I’ve been thinking a bit about the principle of subsidiarity recently as it relates to health care reform. To provide some context, here is the Catechism on subsidiarity:
1883 Socialization also presents dangers. Excessive intervention by the state can threaten personal freedom and initiative. The teaching of the Church has elaborated the principle of subsidiarity, according to which “a community of a higher order should not interfere in the internal life of a community of a lower order, depriving the latter of its functions, but rather should support it in case of need and help to co- ordinate its activity with the activities of the rest of society, always with a view to the common good.”7
1885 The principle of subsidiarity is opposed to all forms of collectivism. It sets limits for state intervention. It aims at harmonizing the relationships between individuals and societies. It tends toward the establishment of true international order.
Despite the rancor which sometimes surrounds the health care debate in the Catholic blogosphere, it seems to me that the basic issue is different prudential judgments regarding the application of the principle of subsidiarity. I’m a bit torn between two ways to apply subsidiarity in this particular circumstance, and so I thought it might be worthwhile to explore the different positions as I understand them.
Position 1: The current health care reform bill is a violation of the principle of subsidiarity. While it is true that there is a human right to health care (and a corresponding duty to ensure that all receive it), this is best accomplished by private means, or at the state and local level. Nationalizing health care is a large step towards the type of socialization that the Catechism criticizes, and the increasing expansion of the national government has a crowding-out effect on private institutions, particularly Catholic charities. Moreover, even if one was to support nationalized health care, this particular piece of legislation is a mess. As its honest defenders acknowledge, it will do little to address the most serious structural problems responsible for increasing costs. The current proposal is a violation of subsidiarity, is fiscally irresponsible, and is harmful to the comon good.
Position 2: Subsidiarity is one principle among many which must be balanced. It is clear both that health care is a human right (with a corresponding duty), and that private organizations and local governments have failed to address the problem. Justice delayed is justice denied. Opposing national health care without any prospect for an alternative solution on the horizon is tantamount to denying a fundamental human right. Yes, admittedly, the current legislation is less than ideal, but “anything worth doing is worth doing badly.” We can address the revenue problems in the future; what we can’t address in the future is the people who will be harmed by a refusal to act today. Increasing the GDP is a component of the common good, but it is far from the most important component. A wealthy society should do more to care for its poor.
I’ve deliberately excluded a discussion of abortion from the preceding sketches, primarily because I thought it might help to focus the discussion on subsidiarity. I’d be interested in hearing readers thoughts on the positions staked out above. Which do you find more persuasive and/or how would you phrase your support or objection to health care reform?