensive and some changes would cause the "system" to be less expensive.  The question in the last several decades has never been whether changes should be made but rather what kinds of changes should be made.

Among its rundown of Democratic Party talking points, this article promotes what I would suggest is in actually a myth: that the Canadian healthcare system is much better than the US healthcare system.  Let me suggest just a couple of thoughts about the US/Canadian contrast.

The Canadian healthcare system benefits enormously from some Canadian legal system decisions, which changes Pres Obama chose not to make part of the so-called Affordable Care Act.  The Canadian government passed laws to cap medical malpractice awards, increase the difficult in getting medical malpractice judgments, and to pay most of the malpractice insurance premiums for all its doctors. Wow!  Annual malpractice insurance premiums for US doctors are typically in the tens of thousands to hundreds of thousands of dollars (less for Canadian doctors but because of the legal malpractice claim reforms).  Imagine how many dollars wouldn't have to be passed through to US patients and insurance companies if the US government picked up most of that tab for US doctors?  And if the Canadian legal system caps malpractice judgments and is otherwise less favorable to medical malpractice claims (all because of legal system decisions), how many fewer Canadian healthcare dollars need to be used to pay medical malpractice plaintiffs and their attorneys?

And then the domino effect: If Canadian doctors and hospitals don't fear malpractice claims (see above paragraph) like US doctors and hospitals do (must), Canadian providers don't need to practice medicine as "defensively," do they?  In the US (I have clients who are doctors), physicians routinely order additional testing solely out of concern about possible malpractice claims.

So Canada decided that a few legal changes could lower the cost of healthcare in Canada.  I'm all for that Canadian-styled change in the US, as were those in Congress who opposed Obama's so-called Affordable Care Act.  But Pres Obama and all those in Congress who voted for the ACA decided to not implement these changes.  Why?

This article suggests that those "... who oppose [the ACA] should turn their attention to providing an alternative ...."  Well, they have and continue to provide (offer) legislative alternatives.  The problem is that Pres Obama and two Democratic controlled houses of Congress passed the ACA and now refuse to change it (except where Pres Obama decides to unilaterally change it).  Perhaps this article would have done better to have quoted Candidate Obama when he said that changes in healthcare would be bi-partisan (but turned out to be done strictly by Democratic votes) and the debate about healthcare would be on C-SPAN for all of America to watch  (turned out to be done behind closed doors -- no Republican or even reporters allowed).

The current problems with the US healthcare system aren't about "rugged individualism" or not understanding lessons from the Old Testament.  The problems result from an incredibly great number of factors, many (perhaps most) of which are legal as opposed to medical and are about political fighting about how much of the US economy should be controlled by a central authority (the federal government).

I for one would like to see a few Canadian legal decisions copied by the US for the sake of the US healthcare system.  Too bad the political left of center, now in control in Washington, disagrees.

I have to wonder, have the authors of this article seen the headlines about the realities of the Patient Protection and Affordable Care Act, with people losing their doctors, losing their insurance coverage, and having their costs increased substantially?  The PPACA isn't even an attempt to provide health coverage to the poor, as the authors claimed here - Medicaid was already in place for the poor, this bill just expanded it.  But PPACA also did much more, as it largely targeted the middle class, requiring younger, healthier people to buy overpriced insurance to subsidize insurance for others.  And I wonder, have the authors any concern for Christian organizations and Christian business owners who are being MANDATED to violate their consciences as part of the implementation of this bill?  From this article, it seems not.  Now certainly, some people may benefit from the PPACA being passed, but to ignore the many negative consequences of it, for individuals as well as for the practice of our faith, is to view the world quite selectively.

The authors also take a dim view of our capitalistic society.  The authors may not like things like profits, dividends, salespeople, or advertisements, but our free-enterprise society is what takes risks and develops new drugs, new treatments, new devices, and then communicates those inventions to the practitioner and the consumer.  Without some significant profit incentive, no drug company would have developed a statin, and millions of people would have died earlier.  Meanwhile, tests have revealed that some of those cheaper drugs that one can buy overseas or through online Canadian pharmacies are actually counterfeits, leaving the patient worse off rather than treated.

To hold on to the idea that the federal government MUST be THE vehicle for solving our health care problems (e.g., through a single payer system) is to ignore a myriad of other options.  One option: states could be left to devise their own programs.  Another: people could be allowed to buy insurance across state lines to increase competition.  And yet another: churches could establish hospitals - WAIT! They used to do that!  There's a concept - our churches, rather than government, could actually be the vehicles for administering charity!  It seems like I read about that somewhere, maybe it was in Acts 6.  Calvin may have had his own ideas for the administering of charity through government, but I'll defer to Acts 6 over Calvin every day.  Sola Scriptura, as Luther said.

