Thinking About Healthcare from a Christian Worldview Perspective

An interview with Dr. Jeff Myers, president of Summit Ministries

Q: How does Summit help its students think about the issues related to healthcare reform in the U.S. from a Christian worldview?

A: We focus on two things: compassion and stewardship. Let’s look at compassion first. What should Christians do to help make sure that people are well taken care of? The second issue is stewardship. What should the federal government do?

Christians are the ones who started hospitals, and lots of different Christian traditions did so, from Catholics, to Presbyterians, to Methodists, to the Moravian Brethren. Christian compassion in healthcare goes back to the plagues in Rome and to the Black Plague in Europe when Christians stepped in while everyone else was running away.

Also, it was Christians who established our system of modern science from which health care came. Historically, Christians have been deeply involved with health care. It makes sense. Taking care of those who cannot care for themselves is what Jesus talked about when he said, “as you did it to one of the least of these my brothers, you did it to me” (Matthew 25:40).

The question with ACA is, “Should we off-load our responsibility to be compassionate to the federal government?” Other countries have answered that question with a “yes.” But here we’re talking about the United States of America, a vast country with 330 million people and a tremendous amount of cultural, ethnic, economic, and racial diversity. It’s not that easy.

This is where the stewardship question comes in. Does turning health care over to the government enable us to be better stewards? A friend of mine who is a former congressman, Bob McEwan, gave me a simple, powerful way to grapple with the question. Bob points out that there are three kinds of economic transactions:

  • A first-party payer transaction is where you are buying something you will use yourself. Because you’re both buying it and using it, you are motivated to find the highest quality at the lowest price.
  • A second-party payer transaction is when you’re buying something for somebody else to use, say a toy for your child to take to a classmate’s birthday party. You’re motivated to find a low price, but high quality isn’t much of a concern.
  • A third-party payer transaction is where you don’t have to pay for the item, nor do you have to use it. You don’t care how high the price is because you’re not paying. Nor do you care whether the quality is low, because you’re not using it.

By definition, every government transaction is a third-party payer transaction. Essentially, we have set up a healthcare system where we don’t care what the price is, because we’re not paying for it (the average person’s taxes don’t go up if lots of people have medical procedures). Nor do we care what the quality is, because we’re not the ones personally using it. There is no incentive to keep the costs down or the quality high. In the end, all the incentives push toward a high cost, low quality healthcare solution. It’s a nightmare in the making.

In compassion, Christians should be involved in helping provide high quality, low cost care to those in need. As good stewards, we should insist that Congress focus on laws that allow a system where people have an incentive to keep their costs low, because they are paying, and keep the quality high, because they’re the ones using what they’re buying.

Here’s a possible way it could happen. Time magazine recently featured two doctors who had founded the Surgery Center of Oklahoma. The Center sets a flat rate for every procedure—including airfare, recovery at a local hotel, and any costs arising from complications. Their prices are half or less than typical hospitals, but there is a catch. They do not accept insurance of any kind.

In a regular hospital, a knee replacement surgery might cost $40,000. Well, if the government is paying, the patient doesn’t care if the cost is $40,000 or $4 million. And they don’t get to decide the quality of care—they have to go to wherever the government sends them. If the patient has insurance, they get more a little flexibility in seeking out quality care, but they aren’t motivated to keep costs down because they have a maximum copay. Neither one is a sustainable system.

At the Center, patients save a lot a lot of money but they’re also motivated to be sure the cost is fair and that they really need the procedure since they’ll be paying out of pocket. They’re also motivated to ensure that the quality is high, because they are the ones getting treated. It moves from being a third party payer transaction to being a first party payer transaction.

I believe a government-run healthcare system fails in both compassion and stewardship. Governments don’t have the ability to be compassionate—they only have the power to coerce some people to solve problems for others, either through taxes or penalties. Plus, government-run healthcare takes away people’s stewardship responsibility. The government becomes a parent. And a parent who is not asking a child to be responsible shouldn’t be surprised when that child is irresponsible.

So whatever system we come up with needs to require people to take personal responsibility for their own health care decisions and their own health care costs. Some have suggested that the government can be a safety net for those in trouble, through tax credits and vouchers. I think those are worthy debates to have. But let’s keep in mind that it is not the Christian approach to ask government to take responsibility for people’s care.

Q: As we talk about the battle of ideas, what worldviews do you see clashing in the health care arena?

A: The two worldviews battling it out in the health care area, along with a Christian worldview, are Secularism and Marxism. The Secularist says that smart people in government should be given responsibility to develop a system that provides the greatest good for the greatest number. Secularists ignore religion and culture, so they’re unlikely to look at the spiritual aspects of healthcare decisions or the inherent value of every person.

But there is also a strong strain of Marxism influencing people. I’ve heard many politicians suggest that rich people get better health care because they have taken it away from poor people. Certainly, poor people have a harder time getting healthcare because of poor health decisions, poor economic decisions, and unfortunate circumstances. My job isn’t to defend the rich, but I do need to point out that such an approach isn’t a way of solving the healthcare crisis—it’s a way for Marxists to build resentment they hope will boil over into revolution. As Cal Thomas pointed out, though, resentment never created a single job or solved a single problem.

Christians must be involved. We must be compassionate. We must be good stewards. We an alternative to a highly-regulative, government-run healthcare system. But we also need to be sure that our system serves the needs of citizens rather than being arranged for the profit of special interests such as insurance companies and pharmaceutical companies. A Christian worldview is more important than ever.