Pushing back the limits of subsidiarity
Micah suggested I add my 1.5 cents on this post; an excerpt:
In broad outline, “Subsidiarists” are people who are fearful or hostile to the state provision of social welfare – preferring that charity be dispensed at lower levels of society: communities and families. “Solidarists,” by contrast, believe that society as a whole is often the best administrator of social welfare, and prefer that things such as health insurance be run by the state.
I find these to be odd definitions. The Catechism says the following (1883,1885, 1894):
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…”
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. [aside: How are "societies" distinct from individuals? How can an individual have a relationship with a "society?" Is not a society just a collection of other individuals? Reply below in the comments]
In accordance with the principle of subsidiarity, neither the state nor any larger society should substitute itself for the initiative and responsibility of individuals and intermediary bodies.
Brown’s definitions are quite odd. There is clearly nothing in the Catechism about being “fearful or hostile to the state provision of social welfare.” The principle merely recognizes communities of higher and lower orders should stick with their own functions, being supportive but not usurping others. Brown doesn’t define what he means by lower-level “communities” either; arguably the U.S. is a community.
As for solidarity, there are many related paragraphs, but here are some relevant ones (1939-1941):
[Solidarity springs from] both by our common origin and by the equality in rational nature of all men, whatever nation they belong to…
Solidarity is manifested in the first place by the distribution of goods and remuneration for work. It also presupposes the effort for a more just social order where tensions are better able to be reduced and conflicts more readily settled by negotiation. [sarcastic aside: clearly, the HHS mandate controversy is a good example of reduced tensions and settled conflicts brought about by a state-run health insurance system. Ask Cardinal Dolan how those negotiations with President Obama went.]
Socio-economic problems can be resolved only with the help of all the forms of solidarity: solidarity of the poor among themselves, between rich and poor, of workers among themselves, between employers and employees in a business, solidarity among nations and peoples.
Again, nothing in there about “society as a whole” as the best administrator of social welfare, or that health insurance be run by the state. Perhaps Brown has an idea of “Subsidiarists” who don’t understand subsidiarity and “Solidarists” who don’t understand solidarity.
Brown’s main point is that, while the “Solidarist” position may not be perfect (though he barely argues this side), the “Subsidiarist” position is untenable because of, well, “modernity.” He cites three reasons:
- Better, but more expensive, medical care. It wasn’t hard for “communities” to take care of people way back when, when most illnesses carried a death sentence so you wouldn’t bother too much with the sick. Now because of our fantastic medical care (a bad thing?) we can keep you alive longer, but it is more expensive for a community by itself to do so.
- Social mobility. No one loves their neighbor now because your neighbors probably only moved here a few years ago, and you don’t find it worthwhile to love them because you will probably move a few years from now. You also won’t even love your own relatives if you can’t see them in person.
- Private insurance, whereby profit-seeking companies would only insure healthy folks and leave the old, sick ones for others to bother with.
It is easy to criticize insurance companies, since they seem to be the ones raising their prices on us. Oh, and the health care providers too.
But what if, say, car insurance worked the same way that we’ve allowed health insurance to work? You buy car insurance not on your own, but it is provided for you by your employer. You don’t get to choose from among the dozens or so insurers that are out there now, but among the two or three (or one!) offered by your company. You don’t pay for car repairs directly, but you make regular biweekly contributions into your car insurance fund from which money is occasionally drawn when repairs are needed. You don’t even pay for the car repairs yourself, nor do you ever see how expensive these repairs are, but your insurer acts as an intermediary where you buy repairs or maintenance without any regard to cost, and your mechanic (knowing this) has every incentive to offer you unnecessary repairs, the most expensive parts, etc. You don’t just use your car insurance for major repairs, but you use it for any car-related expense that you have: oil change, replacing wiper blades, new pine tree air freshener; any time that you visit a garage you think “insurance will pay for it.”
So why is health insurance offered by employers instead of individuals buying it themselves? Because of burdensome income taxes, and because health insurance is deductible. Employees would rather not get taxed on their entire gross income and have to buy insurance afterward, and would rather have their insurance deducted from their gross and get taxed on a lower net income. You get the same insurance and a higher take-home pay.
Of course, the problem with this scenario is the perverse incentives it creates, demonstrated by the car insurance example. When you don’t know how much health care costs, why ration what you purchase?
Where are health care costs low? Laser eye surgery, plastic surgery, etc. Those services that are not usually covered by insurance. In those cases, people shop around for the best and most cost-effective doctors like they shop around for the best and most cost-effective car mechanics.
Brown concludes: “I do not know what the ideal health care system would look like.” I do: it would be one without hugely restrictive red tape and governmental entanglements, it would be purchased by individuals and would not involve your employer in any way, and it would be much cheaper. It would also better reflect both subsidiarity and solidarity.