Is Healthcare a Right or Privilege? Wrong Question.

The question comes up all the time: Is healthcare a right or a privilege? Pope Francis has even weighed in.

I don't think this is the right question.

When people ask whether healthcare is a right or privilege, they are basically asking whether healthcare is either an act of charity or a luxury. And then if it is an act of charity, they ask whether others are entitled to that charity or not. Furthermore, this question implies that the benefits of healthcare go directly to individuals and not to society as a whole.

Sometimes the questions we ask have more power than the answers. A question can frame the debate and imply assumptions about the topic. Without realizing it, most of us answer the question only within the categories that the question gives. The way questions are asked can exert a powerful control over us if we are not aware.

Once asked, the discussion quickly gets derailed in debating the nature of charity itself and whether anyone is entitled to it. These are hot-button issues in US culture that usually promise nothing but gridlock.

I'll use an event from my life to illustrate another way to look at this issue.

My Story

Several years ago, I helped establish the Columbus Catholic Worker (CCW), a center for charity and justice efforts. It was a wonderful experience feeding the hungry, providing clothing to the less fortunate, teaching ESL and offering hospitality to immigrants. Ministry was blossoming in a part of town that was thirsty for Christian love in action. The organization was growing and putting down roots. While it took a village to birth these efforts, the CCW eventually fell under my care and direction. I loved it and felt God's grace pulsing through it.

Today, the doors to this organization are closed. A multitude of reasons converged to bring it to that point, but an often unnamed reason lurking in the background was healthcare. Because of a cancer diagnosis, I needed a "regular" job that came with health coverage. It might have taken several years before the CCW could have grown large enough to offer a salary with health benefits, if ever. I was okay with that. I could live lean for a while. I could wade through and wait out other problems. But I could not wait for health coverage. This organization could have served all of Columbus for many years. It was already having a positive impact on many people. It could have been my life's work. It took a lot of effort from a lot of people to start it, and it's not something that can be re-started so easily. It was hard to walk away from it. 

While I have no regrets about where my life is today, this story illustrates an important point:

I am a citizen who had ideas and energy. I was willing to try out new ideas and take risks. The same could be said of my friends and partners who worked beside me in this ministry. The CCW benefited not just me but dozens of individuals and (dare I say) the whole city. But this work is no longer being done. 

Just imagine how many other people have to scale back--people with ideas, new inventions, innovations and business ideas. They have to limit how much they share these gifts because they are squandering their time and energy securing health coverage. 

We all suffer when we make it difficult for our neighbors to share their gifts.

Americans often live in a Hollywood fantasy that celebrates--and even expects--that others overcome every bit of adversity and still come out on top. After all, it happens in the movies and sometimes in the history books. It does work for some people, and those people deserve to be celebrated. The problem with those stories is that they don't reflect a fair expectation. In real life, real obstacles take a real toll on real people. It's not because people don't have the character, skills or faith to overcome them. Rather, it's just simple math: Someone who runs with a 50 lb weight strapped to his back is not going to run as far or as fast as if he did not have that weight. Yes, the weight may build extra strength and character and force innovation, but it may also come with significant delays, setbacks and failures in the meantime. If someone has a great business idea, I would rather she begin when  she is 25 years old rather than 45. She will bring more wisdom at age 45, but she will also lose 20 years of experience during which she could have been refining her craft rather than working side jobs in an unrelated field.

Everyone loves a good story where people pull themselves up by the bootstraps, fight all the monsters and win.  But it is pure insanity to make the lives of our neighbors as difficult as possible as a game to see who is able to turn that into a heroic quest and win. We are all too quick to assume that if a business venture fails, that it "wasn't meant to be" or that the people just did not work hard enough or have a good enough idea. It could simply be that an environment that is unfriendly to new ideas and ventures is going to result in, well . . . fewer ideas and ventures.

In this country, we are shooting ourselves in the foot. People get angry because a dime of their tax money might benefit someone else. What they don't realize is that when their neighbors are better off, so are they. It's a safer, healthier, smarter, more advanced country we are building. It is a more competitive nation in the world market. Consider my story and multiply it by a thousand. Think of all the businesses, church ministry efforts, nonprofit organizations and other new ventures that are not happening because people either need to either get health coverage or are crippled under medical debt.

