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Positive politics: health care

Well, it’s been a while since I’ve written something on positive politics. Let’s dive in to another completely non-controversial topic: health care.

I’m tempted a little bit to say “just read everything Matthew Loftus has written on the topic” and leave it at that. But that would be cheating, so I’ll leave that as a secondary recommendation.

Maybe this’ll be easier if I just state some positions first, then I’ll try to justify them.

  • A modern, first-world society should have among its goals that its people have the ability to get health care, including medical and mental health.
  • This ability should largely be independent of a person’s individual income level.
  • The only practical way this will happen is via government involvement including taxation and funding for care.
  • Provision of some sort of universal coverage would benefit the American people and society in measures other than just physical health.

OK, let’s dig in.

A modern, first-world society should have among its goals that its people have the ability to get health care, including medical and mental health

This seems like it should be almost self-evident. Government should exist to promote human flourishing. And humans will flourish much more when they have access to medical and mental care than when they don’t.

The ability to get health care should largely be independent of a person’s individual income level.

Again, because it encourages flourishing. Because poor people are currently forced to make bad choices about health care because they don’t have the income to make better choices.

Preventive care isn’t freely available, so treatable issues get ignored until they become emergencies. Emergency care gets used and abused for all sorts of inappropriate situations because it’s legally more available to the poor.

Health issues snowball and drive other societal issues. Lack of basic preventive care leads to more serious health issues. Which can lead to lack of employment, which makes it even harder to afford any care. Repeated or chronic health issues can lead to self-medicating with tobacco, alcohol, and drugs. Which leads to other health issues, and to deterioration of social relationships, and to crime.

There’s no just reason that only wealthy people should have medical care. And poor people might find it easier to work their way up the ladder if they had health care available to them.

The only practical way this will happen is via government involvement including taxation and funding for care.

I’ve heard lots of arguments for why this isn’t the case.

A lot of right-wing Christians will say that the church should provide for these needs. To which I say great, but that solution doesn’t scale. There are by rough estimates about 350,000 churches or other religious communities in America. American health care spending is roughly $3.5 trillion per year. That means each church in America would need to put $10 million per year toward health care. It doesn’t scale.

Update: a friend pointed out that church giving might only need cover the gaps, not the whole medical cost for the country – an excellent point that I missed here. But in 2016, per the Census Bureau, about 9% of the country was without health insurance coverage. So maybe the cost of the gap is only $1M per church instead of $10M… still doesn’t scale.

But there are other collaborative ways that people can band together to fund medical care! I know people who have been in faith-based health care cooperatives where everyone sends in their bills and the costs are split among all members. Great as far as it goes, but at the macro level it still fails the care-for-neighbor test.

Over the past few years we’ve seen a proliferation of social media campaigns for health care help. Donate to this GoFundMe to pay for my uncle’s kidney transplant! Or my sister’s cancer treatment! Or my friend’s medical expenses from his car accident! Seeing successful responses to campaigns can be heartwarming, but how many are there that go unfilled and wither in quiet desperation?

Provision of some sort of universal coverage would benefit the American people and society in measures other than just physical health.

This is closely tied to the point about coverage not being tied to income. How many people would take an entrepreneurial plunge or feel freedom to pursue some other dream if they didn’t have to worry about keeping a standard job at a corporation just so their family could keep health insurance?

How many people would have their mental, social, and community lives significantly enhanced simply by being healthier? How many people’s lives would improve from eliminating the mental stress associated with wondering how a loved one will get care?

But isn’t this gonna cost a lot? And isn’t the government super-inefficient at managing things?

Well, yeah, it’s gonna cost a lot. But the current system isn’t cheap or super-efficient, either. Multiple levels of for-profit for corporations involved ensure that everyone involved gets a cut. It doesn’t take much more than looking through a single hospital bill detailing hundred-dollar Tylenol, thousand-dollar titanium screws, billed costs vs. negotiated costs, and on and on, to recognize that the current system has significant issues.

I know it’s not a simple problem to solve, but the rest of the first world has found ways to address it, and America should too.


So let’s evaluate these against the five-principle framework.

1. Is it good for the poor?


2. Is it good for the planet?

I don’t know that it affects the planet one way or another.

3. Does it promote peace?

More broadly available health care should, in the end, help promote peace, since healthier people will be happier and more stable people.

4. Does it challenge the powerful?

If more equality in this area challenges the powerful, then yes.

5. Does it let the marginalized have a seat at the table to speak for themselves?

Indirectly, more available health care would help the marginalized be in a better place to be able to speak for themselves.


  1. Kim Kim

    “Government should exist to promote human flourishing.” No – that’s what families and communities are for. The role of government is to govern – to rule – to establish and support laws that prevent evildoers from running rampant. What helps humans flourish is unique and specific. Each person has different needs and for each of those unique needs, there has to be a unique response. More so with medical issues. What makes my child flourish in the world is not the same as what makes your child flourish – medically, emotionally, or otherwise. Her needs are one of a kind and the response to them should match up to that standard. And for that reason government should not be in the business to “promote human flourishing” but to rule, govern, establish laws and carry those laws out. The government is utterly incapable to meet unique needs, and that is not the role of government. You pooh-pooh the notion that the government has an incredible, repeating, and well documented record of doing what it does badly. VA health system? Government run. BADLY. When someone has a track record of doing something badly, you don’t give them more responsibility, power and money. That would be foolish.

    • Hmmm, a few thoughts:

      1) If we look at the pattern of government set up in the Old Testament, there were plenty of laws set up that weren’t just in place for the punishment of obvious crimes, but also to define and promote an orderly society. I’m not going to say that the OT is prescriptive for us today, but I think it’s at least a reasonable indication that such a government isn’t contrary to God’s ways.

      2) “Families and communities” are absolutely the first line of knowing what’s best for people and providing for their needs. But what about when the family or community doesn’t have the resources to provide for a particularly costly treatment or situation? Do we just write them off and blame their incapable family/community? That’s not God’s heart. And while churches could in some cases step in and help make up the gap, there just aren’t enough churches in America to pick up the load. It doesn’t scale.

      3) While all people are unique, significant pieces of what encourages flourishing are common to us as humans – for example, nutritious food, care of children by their parents in a stable home, basic education to function productively in society, medical care, adequate housing, etc. We should at a minimum pursue public policy options that encourage these conditions.

      4) Yes, the government does some things badly. The government also does some things reasonably well. Private industry does some things well and some things very badly. The church does some things well and has an awful track record with others. None are a perfect solution. All require wise planning and effective oversight. But it’s short sighted to suggest that the government should not be involved in this sort of thing because they’ve had some issues in the past. We’ve already more or less accepted government provision for basic income and health care for retirees, and while they’re not perfect, the Social Security and Medicare systems work fairly well.

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