The argument of this essay is simple. I want to invite Christians, particularly American evangelicals, to a new consideration of how the coronavirus might cause them to rethink what kind of healthcare policy ought to mark a flourishing society. I name one figure in particular, Matthew Lee Anderson, because he has recently issued a call for Christians to think with specificity about what this pandemic reveals of us. I want therefore to invite (tempt?) Anderson to a form of economic and political radicalism to which he has hitherto been allergic.
But of course this invitation is extended to all evangelicals who agree with C.S. Lewis that pandemics like these reveal, but do not fundamentally alter, the precarity of human life.
Specifically, I want to invite him (and them) to publicly endorse universal, state-sponsored, single-payer health care. My hope is that through this invitation, Evangelical Christians might begin to think together about the world they want to see on the other side of the coronavirus.
As a general rule, I do not think the Christian faith directly dictates particular policy outcomes, such that it would be sin not to support a given policy over some other. Instead, Christian ethics is the application of prudence to policy in order to produce the correct policy means of attaining the moral goods (justice, peace, etc.) enshrined in the Christian faith.
And this case is no different. There may be other, better policies for attaining the kinds of goods I am after here. But it is certainly not the case that the current regime of healthcare provision in the United States would do better than the model I am suggesting here. Furthermore, it would be strange indeed, and likely demonstrate a simple failure to learn from events, if the coronavirus has indeed exposed many long-standing failures in our culture, and yet the public policy positions we advocated on the other side of this pandemic were precisely the same as those whose deficiencies this pandemic has put in plain sight.
In the early writing about the coronavirus, Anderson was one of the first to circulate an essay by C.S. Lewis, entitled “On Living in the Atomic Age,” as a guide for how Christians ought to think of our responsibilities in this pandemic. There Lewis instructs his audience:
Do not let us begin by exaggerating the novelty of our situation. Believe me, dear sir or madam, you and all whom you love were already sentenced to death before the atomic bomb was invented: and quite a high percentage of us were going to die in unpleasant ways. We had, indeed, one very great advantage over our ancestors—anaesthetics; but we have that still. It is perfectly ridiculous to go about whimpering and drawing long faces because the scientists have added one more chance of painful and premature death to a world which already bristled with such chances and in which death itself was not a chance at all, but a certainty.
The payoff of this argument for Lewis is that the bomb does not introduce much new data into our calculus; it simply reveals the world, rather than altering it fundamentally. Lewis makes this argument elsewhere, particularly in his justly famous essay “Learning in Wartime:
I think it important to try to see the present calamity in a true perspective, The war creates no absolutely new situation: it simply aggravates the permanent human situation so that we can no longer ignore it. Human life has always been lived on the edge of a precipice. Human culture has always had to exist under the shadow of something infinitely more important than itself.
Lewis takes the opportunity to relativize the historical significance of a technological development, or a new social reality, with reference to the certainty of death. This trope of coronavirus-as-revelatory seems to have found some acceptance among readers. In recent weeks, thinkpieces applying these Lewis essays to the coronavirus have shown up in places both expected (Matthew Smethurst in The Gospel Coalition, and Jamie Quatro in Image Journal) and unexpected (The New York Times podcast The Daily, and Psychology Today). Elizabeth Dias at the New York Times has also highlighted the easy way in which Christians make sense of the coronavirus through the lens of apocalypse.
Anderson, applying Lewis’s insight to the outbreak of the coronavirus, follows Lewis’s pattern of relativizing the significance of a historical development by reference to perennial facts about human mortality. Anderson glosses this Lewis essay with a connection to the coronavirus:
“In that way, a pandemic makes us acutely conscious of just how fragile our life together really is. Matters were always this precarious, to be sure. And the communities that will be most affected by the coronavirus—the working classes, the aged, and the sickly—have no delusions about how vulnerable life can be. But for the rest of us, well, COVID-19 is God’s megaphone to a slumbering world.”