Prof. Holstege and Mr. Ritsema obviously are men of great faith, but from this article, it appears to me that they also have a great faith in government in Washington.  I have looked at the evidence, and I can't share their faith.

The assumptions the authors make about what constitutes injustice, their airy sweeping away of economic reality, the nature and limitations of government, and even of human nature, as well as their error in understanding of the ACA and what it does require far more space to correct than is available here.  I will restrict myself, therefore, to a couple points.

First, it is a huge leap to go from the truism that Christians should care for the poor to the assertion that Christians should support the U.S. federal government takeover of the health insurance industry through the ACA (aka "Obamacare").

Second, the ACA is not about health care.  People were receiving health care before it became law, even poor and uninsured people in the United States. The proponents of the ACA want us to be confused on this precisely in order to allow the great leap the authors make - that opposition to it means we oppose health care for the poor.  This is a dishonest, insulting calumny against principled, committed, compassionate Christians and the authors ought to apologize for insinuating it.

The question instead revolves around how much we, as a society, pay for health care and, secondly, how we come up with the money.  Very few argue that the pre-ACA method (one can hardly call it a "system") in the U.S. was acceptable.  But the fact is, the ACA has significantly increased the cost and will do more to increase it in the years to come if it is not repealed.  And while it has directed more of that increased cost be paid by the government, we should note well that the government is not paying for it by means of tax dollars, but by means of borrowed dollars - and that massive debt (over $17 trillion and still increasing) carries a moral burden with it, too.

There are other, better ways of containing costs while improving access - ways that have been proposed repeatedly before, during, and after the passage of the ACA.  They may not line up with the authors' apparent preference for single-payer government systems, but that doesn't mean they won't work or that those advocating them are ignoring the Biblical imperative to care for the least of these.

The poor will not receive neither better or more health care under ACA. Futhermore, no one should ever take any rating from the WHO at face value. Why do people believe the government is going to take care of us better than we can take care of each other? Profits earned by healthcare providers are what pay for new and better drugs and medical devices. Take away profit and the capacity to provide healthcare deminishes rapidly. The ACA is not about health care. It's about control of the electorate...or at least that's what Lenin believed. It astounds me that we keep thinking that a godless government is truly going to look out for the welfare of people. It seeks one thing and one thing only: domination. We should guard against being williing dupes to such a ploy. 

This is a purely political op-ed column. Other than the liberal-bias of the Banner leadership, I have no idea why it was printed. One could just as easily make similar arguments against the ACA/Obamacare and likewise, I would have to question the rationale of including it in a church magazine.

I'd like to address specific statements made in the article:

“…our emphasis on rugged individualism at times makes us forget the Old Testament admonitions for justice and the New Testament teachings of Jesus Christ.” 

The author’s imply individualism is somehow contrary to justice and Christ’s teachings in the New Testament.  That is not a just statement.  Individualism is not contrary to scripture.  For instance, rights are not collective, but individual.  Salvation is not collective, but individual.  Individuals must develop a personal relationship with Jesus.  Individualism involves accountability, responsibility, and self-sacrifice – not group sacrifice.  Individualism is not anti-community since communities are made up of individuals.  There are numerous examples of where individuals voluntarily form a community to help each other achieve desired ends such as church, private charities, Christian schools, mutual aid societies, professional associations, etc…  If anything undermines community and is contrary to justice and the New Testament teachings of Jesus Christ, it is government programs that benefit some at the expense of others.  Government is the institution that achieves its goals via force.  Is it really self-sacrifice, compassion, charity, or loving one’s neighbor if it is forced?  The question answers itself.

“This vulnerability is inconsistent with the values found in Scripture, which seems to suggest access to health care for all people, regardless of income.”

  • Does government have the authority to FORCE person ‘A’ to pay for person ‘B’s health expenditures?  Does government have the authority to force a doctor to provide care at little or no cost?  The answer is an easy no.  Such actions would violate the values found in scripture.  When Christians voluntarily help those who need it and exercise biblical charity (addressing physical and spiritual needs), God is glorified.  When the state forces people to meet another’s physical needs, the state is glorified.  Such a system violates the 1st and 8th Commandments.


    “A national one-payer health care system could save enough on administration costs to ensure access to care for all Americans.”