If I want to start a business, I don't have to go out and cut trees down to build a road to transport my goods and services. I don't have to build water or sewer lines. I don't have to train employees in basic math, reading or problem solving skills, because we have public education. The only thing missing is that I can't expect the people I hire are healthy enough to work. It is one glaring piece that is missing.

Universal health care means that our country can be more competitive as people take less time off work due to illness, that communicable diseases are treated before they can spread, and that a major obstacle is removed for my fellow citizens who want the space to innovate. 

To me, it's not a "right" or a "privilege" that I can leave my house and take my car on any road I want. I don't think you are mooching off the government because you drive on the freeway or public city roads. It's just common sense that roads are open and available to all, including businesses. I don't spend any time at all upset that my tax dollars might pay for a road to a remote town in Montana or California that I myself will probably never use. For the same reason, I would not be upset at all that my tax dollars would pay for my neighbors to get the healthcare they need to stay alive, healthy and productive (in that order).

It would be so complicated if roads were only for certain people. Imagine if you bought a "road plan' where you could only use certain roads and had to drive extra miles across the city to use the roads in your "plan." Yet we do that with our complicated medical plans that exclude us from so much.

Charity is great. I wish we could make the decision on healthcare based solely on humanitarian reasons and not take into account whether it makes our neighbor more productive. But this is not going to melt the ice in this discussion in this country. Whether healthcare is a right or privilege is not the only question when we go to the voting booth. Providing universal healthcare is simply what a smart country does that wants to stay competitive and advance as a civilization. Like public roads and public education, it provides a basic infrastructure so that we can all share our God-given gifts more broadly and without reservation. It's the next logical step in the growth of a healthy society.

The False Promise of Personal Charity

Some people say that the best way to address poverty is through personal charity. They say we should not involve the government when trying to help struggling neighbors.

They say it's because the government is inefficient and impersonal. They argue that government programs "force" people (through taxation) who do not want to help, thereby creating resentment and undermining the development of their conscience. You shouldn't force someone to do charity any more than you should force someone to go to church, they would argue. The desire has to come from within. Their point is that the poor are best served by individuals who are personally moved by compassion to assist them directly.

I've heard this line of reasoning over and over. It fails on many counts. First, there's a common sense question that rarely gets asked:

If individual charity were able to solve the problems of poverty, then why hasn't it done so already?

Seriously, show me one place in the world where individuals doing private charity have ever been able to solve the systemic problems of poverty. You can pick any place you want over the course of global history.

If personal charity ever solved the problems of poverty, we wouldn't even need to talk about it. There is nothing stopping people from doing this right now. Neighbors can help neighbors, churches can help neighborhoods, and if the theory held up, we should have eliminated poverty ages ago.

There have been some great individual efforts over the years. People have bonded together through churches and other groups to do marvelous charitable deeds, such as the hospital networks of Catholic religious sisters or ecumenical disaster relief efforts, to name only a couple in a long line of impressive efforts. Of course, a key phrase here is "bonded together." When you come face to face with poverty and attempt to do something about it, the first thing you may realize is that you just can't do much by yourself. You've got to join your efforts with those of others. First, you may try to involve your family. Then you may solicit the involvement of your church. Eventually, you probably realize that the problem needs all of society pulling together, and you work hard to convince people to utilize the government to achieve this goal.

The history of Christians addressing poverty is stunning indeed. Still, many faith-based groups whose mission it is to alleviate poverty openly support the critical role of the government in helping meet this goal. See Bread for the World, for example. Christians who are working hard to alleviate poverty typically support a strong partnership with the government in this work.

The reason is this: The state is the most effective instrument to provide this kind of service. The government is neither good nor bad, it is simply the best tool for the job. No other organization is big enough or as well-connected. The faith community can compel and convince voters to provide this care, but when we do so, the tool we need to use is the government. Why? Because quite simply: It works.

