The idea of a complete government take-over of healthcare is growing in popularity in the US. You can expect it to be a hot-ticket issue for future presidential campaigns. Those who advocate for it let loose their battle cry, “healthcare is a right, not a privilege.” Behind this phrase is the desire for more government control over healthcare. The slogan comes from a place of compassion to see the poor and needy receive healthcare, but looks to a State healthcare plan rather than God’s healthcare plan. In many ways our healthcare system has already been surrendered to government control. More than 60% of all US healthcare spending today is funded by the government. Like all other industries, the source of funding will be the entity that has the final word over what the healthcare industry can and can’t do. In other words, the US government exercises more control over healthcare than the private sector. The results have been disastrous for the poor–exorbitant prices, restricted access, and lower quality.
Where should Christians stand? Should healthcare be a public or private matter? Does this topic contain neutral ground where God has left it up to the collective preferences of societies to decide how healthcare for the poor ought to be administered? No. All human activity, including healthcare, is either for or against Christ (Matt 12:30), hence, neutrality is a myth. We as Christians should strive to hold every thought captive to obey Christ (2 Cor 10:5), even how we think of healthcare. And so we must search God’s law-word to renew our minds so that we might submit to how He wants the health needs of the poor to be met.
THE MEDICAL IMAGERY OF THE GOOD SAMARITAN EXEMPLIFIES THE SECOND GREATEST COMMANDMENT TO LOVE ONE’S NEIGHBOR AS THEMSELF
God is certainly not silent on healthcare. From the balm in Gilead (Jer 8:22) to Paul’s prescription of wine for Timothy’s frequent ailments (1 Tim 5:23), the Scriptures are filled with medical remedies for illnesses and injuries. Amidst all these passages, none expresses God’s concern for healthcare more explicitly than in Jesus’ parable of the good Samaritan–Luke 10:25-37. This story was prompted by a lawyer’s question designed to test Jesus. His question pertained to eternal life and what he must do to inherit it. Jesus points him to the law of God and asks him what is written in it and how he reads it. The lawyer answers by quoting part of the Shema from Deuteronomy 6: “love the Lord your God with all your heart and with all your soul and with all your strength and with all your mind” (v.5) and Leviticus: “love your neighbor as yourself” (v.19:18). Jesus confirms his answer. Realizing his own inability to inherit eternal life through perfect obedience to the law, the lawyer seeks to justify himself by asking who his neighbor is. Jesus answers this question by telling a story about a Samaritan who provided medical attention for a Jewish man who fell victim to robbers who beat him, stripped him of his clothing, and left him half dead. The Samaritan was said to have compassion and bound up his wounds after treating them with wine for disinfection and oil to quell the pain. He then sat the man on his own animal and took him to an inn for further treatment. It is no accident that the word hospital comes from the Late Latin hospitale which means “guest house” or “inn.” Jesus makes use of medical imagery to illustrate to a self-righteous lawyer what it looks like to truly love one’s neighbor as themselves–a summary principle of God’s law (Matt 22:34-40). Jesus’ charge to the lawyer after telling him the story of the good Samaritan was to “go and do likewise”–a universal command for all image bearers of God to implement.
CHRISTIANS PIONEERED IN HEALTHCARE AND HOSPITAL SERVICES
The early church took Jesus’ command to “go and do likewise” seriously. If there is one people group the world owes gratitude for delivering the framework of healthcare and hospital services, it is the early Christians. Medical practices have always existed, but regarding the establishment of an institution consisting of a staff of physicians who conducted diagnoses and prescribed remedies, along with nurses who provided basic needs for patients, the Christian church pioneered. Most Historians would affirm this, although there are some who would claim that the Greeks and Romans were exceptions. However, these exceptions were limited to hospices for wounded soldiers and not the kind of healthcare service that is open to the public like the hospitals early Christians invented.
