During this U.S. Government shutdown, it may be an fitting for American Christians to consider how the Patient Protection and Affordable Care Act, better known as Obamacare, at the centre of the dispute, matches up with Biblical ethics. It seems that Biblical ethics may bring some clarity to the discussion. I write as an Australian, a resident of Canada and a reformed pastor/scholar.
At first sight there is much about the Act that is appealing: 20% of Americans currently uninsured (or who get insurance on the individual market) will be eligible for government subsidised health insurance-about 30million people. Yet the high cost of subsidising medical insurance has been sharply critiqued. Also it has been argued that placing rules and restrictions on the health insurance system leads to inefficiency—the free market lowers costs.
Tithe laws demonstrate some biblical principles concerning economics and the protection of the poor. Among Israel’s neighbours in the ancient Near East, a tithe of all agricultural produce was customarily paid as a tax for the benefit of the temple and its elite clergy and also the king. The tithe accumulated wealth for the privileged. The biblical book of Deuteronomy turns this custom on its head in two ways. First, instead of being taxed, the Israelite family consumed the tithe through feasting at the sanctuary—the stranger, orphan, widow and Levite joined in! Here is a wonderful image of generosity and inclusion: the Israelite family includes the underprivileged in their feasts—this would have been at great cost (Deuteronomy 14:22-29; 16:1-17; 26:1-11). Indeed Old Testament Israel was to invite these people into the daily life of the extended family, sharing in farming and relationship—they became kin.
Second, every third year a tithe of agricultural produce was stored locally, for the benefit of the stranger, orphan widow and Levite (Deuteronomy 14:28-29). This was a costly provision for the benefit of the disadvantaged.
Some biblical principles may be extrapolated here. First, all people, including the vulnerable, have the opportunity to benefit from the productivity of the land that God has given. Second, vulnerable people must be protected, even at a cost. Third, vulnerable people are included in society. Fourth, the potential for the elite to accumulate resources is seriously limited (see too the ‘law of the King, Deuteronomy 17:14-20).
These principles would seem to address the criticism that that medical insurance is too costly: Biblical ethics would seem to suggest that protection for the most vulnerable must be a budget priority. If the deficit is to be reduced it must be reduced by other means (I wonder if the tithe laws suggest that it is the wealthy who ought to bear this burden?).
Regarding the argument that restrictions create inefficiency, these biblical laws urge us not to lose sight of compassion for vulnerable people. Pursuing economic efficiency is an important aspect of Biblical stewardship. Yet no matter how efficient the insurance system, it remains that people without means rely on subsidy if they are to be insured. And it remains that poorer people are the most vulnerable to recalcitrant insurance companies—and are protected by a measure of restriction. The tithe laws call us to pursue a life of flourishing for vulnerable people in our midst.
I have found it useful to take time to consider how these issues affect real people. Here are two examples: Angela Graham, of Aurora Colorado, told the New York Times that she is ‘very interested in taking out a policy’. Angela’s job conducting telephone surveys does not provide her with health insurance. Angela says, ‘I don’t go to the doctor these days. I just pray.’
Mr Messinger is off work on disability payments and currently pays $500 each month for insurance. He says: “I’ve been waiting for this to kick in. Things have been incredibly tight.” Providing affordable health care for vulnerable people is clearly a pressing issue.
In conclusion I think it may be stated emphatically that Christians must think biblically rather than ideologically about this issue. Scripture, rather than political tradition, must be our guide. It seems clear that access to medical care is a key issue implicated in the suffering of those on the bottom rung of the economic ladder in America. Biblical ethics calls for a response of compassion and generosity and the Affordable Health Care Act is such a response. Biblical law has as its goal (at least in part) the flourishing of all, especially the most vulnerable. Christ has secured this flourishing in his resurrection, where new creation has begun. And when ‘shalom’ is embodied in the church and in society, Christ is honoured.