The Complexities of Health Care

Before sketching the complexity of the moral and biblical issues surrounding health care today, it is important to highlight a non-negotiable imperative of our faith: it’s our responsibility to care for our neighbor, particularly our neighbor’s physical needs. The Heidelberg Catechism teaches that the commandment against murder includes our responsibility to protect our neighbors “from harm as much as we can” (Q&A 107). We Christians are called not only to avoid being instruments of harm but also to be instruments of preventing and ameliorating harm.

Our goal in the provision of health care should be to promote health and prevent sickness for everyone to as great an extent as possible. The debate about the provision of health care does not lie, therefore, at the level of first principle. What Christians from a variety of contexts and perspectives do disagree about has to do with prudence. How can we best meet the needs of those who are ill? How should we, both individually and as a society, approach the question of protecting our neighbors from harm?

There is no single Christian position on health care beyond the general principle just stated. And there is no single biblical system of providing health care that applies in the same way to all people in all places at all times. What the Bible does provide is a set of responsibilities and rights to be accounted for and reckoned with in particular concrete contexts and cultures. But there is no simple way to move from these biblical principles to a particular and universally valid system of health care provision. The requirements of justice in a particular society have much to do with the cultural, economic, political, and historical contexts of that society.

The Role of Business, Church, Family, Government
Just as there is no single biblical model for government or economic order that applies everywhere, there is no single institution or organization that bears absolute responsibility for providing health care. What we have instead is a model of responsibility that covers a variety of institutions and forms of human relationship, including businesses, churches, families, and governments. The solutions surrounding the challenges of providing health care are not simply to be met either in the political arena or in the marketplace but in and through a variety of institutions.

Businesses have a duty to compensate workers fairly. As the apostle Paul puts it, “The worker deserves his wages” (1 Tim. 5:18). Over the last half-century it has become commonplace in the United States that this compensation includes not just remuneration in the form of money but also benefits, often including health care insurance. But the connection of health care insurance with employment is not a divine mandate. It is, rather, the result of particular developments unique to the labor dynamics of the U.S. What is sacrosanct is the right of workers to a fair wage, a wage that, accounting for particular factors and circumstances, provides for the basic needs of their families—including health services.

Churches too have a responsibility to care for the material welfare of people. We see this not only in the sixth commandment but also in other biblical texts that exhort us, “as we have opportunity” to “do good to all people, especially to those who belong to the family of believers” (Gal. 6:10). Since we live in a fallen world, there will be instances where compensation in the marketplace is not sufficient to meet the needs of those who are ill. Tragedy will strike that has not been adequately prepared for through insurance or savings.

Explaining Galatians 6:10 in a rather different context, the German theologian Dietrich Bonhoeffer said that “the church has an unconditional obligation toward the victims of any societal order, even if they do not belong to the Christian community.” Historically Christians have a rich institutional legacy of such responsible action, notably in the formation of hospitals as well as through the diaconal work of individual congregations. The sovereignty of this Christian legacy ought to be respected and celebrated in any political health care reform efforts.

Families too have a role to play in providing care for others. Mothers and fathers treat sicknesses in children on a daily basis. This is a mundane testimony to the concrete bonds of love and obligation that bind us together in families. And even though we are born anew through the Spirit and placed into relationship with other Christians in the church, we still have obligations to care for our natural kin. The apostle Paul warns that “anyone who does not provide for their relatives, and especially for their own household, has denied the faith and is worse than an unbeliever” (1 Tim. 5:8). We see Christians fulfilling these responsibilities as they offer spiritual support to those who are sick, help to pay the medical bills for ailing family members, or provide in-home health care for elderly parents.

Individual Christians are also called to provide for those in need. The Good Samaritan, who took action to care for the stricken victim, provides a model for effective Christian compassion. Doctors, nurses, and health care professionals embody this kind of sacrificial service every day in their individual callings. We are also called to form organizations and groups to provide for one another on a more regular and ongoing basis. Mutual aid societies, co-ops, health care sharing ministries, and other charitable endeavors attest to this Christian obligation.

Finally, government has a responsibility to protect the welfare of its people. Addressing the problem of material welfare, Abraham Kuyper once said, “The holy art of ‘giving for Jesus’ sake’ ought to be much more strongly developed among us Christians. Never forget that all state relief for the poor is a blot on the honour of your Saviour.” Here Kuyper strongly affirms the priority of social obligations in the rich variety of relationships just described.

But he also affirms that where those obligations remain unmet, and where we fail to do justice to those obligations in various ways, the government has a role to intervene. This intervention, says Kuyper, is always to be done “quickly and sufficiently” to redress the injustice and to restore the relationships that have been broken, so that the requirements of love and justice can be fulfilled in their proper spheres. The need for government action is thus not primarily a mark of justice but rather is a sign of injustices perpetuated in other institutions.

Christians are called to properly balance and relate spiritual and material welfare. As the Puritan pastor Richard Baxter wrote in his treatment of Galatians 6:10, Christians must always keep the eternal and spiritual things of God in view, a perspective all too often lost in public debates. Human beings are more than just physical realities, and there is a deep connection between the health of the body and the flourishing of the soul. “Do as much good as you are able to men’s bodies, in order to the greater good of souls,” advised Baxter. These words provide a sound basis for judging the prudential arguments about the best ways to address the challenges of health care in the world today and for making sure that Christians faithfully seek first the kingdom of God and his righteousness.

Related link:
Health Care: A Moral Imperative (The Banner)

Health Care Reform (Office of Social Justice)

Web Questions

1. Ballor contends that “our responsibility to care for our neighbor” is a “non-negotiable imperative of our faith.” Besides health care, can you give examples of that? And who is our neighbor (see Luke 10:25-37)?
2. Ballor observes, “Our goal in the provision of health care should be to promote health and prevent sickness for everyone to as great an extent as possible.” Explain why you agree or disagree.
3. Christians are not agreed on how that shared goal can best be met. Can you outline some different, even contradictory, ways in which we individually and as a society can meet that biblical obligation in how we provide health care?
4. Describe Ballor’s vision for best providing health care for all. (Hint: who shares in that responsibility?)
5. Ballor says it is the government’s role to step in if and only if the other agents do not provide the needed coverage for all. Apply that principle to the health care system in Canada and the U.S. Should Canada roll up its government-run universal health care system? Should the U.S. government intervene because society as a whole is allowing too many folks to remain without requisite health care?
6. Bottom line, what can we do as Christians to meet the biblical principle of taking responsibility for our neighbor in the area of health care?