By the turn of the 2nd century, Christians had already begun to develop infrastructure to accommodate treatment for the sick. Deacons and deaconesses predominantly led this assistance focusing on palliative care. In 360 A.D. Basil, bishop of Caesarea led the church in what was a giant leap forward in medical charity. He founded a hospital in Cappadocia that was so effective in helping the sick that hospitals in Constantinople, Alexandria, and through the eastern empire that were modeled after Basil’s began to spring up. At the end of the 4th century, Fabiola established the first hospitals of Rome. In the 9th and 10th century, benedictine monks preserved and copied ancient medical manuscripts, cultivated medical herb gardens, and experimented with elixirs to cure diseases. During this same period, the Jerusalem hospital was founded by a community of Augustinian Christians. In the 11th century, contributions by wealthy crusaders made possible the construction of a new and bigger hospital in Jerusalem. The magnitude of the medical care that was provided there had never before reached such a level. German pilgrim Theoderic of Würzburg observed, “going through the palace we could in no way judge the number of people who lay there, but we saw a thousand beds. No king nor tyrant would be powerful enough to maintain daily the great number fed in this house.” During the same century, Benedictine monks at the Medical School at Salerno translated many ancient Greek and Arabic medical writings into Latin for the purpose of re-introducing them to the West. Among these texts was the famous Articella (Little Art of Medicine) which include the writings of ancient Greek physicians Hippocrates and Galen. From then on healthcare exploded around the world as hospitals, medical knowledge, and physicians began to multiply and develop worldwide.
The Christian church gifted the world with what we refer today as healthcare and hospital services. Built upon the bedrock of the second greatest commandment to love one’s neighbor as themselves and Jesus’ application of it expressed in the parable of the good Samaritan, Christians successfully brought healing to the world in the name of Christ and for his kingdom. The healthcare model that the church invented became such a beacon of hope for physical wellness that the rest of the world mimicked the Christian example. But things began to take a turn for the worse when the civil government began to overreach their God-given jurisdiction by its attempts at taking control over healthcare.
GOD’S LAW DOES NOT PERMIT CIVIL GOVERNMENT TO ASSUME THE RESPONSIBILITY OF HEALTHCARE
Civil government has made Jesus’ command to “go and do likewise” (e.g., provide healthcare for those in need) virtually impossible as the US healthcare system creeps closer toward complete state control. The underlying reason that the civil government is prone to debase healthcare is that God did not design it for that purpose. God’s purpose for civil government is to punish evil as the avenger of His wrath (Rom 13:3-4). It’s sole obligation is to provide justice for the criminally oppressed … nothing more. Healthcare is a charitable service that has been delegated to all men by Jesus’ command: “go and do likewise.” God has not given the civil government any jurisdiction, responsibility, or right to forcefully monopolize over healthcare. The state bears the sword … not a scalpel. It is used to the brawn motion of striking foreign and domestic enemies and lacks the precision that physicians use in surgery. When the civil government is confused as to what her role is before God, damage is sure to ensue. Despite God’s clear parameters for civil government, state intervention in this industry is increasing and it is precisely for this reason that medical costs have gone up, quality has gone down, and access to treatment is shrinking.
THE SAMARITAN’S DILEMMA
Healthcare, like all other efforts to help people, confronts what economists ironically call “the Samaritan’s Dilemma.” This idea recognizes that too much charity can be just as destructive as too little. For example, an individual in financial need can receive charity in the form of money as an opportunity to help lift themselves out of poverty, but as monetary charity increases, the same individual is pressured to rely on what he receives as a means of survival. Thus, the individual is enabled to free-load off others even though they are more than capable of being self-reliant. Helping too much perversely increases “needs” that really aren’t there, while at the same time unnecessarily adds to the burden of society. There is an optimal amount of charity that strikes a perfect balance between “too little” and “too much” charity. That balance is determined by true need, the cost of assistance, and the donor’s preferences.
The private sector will always be able to calculate the medical needs of society better than the civil government. This is because the private sector has the incentive and ability to make sure they avoid helping too much or too little. For example, non-profit hospitals will lose funding when their donors hear that their contributions aren’t meeting a true need. The same incentive exists among for-profit healthcare. For example, the high prices on prescription drugs indicate a pressing health need and act as a signal for drug manufacturing firms to enter into the market to ease the demand so that prices will drop (unless government intervention prevents prices from dropping as we’ll see with patents and FDA regulations). So whether it be non-profit or for-profit medical institutions, private healthcare’s entire existence depends on accurately calculating the true healthcare needs of society. In contrast, the civil government lacks the incentive and the ability to accurately assess true need; a negative consequence of overstepping its God-given jurisdiction.