  • The two paragraphs that lead up to this statement includes one reference and a list of claims that can be easily refuted with counter evidence, which I’m sure other Banner readers will (or already did) address.  What might not have been addressed is the constitutionality of such a system.  It is a characteristic of Christianity to be concerned with the rule of law, especially if that law is intended to preserve our God-given rights from an institution operated by inherently sinful men, which, as shown throughout history, expands at liberty’s expense.  If a national one-payer system is what most of the states want, then let them ratify the constitution (though it would be a mistake).  Otherwise, what would be so bad about each state developing its own system?  With 50 different experiments we would find out much more quickly the systems that work better than others.


    “People also express the fear that with national health insurance (is it really insurance?) the government would make people’s medical decisions.”

  • The fear is that with national health “insurance” the government would ration health care services.  Your ability to receive the care you need is no longer up to you, your ability to pay, or your doctor, but up to government bureaucrats.  It can be no other way because such a system massively increases demand for limited health services without a sufficient increase in health service providers or equipment.  Government rationing would be the only way to control costs.  Long waits would be another effect.  If one genuinely wants to fix the problems with our health care system so that more care is available, then the solution must lead to the creation of more health care.  The authors’ solution does not do this, but instead suggests a way to redistribute it, forcefully.  This will not solve our health care problems, it will only exacerbate them. 


    “Gushee suggests that Jesus’ call to love our neighbor as ourselves means we need to care about these people.”

  • Lover our neighbor as ourselves?  Does that mean using majority vote to steal the fruit of another man’s labor to help the needy?   There is a fine line between charity and theft, and government is inherently incapable of charity.  Its very nature is force and so many well meaning Christians need to come to the understanding that government can steal, that it can and does violate the 8th Commandment.  Or doesn’t the 8th Commandment apply to civil government?   It is a moral imperative that Christians advocate biblical means to achieving honorable ends.  No one would argue that Christians should care about the needy and that it would be good for everyone to have affordable health care, but it is not the intentions that should determine one’s support for a policy.  Instead policy recommendations should be judged on its means (methods) and results.  The primary concern for Christians should be the means – they must be biblical to receive our support.  Besides, our God is an ends-result God.  If the methods used are biblical, then we should have faith that God will bring about the desired ends. 


    “Health care reform must rest on a foundation of biblical values that affirms each person’s life as a sacred gift from the Creator.”

  • Rights, being endowed to us by God, means they are inalienable and that government does not have the God-given authority to limit or remove any of them.  These rights were granted to all humans: men and women of all races, poor and rich.  Thus, no one can have a right to something that would violate the equal rights of others.  There is no right to socialized health care since it would inevitably violate the property rights (to name the most important) of others. 

  • Life, liberty, and property are sacred gifts from the Creator and when any of these is violated, the other two follow.  A national health care system will make the elderly and those with pre-existing conditions and disabilities more vulnerable as care is rationed by bureaucrats who have to decide how resources will best be used. And they will invariably choose to allocate health care resources to the young and able, or to those with political connections.  The only way to make sure all people have access to health care is to have more health care providers.  The solution advocated by the authors does not do that, it only changes the allocation of existing resources, and charges the taxpayers for the bureaucracy necessary to accomplish the task.  Not to mention the incredible growth that would occur in the size of government if such a system were created.  That would mean an even smaller private (i.e. wealth producing sector) to fund it.  I find it difficult to understand how so many Christians who understand the inherent sinfulness of man want so eagerly to place so much power into the hands of so few of them.  And may I remind you they are politicians who have the incentive to benefit themselves and their constituents at the expense of others.  It would be much wiser to decentralize power among the many.


    “Would God be pleased with us allowing his children to suffer because of an ideological struggle about who has responsibility for caring for the needy?”

  • That ideological struggle is the crux of the issue.   God would not be pleased with the Church or the Family or wealthy individuals (especially wealthy Christians) for allowing his children to suffer.  God ordained three separate governments and delegated each specific and limited responsibility.  Scripture makes it clear that charity is the responsibility of the Church and the rich.  It is also clear that when a family fails to care for its own it is worse than an unbeliever.  As for the civil government, it is their role to prevent injustice as the authors state, and it would be unjust to violate the rights of any individual, no matter the cause.  When the state uses its force to do something that would cause me to get arrested if I were to do it, then it has become the criminal it has been ordained to restrain. 


    “As Steven Brill reported in Time magazine, the system of paying for health care in the U.S. is broken.”

  • Steven Brill is correct.  It is broken, but the authors fail to diagnose the primary causes and their solution actually makes them worse.  Below is an excerpt from which does identify the primary causes and offers a solution.


