hristians can agree that the current health care debacle stems primarily from
moral failure. But which direction does a biblical ethic direct us? In the
following dialogue, the managing editor of Credenda/Agenda, Douglas Jones and
Dr. Keith Pavlischek discuss what the biblical relationship between health care
and the State ought to be. Douglas Jones argues that Scripture calls for a separation
of health care and State, and Dr. Keith Pavlischek argues against such a separation.
Dr. Pavlischek is Director of Crossroads, a ministry of Evangelicals for Social Action, whose goal is to encourage evangelical reflection on public policy (Crossroads, 10 Lancaster Ave., Wynnewood, PA 19096). Dr. Pavlischek received his Ph.D. in Religion, Ethics, and Society from the University of Pittsburgh and holds masters degrees from the Institute of Christian Studies and Westminster Theological Seminary. Prior to his current position, Pavlischek taught in the Philosophy and Religion Department at Northeast Missouri State University. He coaches Little League Baseball and is the author of John Courtney Murray and the Dilemma of Religious Toleration.
DJ: Given scripture's clear condemnation of legal privileges against the poor (Is. 10: 1-4; Amos 2:6; 4:1-3) and the injustice of governmental theft (Ezek. 46:18; I Kgs. 21; I Sam. 8:14), a genuinely Christian ethic ought to aim to reform the health care system by, among other things, dismantling the legal/monopolistic privileges of doctors and ceasing all coercive transfers of income. By radically reducing health care costs in this just manner, we can once again allow families, churches, and other private associations to extend support to the remaining needy. Our ethical model for health care should be the compassionate Samaritan (Lk. 10:30ff.), not the mauling hands of the idolatrous Roman state (Rev. 13).
KP: Your argument seems to be: (1) Scripture condemns all "legal privileges" against the poor. (2) All governmental regulation and licensing of doctors (legal/monopolistic privileges) constitutes a "legal privilege against the poor." Therefore, (3) Scripture condemns the regulation and licensing of doctors. Therefore, (4) Scripture requires the dismantling of the governmental regulation and licensing of doctors. I reject 3 and 4 because it is not at all clear to me that 2 is true. Nor is it clear to me that the proof texts you cite imply that "all coercive transfers of income" constitute theft. The "compassionate Samaritan" and the "idolatrous Roman state" do not exhaust the political options.
DJ: Well, since you object to the clarity and not the inferences above, perhaps the following will help. Legal monopolies are designed, despite the altruistic rhetoric, to restrict entry into a field and thus increase the profits of those protected. Over this century, this type of legal privilege maintained by the State and the medical community have most harmed those who cannot pay the artificially high prices the poor. As to theft, the passages cited show by positive and negative example that rulers who confiscate property (including income) of their subjects are wicked. The current and proposed health care systems combine both of these unjust features contrary to more compassionate options.
KP: If your argument is simply that admission to the medical profession/schools should be less restrictive so that a greater number of doctors can compete for services, I concur. But that does not support the stronger claim that all government regulation and licensing of doctors/medical schools constitutes a "legal privilege against the poor." But that rather bold proposition must be established to support the conclusion that all licensing and regulation by the government is unjust/hurts the poor and should be abolished. The passages you cite merely support the proposition that some governmental actions are unjust/hurt the poor. Do you believe they support the radical libertarian slogan, "all tax is theft?"
DJ: Let's not confuse the argument against government licensing with an argument against civil theft or regulation in general. Licensing is a legal privilege against the poor because it limits competition and coercively increases prices in order to benefit a particular industry. This ancient practice directly harms those who would otherwise have far more affordable options. Are you suggesting that such privileges don't harm the poor? As to your question about theft, are you assuming that the commandment applies only to private individuals? Are pirates and civil legislatures exempt from the commandment? Do you believe that these biblical prohibitions support the Republican/Democratic assumption that "no tax can be theft"?
KP: To answer your questions: (1) I already conceded that some licensing and regulation can harm the poor. For your argument to be sound you must establish that Scripture teaches that all governmental licensing/regulation (taxation?) harms the poor. That's why my question, "Do you believe Scripture teaches 'all tax is theft,' cannot be dodged. As for questions, 2, 3, and 4: No (although I'm not sure who categorically asserts "no tax can be theft" -- Is this a straw man?). But antecedent to the evaluation of any given policy in a democratic republic is a tacit recognition that elected representatives are legis - lators who can license, tax, and regulate. Coupling "pirates and civil legislatures" obscures that point.
DJ: Again, don't confuse the arguments against licensing and taxation. All governmental occupational licensing harms the poor because it in principle aims to exclude competition in order to benefit those protected. As to taxation, we are morally obligated to pay tribute to God's ministers (Rom. 13:6), but we ought not to be criminally obligated (Ez. 46:18). As with other servants, like pastors, it is immoral for them to require tribute on threat of violence. Property taken on threat of violence is always theft, whether the perpetrator is a mugger or a democratic majority. If you agree that the popular assumption that "no tax can be theft" is false, then what taxes would you deem as theft?
KP: Romans 13 indeed teaches that citizens are morally obliged to pay taxes, which is equivalent to saying that it is unjust/wrong not to do so. The passage also teaches that the authorities have been established by God as a "terror" (v. 3, NIV) for those who do wrong, including those who rebel against their authority to levy taxes (v. 6). It follows that magistrates would act unjustly if they abdicated their God-given authority to employ the "sword" to coerce "free riders" who unjustly refuse to pay taxes. Why? Refusal to pay taxes represents rebellion against the authority established by God (v. 1-2). "Voluntary taxation" ("morally but not legally obliged") is an oxymoron, sort of like, "Calvinist libertarian."