There are many state and federal programs designed to help the poor with their healthcare needs of which two stand out–Medicaid and the State Children’s Health Insurance Program (S-CHIP). These two programs and many others like them are always backed by good intentions but because they are run by the state, they inevitably fall into the extremes of the Samaritan’s Dilemma for the reason that they have no ability to calculate true need, thus perverse incentives arise. Let’s look at how this occurs.
Medicaid is a federal and state program that intends to help with medical costs for lower income individuals. In actuality, Medicaid has been one of the leading government intervention schemes that caused healthcare costs to rise drastically since its establishment in 1965. Once Medicaid came on the scene, the demand for healthcare services rapidly grew overnight as many individuals began signing up for the new program. When demand for healthcare increased so did costs. Services became more expensive because the supply of healthcare services could not keep up with the growing demand. America quickly developed an over-reliance for hospital care. Medicaid gave them the ability to use medical services whether they truly needed it or not. Costs unexpectedly kept rising and to fix the problem, the US government increased its spending
Washington Post Columnist, Robert Samuelson points out the drastic increase in government spending on healthcare since the arrival of Medicare and Medicaid. He writes, “before 1965, government spending on healthcare was down to 2% of federal outlays. Now it is one-third of government spending.” Samuelson continues, “Government can’t cut health spending, so new spending reduces spending on other programs, raises taxes or bloats deficits. The effects are felt keenly by middle-income Americans and the poor, because the high cost of modern medicine consumes more of their incomes. We have created a monster, inspired by good intentions, that is slowly and menacingly taking charge of our future.”
Medicaid sent the US on an endless spending spree with no way out and with no real solution to bring down prices for lower income individuals. Although backed by good intentions, this program ended up hurting the people it was designed to help; namely the poor.
Medicaid also creates perverse incentives for states and the federal government. They both share the burden of Medicaid expenses so there is little incentive for accountability on how the funds are being spent. Furthermore, states will be compensated for their Medicaid expenditures plus some additional funds. So if a state wants to increase its budget, all it has to do is expand Medicaid spending. All this to say that there is a substantial amount of economic waste and a misallocation of resources due to the Medicaid program.
Advocates for programs like Medicaid understand that they cause medical prices to rise but do not believe society should wait for prices to fall naturally before helping lower income individuals with their healthcare costs. They often argue that the US government cannot risk the poor dying from health problems while the country waits for more suppliers to enter into the market so that medical costs can fall. This argument tugs at some heart strings, however, it brings light to an issue that never existed. It assumes that before Medicaid, society left the poor for dead or in bad health regarding their medical needs. This simply was never the case. Dr. Everett Koop who served as the 13th Surgeon General of the United States under President Ronald Reagan from 1982 to 1989 speaks to this very issue in his book an Honest Conversation on Critical Issues. Koop recalls the charity that doctors bestowed on the poor before programs like Medicaid and its sister program, Medicare. Dr. Koop states, “When I first entered medicine and for many years thereafter, I and most physicians did not expect to be paid for everything we did. Donating care to some people who couldn’t afford it was something expected of the profession. All that vanished with the coming of entitlement programs like Medicare.” President of The Future of Freedom Foundation, Jacob Hornberger also recalls how the poor were treated before Medicaid. He states,
I grew up in Laredo, Texas, which is on the Texas-Mexico border. When I was a kid, we were told that the Census Bureau had named Laredo the poorest city in the United States. Every day, the doctors’ offices in Laredo were filled to capacity, sometimes including people from Nuevo Laredo, Mexico. Doctors knew that a large percentage of them could not pay. Yet, I never heard of one single doctor turning anyone away. They were knowingly providing free medical treatment to the poor on a purely voluntary basis.
According to the testimonies of Koop and Hornberger, healthcare charity was quite common even among for-profit hospitals, but that experience changed when Medicare and Medicaid were established. Healthcare costs began to sky-rocket. Doctors and hospitals began entering into convoluted arrangements in order to deal with soaring costs and expenses. Physicians began to despise the profession that they previously loved and started retiring at earlier ages. Medical invention and innovation lost their momentum. Patients had to start buying insurance to protect themselves from the increasing cost crisis. Many consumers today are falling into medical bankruptcy due to exorbitant prices.