    “…Medicare, which is far more efficient that private insurance.  We need to insist that hospital managers be paid a more reasonable salary, and that hospitals make a more reasonable profit.”

  • Medicare has an unfunded liability into the trillions.  No private insurance would still be around if that were the case for them. 

  • How is any one person or group of people to know exactly how much a certain occupation should get paid or what a reasonable profit is?  There is absolutely no way any government could ever efficiently provide any good or service.  It would have to be omniscient to do so. 


    “John Calvin freely spoke of the government’s obligation to ensure that the basic needs (he called them “rights”) of the poor are met, both in terms of basic provisions and in terms of health care.”

  • I am not sure of the veracity of this claim, but either way it reflects a misunderstanding of what rights are.  See above comments under the section titled “Health care reform must rest on a foundation of biblical values that affirms each person’s life as a sacred gift from the Creator.”


    U.S. health care vs. Canadian health care

  • With 30 minutes of research one will find a plethora of counter evidence or significant unintended consequences to everything the authors claim.


    “Those who oppose [the Affordable Care Act] should turn their attention to providing an alternative that provides access to health care for all, regardless of income.”

There is no such thing as a free lunch.  If access to health care is not limited by one’s ability to pay, then it will be limited by government rationing and scarcity.  At least in the former private charities, churches, and other voluntary organizations can help meet the deficits of those needing care.  In a universal health care system that is not an option.  The government will make the decisions for you.  Any plan to improve the health care system in the United States must first NOT violate any biblical principle.  Second, it must solve the primary causes for the high cost of current health care (see above).  As mentioned earlier, for a solution that does this see:

As a public health nurse I encourage people to seek out facts about the state of America's health care and the ACA. In January, 2013 the Institute of Medicine published a report titled, U.S. Health in International Perspective: Shorter Lives, Poorer Health. They compared U.S. health data with that of 16 other high income nations. They concluded, "For many years, Americans have been dying at younger ages than people in almost all other high-income countries. This disadvantage has been getting worse for three decades, especially among women. Not only are their lives shorter, but Americans also have a longstanding pattern of poorer health that is strikingly consistent and pervasive over the life course--at birth, during childhood and adolescence, for young and middle-aged adults, and for older adults." What is striking from this report is that it is not only the poor or unisinured that lag behind other nations but also those with adequate wealth and health care. (

Frontline produced 2 excellent documentaries on health care. I encourage people to watch them: Sick Around America & Sick Around the World. Two other documentaries -- Escape Fire and Unnatural Causes--can be found at the library if you can't watch them online. If you like Ted Talks I recommend Hans Rosling  Let my dataset change your mindset. 

As for the ACA expansion of Medicaid benefits-- What most people don't realize is that most states cover children and adults with disabilities but not adults 19 to 64 who do not have dependent children. One of the reasons to cover this age group is that the longer people go without preventive care and chronic disease management the sicker they become and the more costly their health care. Pilot programs in a few states such as Wisconsin, Minnesota, and Oregon have shown a decrease in hospitalizations and cost savings by providing basic health care coverage. Although the ACA isn't perfect it is a good start.  


It’s about time the CRC hear this call to a more enlightened view of government involvement in our society, and continue to advocate for Calvin’s perspective. I hope to see the Banner print more articles about this philosophy, in order to achieve Calvin’s goal of a truly “moral” government which is rooted in “religion and divine worship” that defends “God’s pious worshippers.”

Michael: I have no problem with CRC members advocating any political position they decide to advocate and all sorts of issues, but your comment suggests you want the denomination (the Banner in particular in this case) to adopt political positions on issues like this (and as to what kind of government is "enlightened") and then publish articles with the intent of persuading its readers of the particular laws the government should create and implement in matters such as this.  Am I correctly understanding you?

This article makes the fundamental error of confusing justice and fairness.  Is God fair?  Of course not.  If He were fair, no one would be born with illness or deformity, everyone would be born into equal opportunity, and most importantly, everyone would be among the elect.  But is God just when he allows these unfair or unequal situations to arise?  Who among us would deny that?
I agree with the article that "government's God-given task is to correct and prevent injustice."  But the existence of an injustice requires an unjust act.  In the words of Jesus, "Who sinned that this man was born blind?"  If someone did, then by all means the government should make that person pay to help bring him sight.  But when a poor or sick person's situation has not arisen from someone else's unjust act, it is the church, not the government, whom Jesus commands to help him (and there are already Christian healthcare coops that do just that).  Jesus never commands us to put a gun to someone else's head (either personally or through the government) and demand that he or she give to the poor.  When we do that, we ourselves become guilty of injustice.