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For class this week, we read a book by Paul Farmer called Pathologies of Power. Since this book was written before the explosion of the current healthcare debate, it doesn't figure too prominently in the text. Farmer is mainly concerned not with unjust healthcare arrangements here in the US, but those in Third World countries, like Haiti, for example, where structural violence, more often than not, supported and perpetuated by the United States (and conservative Christians especially), deprive the poor of access to the most basic health services, or even the means of subsistence. When you read Farmer's account, it is pretty obvious that these situations are the result of gross injustice and downright wickedness in the First World countries, but what is not so obvious, and so what I began to puzzle about once again, is how the healthcare debate in the US right now fits into all this.

I found myself wondering just why it is that Christian conservatives in America oppose so violently the idea of universal health care. Is it just that we don’t trust our government to oversee it wisely, that we are sure that the evil secular state will no doubt use the health care system as a cover for its own sinister purposes and will waste billions of dollars in inefficiency? Why then did such concerns not trouble us overmuch when it came to the Iraq War, for instance? No doubt the state used that as a cover for sinister purposes and no doubt it was terribly inefficient. Are we eager for the idea of universal health care, but just don’t like the current propositions for getting there? I don’t think so, having recently come from this conservative camp.

In this camp, the notion that health care might be a “human right” is greeted with consternation. Part of this, no doubt, is due to a proper suspicion of rights language--it destroys relationships of gift and gratitude, and it has a tendency to make the state the creator and guarantor of rights. But does the conservative accept the principle involved--that it should be obligatory on us to give medical aid to those in need? I don’t think so. We are told instead that receiving health care is a “privilege”--something you earn, or else that is extended to you as an extraordinary offer of grace. The conservative Christian might accept that Christians should--at least, if the need is “near and clear,” right in front of their face--always extend such extraordinary grace. But we shouldn’t expect or ask society as a whole to do that. People ought to do good things, but the government shouldn’t force them to do good things.

Of course, we might dispute whether it's true that the government shouldn't legislate that people do good things, but let’s leave that point aside for a moment. The question here is whether requiring free health care is equivalent to the government requiring that people do some good thing (perhaps like a law requiring that men give up their seats on buses for women), or more like the government forbidding that people do a bad thing (like a law forbidding men beating up women on buses). The conservative argument is that it’s the former. Farmer, I think, would argue that it’s the latter--denying a sick person access to health care unless they can pay for it is exploiting them, it is like beating them up; it’s not simply like failing to give them your seat on a bus. This is, perhaps, where the debate over whether health-care is a “right” cashes out in practical terms. Is the failure to provide it the failure to do something nice that you need not do, or is it a kind of mistreatment of the person by failing to give them that which they unequivocally ought to receive?

Christ’s parable of the Good Samaritan in Luke 10 might help us out a bit here. On the one hand, we might argue that this is a matter of “how to inherit eternal life”--it is a sort of above-and-beyond ethic. On the other hand, Jesus doesn’t seem to view it this way. This kind of care for the injured man by the Samaritan is purely and simply what God’s law requires. But we might say, the Samaritan’s actions are actions of “compassion”--they are depicted as an act of special kindness, not an act of obedience to the law. On the other hand, Christ tells this parable in response to the lawyer who “desiring to justify himself, said to Jesus, ‘And who is my neighbor?’” In other words, the lawyer thinks to himself, “Ah yes, I am required to care for my neighbor, but, after all, this sphere of responsibility is fairly limited, right?” Jesus’s response makes clear that there can be no self-justification here, no attempt to limit the extent of our obligation to love our neighbor. And, so what if this is addressed to “Christians”--if this is God’s view of righteousness, shouldn’t we want the rest of the world to behave this way too?

I suppose, then, that I would be much more comfortable with the conservative Christian opposition to a government health-care program if we weren’t so often guilty of attempting to justify ourselves by doing the bare minimum, but were out there seeking every opportunity to give care to the sick and needy, and encouraging the rest of society to do likewise.

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