At this point, Anderson pivots to a theological consideration about how the fear of God perfects, and occasionally drives away, other kinds of fear. This is a theological excursus with which I agree; the coronavirus reminds us of the fragility of our lives and of the fact that, as the old King James teaches us, the life of a human is “even a vapor, which appeareth for a little time, and then vanisheth away” (James 4:14).
But I want to pause him before this edifying theological excursus and ask him to respond to a question. And I do so, in a roundabout way, at his own inducement. After all, in his most recent public comment on the coronavirus, he wrote:
“when lives are actually at stake, it is doubtlessly safer to err on the side of spiritual analyses while punting the practical questions to others. Yet doing so reduces the church’s moral and political witness to generalities, and leaves those who are responsible for making decisions bereft of counsel about how they should proceed given the vast range of complexities they must address.”
I agree entirely, and so I want to use this opportunity to press him for specifics, for answers to practical questions, for policy proposals, and for a kind of response that is attentive not just to spiritual consolation, but also recognizes the significance of material conditions for a human life of real flourishing.
At a higher level of abstraction and theorizing, I am attempting here both to show the legitimacy of a Marxist critique of Christianity, and defuse that critique in this particular instance. It is widely known that Marx’s critique of religion has very little to do with the theological substance of Christianity. The major critique of Christianity concerns the way that Christianity, when abused, can cause a people simply to endure their present misfortune and outrage at injustice, and sublimate their righteous indignation against those injustices into a kind of heavenly escapism, which sublimation thus leaves the present injustice intact and unchallenged. Christianity, in short, can be weaponized, and it can be weaponized in the service of grave injustices.
The best way for a Christian to defuse this critique is simply to demonstrate that the belief in some kind of eschatological redemption does not foreclose the possibility of advocating for the ameliorating of societal injustices. It is precisely this method to which I am inviting Anderson and his colleagues. Spiritual consolation does not supplant calls for societal improvement, and societal improvement ought not replace a real need for spiritual consolation of the faithful.
The question for Anderson is this: How far does he intend us to extend this metaphor of coronavirus-as-apocalypse? And the temptation I offer him here is this: that he ought to entertain a kind of radical rethinking of the structure of American life, which this pandemic reveals. After all, our reigning pandemic has not only exposed the perennial fact of the fragility of human life. It has also exposed the contingent fact of a disordered, mismanaged, backwards healthcare system. And while it is not within our power to remedy the former, we might be able to ameliorate the latter. Christians ought to take the lead in thinking about how to do so.
Recent weeks have provided us with at least one death because of a possible coronavirus patient being turned away from care because he was uninsured. These stories offend our moral imaginations, and therefore the Trump Administration is to be lauded for recently announcing that part of the stimulus package recently passed includes covering coronavirus-related healthcare costs of the uninsured.
But this is a stopgap measure, not a structural change. And it is clear that the current structure of healthcare financing will likely not survive this pandemic. One analysis says that health insurance premiums, already at astronomically high levels in America, could increase next year as much as 40 percent as a result of coronavirus. The seismic unemployment effects currently felt in America are simply not replicated around the world (a fact that shows that the current debate between the preserve-the-economy faction, and the preserve-human-lives faction is a false dilemma foisted upon us by bad public policy and unsubtle ethical theorizing).
What is only rarely recognized is that the current regime of employer-provided healthcare is a radically contingent and extremely recent development. It dates back to wage freezes during WWII, and no earlier. Defenders of the current system, especially Christian defenders of this system, will need to explain what causes that system, contingent and novel as it is, to commend itself to our acceptance. My own view is that as a system, it is neither sensible nor sacrosanct. What has been made can be unmade.
Of course I am not suggesting that even a massively restructured health care system would prevent a pandemic from spreading; the coronavirus teaches us that currently the only measure that can do that is a regime of early and comprehensive testing, combined with aggressive and unrelenting restrictions on human movement (and given the deception and coverup by the Chinese government in response to this outbreak, we may never know whether even those measures were successful). But a fundamentally restructured healthcare system would soften the shock that this, and future public health crises, unleash upon humanity.
