How to Think About the Healthcare Debate?

The hundred-year-plus trend towards centralized power in American governance has produced a state of affairs that cries out for the church to, as they say, “be the church." So, what is the Christian obligation in the healthcare crisis?
Michael Daily


by Michael Daily

Pastor and former Executive Director of the Pregnancy Resource Center of Metropolitan Richmond (VA)


A few weeks ago I enjoyed a spirited discussion with three knowledgeable friends concerning the current debate over a national healthcare policy. Among other things, these friends pointed out the need for something to be done, and reflected on what a Christian obligation might be.

Shortly after this conversation took place, I listened to Ken Meyers, of Mars Hill Audio, interview Paul A. Rahe, author of Soft Despotism, Democracy's Drift: Montesquieu, Rousseau, Tocqueville, and the Modern Prospect. While not specifically about the current healthcare legislation, the interview was one of the most helpful aids to framing the issue that I have yet come across. Rahe makes a number of observations that each bear heavily on how we ought to think about legislation such as is currently before congress.

He points out a number of realities that any form of government must deal with: 

· What he calls the "tyrannical impulse", that is, the tendency of those in authority to consolidate and increase their power.

· Challenges to governing presented by size and scale—the larger a territory and its population, the greater the number of decisions which must be made and actions undertaken.

· The necessity of morality on the part of the governed—he offers the hypothetical example of a nation composed entirely of substance abusers and asks if it is remotely possible that this group could successfully govern itself.

These three factors combine in numerous ways to complicate governance of any populous country with a large geographic area. In the interview Rahe frequently cites two of the authors mentioned in the subtitle of his book, Montesquieu and Tocqueville, who thought and wrote about these matters in the 18th and 19th centuries respectively. Perhaps the key insight relevant to the healthcare debate is this: when the executive branch consolidates for itself the power of the judicial and legislative functions (as is now the case with federal agencies) the effects of all other institutions are marginalized. When these other institutions are marginalized, what is lost are the sources of positive moral transformation. Thus proceeds a populace spiraling downward, less and less able to care for themselves, who then turn to government to solve their problems, while the head of the government utilizes the opportunity to become more powerful and entrenched in office.

In my opinion, this has already taken place to a considerable degree. An example in recent history is observable in national attempts to address poverty. As the federal government became the principal provider for the needs of the poor and needy, the influence of other institutions—such as the church—waned. Since the church is the institution foremost able to accomplish lasting moral transformation, a vicious cycle was initiated. The power and influence of centralized government grew through the votes of those seeking its care, while the morality of the voting public waned, which fostered irresponsibility, poverty and more need, causing more and more people to seek a government bailout from their troubles.

Nationalized healthcare appears to be the next logical step in this progression. It's not impossible to envision a future when people check themselves into the hospital for the free room and board because they are too crippled morally to lift food from the plate into their mouths. (Proverbs 26:15)

The Mars Hill interview is long on diagnosis and short on prescription, but Rahe does point to one way forward—what Catholic thinkers term "subsidiarity"— what The Oxford English Dictionary defines as "the idea that a central authority should have a subsidiary function, performing only those tasks which cannot be performed effectively at a more immediate or local level."

It makes sense to me that the closer a person or institution is to the problem or need, the better the chance that the need will be met properly and the likelihood diminished of power being unhealthily consolidated far from the point of need.

This hundred-year-plus trend towards centralized power in American governance has produced a state of affairs that cries out for the church to, as they say, "be the church". No other entity has the capacity to respond as well on both the local and national levels, to effectively transform a people's morality, and at the same time deliver the only known antidote for the tyrannical impulse—the self-denying, soul-satisfying Gospel of Jesus Christ.

For the past nine years, Michael Daily has served as pastor for Freedom Fellowship Church ( , a small, non-denominational congregation in Montpelier, Virginia. Prior to that, Michael worked for nine years as Executive Director of the Crisis Pregnancy Center (recently renamed the Pregnancy Resource Center) of Metropolitan Richmond. Michael and his wife of twenty-seven years, Carol, live in the Center of the Universe, Ashland, Virginia.



Originally published February 09, 2010.