DJ: Submission to unjust laws is a separate issue from the morality of those laws. Christians ought to pay their current taxes faithfully, even though the coercion involved is immoral. But how ought righteous rulers receive tribute? Are you really claiming that God is pleased to use the threat of violence against innocent citizens for His charity work? On your view, the righteous, non-thieving prince of Ezekiel 45-46 is sinning, and the punishing king of I Samuel 8 is really a model of righteousness! Your renewed defense of "no tax can be theft," in which moral obligation implies criminal punishment, works only if all sins are crimes . But that is clearly contrary to Scripture.
KP: If there is a connection between Ezekiel 46:18 and the proposition "Free riders should not be compelled (by coercion if necessary) to pay taxes," it doesn't leap to the eye. I neither said nor implied that tax cannot be theft. Funds appropriated for the private treasury of public officials is one example of what would constitute theft, taxation without representation another. I reject the proposition "All tax is theft" and the proposition "No tax is theft." I reject what you seem to affirm, namely, that taxes levied by due process of law for the public good necessarily constitutes theft. Theologically, I'm defending the traditional Calvinist view against your Anabaptist view of civil authority.
DJ: No Anabaptism. I'm just siding with the biblical view recognized by that older "Calvinist," Augustine, who claimed: "Justice being taken away, what are kingdoms but great robberies?" Ezekiel 45:8 and 46:18 apply the eighth commandment to "the princes," directing them to cease "violence and plundering" and "practice righteousness," no longer taking property coercively. Ideally, we ought to fund the State like the Church. The eighth commandment prohibits me or a representative from stealing to help pay Aunt Mary's medical bills. In repudiating this prohibition, our rulers have exacerbated the health care problem by artificially increasing medical demand and prices through "free" medical programs. What biblical criterion do you use to judge this a "public good"?
KP: (1) The eighth commandment no more forbids taxation than the sixth forbids killing in a just war. (2) The Ezekiel passages are far from being dispositive as they can plausibly be read to prohibit unjust taxation for the private treasury of princes. (3) No traditionally Reformed Calvinist ever claimed that the state should be funded like the church. (4) Regarding Aunt Mary: Before discussing whether a Christian political philosophy can legitimately understand health to be a public good, you must indicate those things for which government can legitimately levy taxes. Convince me that you are not an anarchist. Tell me what does constitute a public good and perhaps we can move on from there.
DJ: Ah, but you've agreed that "some taxation is theft," so the eighth commandment is in play. You just haven't given a biblical principle for restricting it. Why is it stealing for a ruler to enrich his private account but not if he enriches someone else's private account? Both involve taking by coercion theft. Romans 13 won't help; it's silent regarding the moral preferability of violent vs. voluntary support of a ruler. But it's a grand place to learn the legitimate "public good" of the civil ruler, namely, punishing criminals "an avenger to execute wrath on him who practices evil." Health, education, and welfare are outside the State's purpose.
KP: The burden of proof is yours. For the eighth commandment to be in play you must establish that "coercion" is a sufficient condition for an action to be labeled "theft." You've just conceded that Romans 13 (the locus classicus on civil authority) doesn't establish this. Scripture is indeed silent where libertarians are most dogmatic, i.e. that "health, education, and welfare are outside the State's purpose." Is that what Ezekiel is teaching? You seem to hold that non-libertarian political theorists legitimate "theft" (a weighty moral accusation). Do you believe then that libertarian ideology should receive creedal status? Or is Scripture really insufficiently perspicuous on this point? I stand firmly within traditional Reformed orthodoxy on this one.
DJ: Instead of again arguing by label (Anabaptist! Anarchist! Libertarian!), you would do better to engage my Scriptural arguments. The Holy Spirit, not some pagan libertarian, teaches us (as I argued previously) that the purpose of the State is to punish criminals (Rom. 13:4). Unless you consider health, education, and welfare forms of criminal punishment, the State ought not to intervene for non-criminal reasons in these areas. As to theft, Romans 13 shows us that the ruler deserves our financial support, but it doesn't focus on the proper means of collecting that support. Ezekiel and the eighth commandment clearly do. And in which traditional Reformed creed do you find support for State-managed health care?
KP: Either Scripture clearly teaches "all tax is theft" (i.e., libertarian ideology) or it doesn't. If it does, then you should be willing to make it a matter of creedal orthodoxy, especially since Reformed Christians who deny what you affirm are, in your view, legitimating theft. Are you? If it doesn't, your argument collapses. With traditional Calvinists (like Calvin), I see no exegetical reason for reaching the conclusion that Romans 13 teaches that government's legitimate function is restricted only to retributive justice (i.e., punishing criminals). I fail to see how the lack of "State-managed health care" in the creeds has anything to do with the permissibility of some government regulation/licensing/taxation for health care.
DJ: Creedal and traditionalist questions are interesting, but they're irrelevant
here. Though you'll disagree, I think three arguments still stand: (1) Scripture
condemns legal privileges against the poor, such as civil licensing, (2) the
eighth commandment condemns not all taxes (a view I never defended) but all coercive
takings in similar circumstances, and (3) the purpose of the State is criminal
punishment, leaving health care to the family and church. Eliminating an artificially
restricted supply and prohibiting an artificially bloated demand should be some
of the first steps for a godly culture. But a culture like our own, which so
blatantly ignores such minimal points of justice, deserves the health care judgment
it gets. Let us pray for revival.