Debates about healthcare reform are far from novel. However, nuanced debates about how more robust healthcare protections can contribute to a just society have been virtually absent from recent Christian discourse, except on the political Left. Noteworthy exceptions to this pattern from the Mere Orthodoxy archives include Matthew Loftus’s 2017 essays Creating a Just and Good Healthcare System, and A Christian Manifesto on Healthcare and the State. If my invitation here is little more than an opportunity to revisit those essays and inject them into evangelical discourse during this pandemic, I will be satisfied.
But I do have higher ambitions. I want nothing less than for Christians to put into practice what we were taught from our youth; that religion undefiled is care for widows and for orphans (James 1:27). I want Evangelicals to be at the forefront of the structural improvement and amelioration of a broken healthcare system. Evangelical Christians have something to say about these issues, yet hitherto their political attention and energies have been directed elsewhere.
Christians thinking together about how to create a society that can endure enormous exogenous shocks like these and, insofar as is possible, avoid the tragic moral dilemmas that they commonly introduce, will only grow more and more important over the next several decades. If even the most moderate projections by climate change experts are correct, these kinds of natural disasters and cultural shocks will continue to be central and traumatic parts of our lives. There will be no return to normal.
It is to this structural amelioration of a broken healthcare system that I invite Anderson and others of like mind. Construed strongly, Anderson’s essay shows us that what the coronavirus has exposed is, among many other things, a healthcare system and a system of social value that is systematically prejudiced against the elderly and the disabled, and an economic system that pits the health of humanity against the health of an economy.
Those who have been following the discussion among Christians online about the coronavirus and the response of Christians to it are rather familiar with those options. Much of conservative Christian conversation has been taken up with adjudicating the tradeoffs between reopening the economy on the one hand, and continuing the regime of social distancing for the preservation of human life on the other. It is lamentable in the extreme that Rusty Reno, of First Things magazine, had the first and loudest statement of the ethical considerations that should guide American Christians in this pandemic, because his essays and diaries have bequeathed to the conversation straw men aplenty and confused distinctions galore. Christian ethical deliberation concerning how we are to act in this pandemic, and the vision we ought to shape for the future beyond this pandemic, will be richer to the degree that it proceeds not only in disagreement with, but utterly without reference to, Reno’s essays.
The considerations I am inviting are rather different than those that have marked the Christian conversation about the coronavirus thus far. But given that there will be no return to normalcy after the coronavirus, and given that the coronavirus-as-apocalypse argument has unveiled many of the cracks in American society, what form of public life should Christians advocate instead of what this virus has unceremoniously cast aside?
This conversation will be equal parts bioethics and public policy; there will therefore be occasion for both policy wonks and ethicists sometimes to teach and sometimes to learn. This is an invitation I issue not just to Anderson, but to all constructive Christian readers of these pages for whom the coronavirus has revealed an unlivable world.
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I consider myself fairly agnostic on issues like best healthcare policy, but I think there is some problem with how this is approached.
That, of course, will be the point of contention, won’t it?
The problem here is that if we try to be precise about this “payoff” then there are senses in which it is true and not true. (As is typical, and to some degree required, of article writing, Matt Anderson speaks in a somewhat imprecise manner.) The senses in which it is not true might turn out to be the most relevant to attempts to draw healthcare policies from our current COVID-19 predicament.
In this regard, Jonah Goldberg has perhaps put it best. He recently said something along these lines, if I might paraphrase: ‘I have a rule about not running the garden house inside the house. Of course, if my kitchen catches fire, running the garden hose in the house might be the smartest thing to do. But that doesn’t mean I’ve now learned that running the garden hose in the house is a good rule.’
If, following some appeal to a not-very-precise remark by C.S. Lewis followed by a not-very-precise application by Matthew Anderson, you intend to claim that COVID-19 “simply reveals the world”–that our house is always on fire and, thus, requires a rule of running the garden hose in the house, then you’re begging the question.