The State Children’s Health Insurance Program (S-CHIP) is a government insurance plan which provides medical coverage for children under age 19. This plan is only available to individuals whose parents earn too much income to qualify for Medicaid, but not enough to purchase private coverage themselves … supposedly. The same perverse incentives that emerge under Medicaid are even worse under the S-CHIP program. Those that are more than capable of relying on themselves to purchase healthcare coverage for their children experience tremendous pressure to rely on another entity to pay for their children’s insurance for them. One author states,
As a result of these perverse incentives, states have expanded S-CHIP eligibility dramatically. Nineteen states offer S-CHIP to families of four with incomes of $73,000 or more. In New York, S-CHIP is available to families of four earning $98,000 annually. Because S-CHIP targets families higher up the income scale than Medicaid does, and because higher‐income families are more likely to have health insurance to begin with, SCHIP leads to even greater “crowd‐out” of private insurance than Medicaid.
This goes back to the Samaritan’s dilemma. By helping too much enables those who are self-reliant to take advantage of charity. In the case of S-CHIP, middle class families are relying on government programs when they don’t have to, thus putting strain on taxpayers and forcing private insurance companies to leave the market.
The Affordable Care Act (ACA), more commonly known as “Obamacare” has a similar crowding out effect as S-CHIP which we won’t discuss here for the reason that it deserves its own discussion.
There are other forms of government intervention that have made access to healthcare difficult for the poor. I’m referring to those laws which create more scarcity in healthcare which cause shortages and high prices; two unfortunate occurrences for the poor and needy.
Licensing for healthcare professions accomplish one thing and one thing only, and that is to limit the amount of healthcare professionals who enter the market. If there are less professionals in the market, fees go up because their services are in higher demand. Both the American Medical Association (a medical cartel) and the government at the state and federal level work together to enforce licensure laws. Licensure laws hold no economic benefits. They only protect crony government capitalism (not to be confused with private capitalism). Back in the late 19th century, allopaths (mainstream physicians who practiced dangerous treatments such as bloodletting and high-doce metal injections) began to call on the coercive power of government to severely restrict (if not ban) the safer, more effective, and higher demanded physicians such as eclectics and homeopaths. Eclectics emphasized plant remedies, bed rest, and steam baths, while homeopaths focused on small doses of medicine; letting the body heal itself as much as possible. They also emphasized healthy diets, good hygiene practices, and stress reduction. These groups were so successful that they became a threat to the incomes of the allopaths which is why they pushed for the government to enforce licensure laws. Not only were the eclectics and the homeopaths shut down but also the schools that trained them.
We often hear the argument that licensure laws protect us from carnival-tent quacks and their dangerous snake oil elixirs. This persona of physicians back in the 19th century is just as mythical as Hollywood’s portrayal of the wild west. But if licensure laws didn’t exist what would protect us from letting any amateur physician practice medicine? That question can be answered in one word–reputation. A free society has a knack for using an individual’s or establishment’s reputation to help make smart and safe business decisions. Reputation can let good physicians roam freely in the market while weeding out the bad.
Patents are largely to blame for exorbitant prices. They ensure the price for prescription drugs (especially life-saving ones) remains high by excluding other pharmaceutical firms from entering into the market that would, by increasing supply, lower the price. For instance, The biopharmaceutical company Gilead Sciences, Inc. outlandishly raised the price of a cure for hepatitis C known as Sofosbuvir after obtaining a patent on it. Costs were raised to $1000 per daily pill, despite the fact that it only costs $1 to make. Under free market conditions, other firms would normally come to the rescue by competing with Gilead by finding ways to offer Sofosbuvir at a lower price. However, under the intellectual property rules that are currently in place today, the government would criminally prosecute any firm that competes with Gilead by using the same chemical formula. There is no doubt, these kinds of policies are deadly in the most literal sense.
Patents eventually expire, but there is a loophole in maintaining a patent. This loophole is called “evergreening.” In the medical industry, evergreening is when brand-name companies alter their patented-drugs just enough to justify obtaining a “new” patent. Since patents expire after a certain number of years evergreening is strategic in keeping competitors out of the market.