It is like trying to tunnel through a mountain with toothpicks. You can bring an army of extremely dedicated people, but it would take millions and millions of people and probably just as many years to dig that tunnel using toothpicks. Another option is that somebody could bring in a carton of dynamite, a bulldozer and a team of engineers to blow that tunnel wide open. The government is like the second option--dynamite, bulldozers and experts. There are some things a large body like a government can do that no team of individuals could ever do, no matter how noble or well-intentioned. A large body is often greater than merely the sum of its parts.

It is easy to understand why people are wary of the government. Some of the worst actions in human history have been done of, by and for governments. But on the flip side, any society that has been able to reduce, minimize or come close to eliminating poverty has been a society that has learned to effectively involve the government in this process.

There is another reason why government matters so much: The future of the human race will be based on our ability to cooperate with each other. Community is extremely difficult. It's extremely messy. But it's also essential. God gave us a big planet, but it is not so big that any of us can live in isolation from our neighbors. No matter how hard we try, no matter how strongly we detest it, the fact remains that we are stuck with each other. We share this planet. In light of this, we have a choice: We can either learn to work together or we can fight with each other, but we can't pretend to ignore each other. The government is not the only way that people come together, but it is the one institution that includes ALL members of a society. Eliminating the government from charity efforts eliminates an essential way that people can work together.

This is an especially difficult concept for us in the United States. Many of the people who helped form this country tried to solve their problems by simply moving away from people they had difficulties with. This method of dealing with problems is deeply embedded in the American psyche. When people get on your nerves, you can simply "go west" to get a little peace and quiet, a little piece of your own ground, and live with minimal interactions with neighbors. You don't have to learn to live with difficult people, rather you can just pick the people you want to be with. People first left the problems of Europe behind. When life here got too tense, many continued pioneering westward to get away from everyone. Part of the American Dream is the illusion that you can create and control the bubble you live in. Perhaps this method worked for a couple hundred years until the empty spaces ran out and we were stuck staring eyeball to eyeball with our neighbors, again. Still, the fantasy remains that the individual acting alone is the most advanced and enlightened form of human activity. Yet Christianity has always held that life is about "we" not about "me."

There have been many societies across human history that have provided very little government support to struggling citizens. The result? People lived in desperate poverty. The personal charity efforts of their neighbors did not change that. There is no historical example where a society has removed government sponsored social services and then ended up with individuals taking on the burden doing a better job of helping their fellow neighbors in need. People do help each other out, but rarely to the point of eliminating poverty or making up for what a whole-government effort could do. The only exception I can think of would be very small societies, like the Amish or traditional hunter-gatherer societies. Small societies like that rarely have the wealthy living next to the desperately poor, but that juxtaposition is common in any larger societies.

I suspect that the real reason why some folks are against the government getting involved is because they know that it might actually effect some real changes in power.

So what about forcing people to do charity? I don't get why this is a big deal. If I'm sick and need to go to the hospital, I'm sure glad there's a road I can take to get there. It doesn't matter to me in the least if workers built that road out of charitable love or whether they built that road just because it was what they had to do to get a paycheck, I'm just glad there's a road when I need one. I don't need to know the motivations of each of the highway workers. But I can trust that the decision to build that road in the first place and allocate tax dollars to pay for it was certainly wise and probably charitable, and I'm glad that enough of my neighbors were smart enough and generous enough to make sure that road exists. People had a vision for making society better and part of the vision included building a road so that people could get to the hospital.

The same analogy holds true when it comes to giving a hand-up to people in poverty. If folks need assistance with food, heating bills or medical care, I think we should provide it. What helps my neighbor helps me.

Besides, why are we making a game out of poverty? I would hate for the poor to suffer just as a test to see if other people develop the "right attitude" out of which to help them.

Whenever people are able to make huge gains eliminating poverty, the government is almost always a huge part of that effort. And that is because the future of the human race will be determined on how well we cooperate with each other, and that includes, among other things, the oftentimes messy but always necessary aspect of the government. Individual charity is still important. It is still an extremely high calling. But it is through individual charity that we learn how important it is to involve others in this task.