Some would argue that patents protect the profits of pharmaceutical firms which enables them to have the financial resources needed for further research and development (R&D). The possession of patents allow them to continue to innovate newer drugs that benefit society. But what patent advocates fail to realize is that even in the instance of new prescription drugs being reverse-engineered and copied, innovation could still be rewarded without patents. Companies who invent new drugs would have first-mover advantages and delays in ramping up generic drug production would also give them an edge among copy-cat companies. In 2006, the British Medical Journal asked the readers to submit a list of the most noteworthy medical and pharmaceutical inventions in history. The list was eventually narrowed down to fifteen items: penicillin, x-rays, tissue culture, ether anesthetic, chlorpromazine, public sanitation, germ theory, evidence-based medicine, vaccines, the pill, computers, oral rehydration therapy, DNA structure, monoclonal antibody technology, and smoking health risk. Of these inventions only two of them had anything to do with patents. Another survey conducted by the United States Centers for Disease Control yielded similar results. Out of the ten most important medical inventions of the twentieth century, none of them were patent related.
Medical history has shown that some of the greatest medical discoveries have been made accessible to the public without patents. We don’t need them to ensure further medical R&D. If the U.S. wants to see prescription drug prices fall, the answer is not further regulation in the form of any sort of price ceilings on drugs. That would only result in a shortage. The answer is to return to God’s law–get rid of patents altogether! This would allow other biopharmaceutical firms to enter into the market, boost the supply of much-needed drugs so that prices can fall.
FDA regulations also affect the price of prescription drugs. In 2015, American investor Martin Schreli purchased the rights to sell a drug used to treat parasitic diseases known under its trade name as Daraprim. After obtaining the rights he raised the price of the drug from $13.50 to $750–a 5,000% increase. He was able to do this because the importation of the drug was highly regulated by federal law giving Schreli a large edge in the Daraprim market. The increase in price was solely due to FDA regulations that kept Schreli’s competition at bay allowing him to profiteer; not by any sort of change in demand. In fact, during this time a generic form of the drug was available in India for just 10 cents. Schreli’s price increase was so outrageous that news outlet, International Business Times made the comment that it would have been cheaper for a patient in America to have flown out to India and bought a year’s supply of the drug than to buy a single tablet of Daraprim in the US.
America’s healthcare system as we know it today is a great mess; all because we refuse to follow God’s law which is simple, easy to follow, and not burdensome (Deut 30:11; John 5:3). Mankind saw that society was sick and instead of trusting in God for direction, we turned to the State as the answer to all our medical needs. The result has been harmful–exorbitant prices, restricted access, and lower quality. But what if we followed God’s law-word? History shows that the church has already demonstrated to the world that God’s plan for healthcare is, and always will be, superior to man’s. God blessed the efforts of Christians in the past who pioneered in medical service because they knew that healthcare was a spiritual matter that pertained to Christ’s kingdom. Today Christians are confused as to what the mission of the church entails, the extent of Christ’s reign, the validity of God’s law, and the power of the gospel to permeate throughout all of life, hence, healthcare stopped being a religious matter. As a result, the church stood by and did nothing as the world gave up the responsibility of healthcare to government control. If Christians continue to do nothing and let the secular state take over healthcare, we can anticipate higher taxes to fund a single-payer system (i.e. a socialist healthcare system), shortages that come with socialized medical services, more regulation over “hazardous” behavior, mandatory vaccinations, and loss of licenses for doctors who refuse to perform abortions or gender reassignment surgery.
Turning things around will not be easy but nothing is impossible with God. The church has already been promised great victory for its future. Isaiah prophesies about a time when God’s kingdom will be dominant in the world and His law will be the rule for all nations (Isa 2:2-4). We are told this occurs in the “last days” (v.2) which the NT authors teach is the new covenant era (Acts 2:16-17; 1 Cor 10:11; Heb 1:1-2; 9:26). Isaiah later describes the outworking of God’s kingdom and what physical health will generally be like for mankind:
For behold, I create new heavens and a new earth…
No longer will there be in it an infant who lives but a few days,
Or an old man who does not live out his days;
For the youth will die at the age of one hundred
And the one who does not reach the age of one hundred
As a result of Christ having brought the kingdom during his first advent (Luke 11:20; Mark 9:1; Matt 28:18), the world is now on course toward complete restoration, and part of that restoration is long life and good health. One day the restoration will be complete when Christ returns to ultimately defeat death (1 Cor 15:24-26). Until that time comes, the church should be faithful in caring for the health needs of the poor and needy as God would have us do according to His law.
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