One of the articles you point to, which I guess attempts to make the “simply reveals the world” case, says:
One of the problems with the appeal to this sort of piece is that it’s clearly a garden-hose-in-case-of-fire example and not the revelation of a new rule. Another problem is that, on some accounts, this is what Congress has tried to do. According to Heritage:
All of that sounds like what the other article in NYTimes is praising other countries for, doesn’t it? Why the high unemployment rate then? First, what makes us think that filing for unemployment is a good indicator of the failure of the CARES Act in this area? Perhaps it has something to do not with the failure of the CARES Act, relative to, say, Britain, but has more to do with how the unemployment system works in Britain? A much more fine-grained analysis is needed here… and by people not wanting to push their priors.
Just to be clear, Christian defenders don’t need to give uniquely Christian defenses of “this system” (I use quotes because I don’t know anyone on any side of the isles who doesn’t recognize the need for some changes). Defenses of a “free market” system have already been given by people like, say, Thomas Sowell or organizations like Heritage. These people and orgs are already attempting to make the case that state-sponsored, single-payer health care would be less desirable in ways that align with a Christian’s concerns in health care.
Doesn’t Matthew Anderson want that? Do you think, say, Ted Cruz or Marco Rubio wants that? If you’re eager for Christians to dialogue on this issue, all suggestions or even vague gestures that the issue might be between those who want to care for the poor and those who don’t need to be set aside as gross attempts at demagoguery. The issue is clearly over disagreements on properly and efficiently achieving those ends.
This reminds me of something I recently read in Hume:
Hume’s overconfidence in how obvious the answers to certain questions were cause him to dismiss disagreement as being due to “selfish avidity, or too extensive enthusiasm.”
The vast majority of evangelicals, including those who have a (social)media spotlight, actually have nothing specific to say about healthcare policies because it requires a specific knowledge and experience in a complex economic system that almost all of them lack. Thus, they reasonably rely on others who might be pundits in that field, and who they take to be reliably aligned with their general outlook, to do the talking. They may be wrong, but they aren’t shirking some duty to opine on complicated issues.
The above quote exemplifies how tangled these seemingly simple subjects are. Now you weave the issue of climate change and its baggage into a meta-discussion on healthcare…
It may be that part of the problem regarding an anemic or at least disunified Christian outlook on healthcare and, I admit, part of my problem with this article, is that it’s easier to have meta-discussions about arguing over healthcare that skim off complicated issues in single sentences (climate change) and primarily focus on framing the opposition and the stakes than it is to have actual discussions arguing for the feasibility and propriety of specific healthcare policy.
I think advocating for nationally-based healthcare overhauls is a bad idea for a few reasons. First of all, the larger something gets, the more fragile it comes. See the current healthcare system; it’s already way too big. Making it bigger (national) will only continue to make it more fragile. Moreover, Nassim Taleb writes this in Skin in the Game, “One should not mess with a system if the results are fraught with uncertainty, or, more generally, should avoid engaging in an action with a big downside if one has no idea of the outcomes” (10). I think that the biggest problem with the Affordable Care Act; it solved one specific problem but it didn’t take the system into account and threw everything out of whack. Advocating for a universal (national), single-payer healthcare system I think will do the same thing.
Kudos for pointing this conversation toward specifics and challenging American Christians to take this opportunity to actually rethink the world in the light of this “apocalypse.” It’s probably the most helpful thing anyone has written about Coronavirus on this website for the past few months.
As for Lewis, I think we should be a little more hesitant to ascribe wisdom to what was actually luck. Writing off the “novelty of our situation” seems a lot more plausible in retrospect when the “situation” in question (the atom bomb) never actually materialized. But had the Korean War or the Suez Crisis or the Cuban Missile Crisis actually gone nuclear (and all three very nearly did), Lewis would have been left with (radioactive) egg on his face. Lucky for him, the “scientists” that invented the atom bomb (and later, the H-bomb) realized very keenly the “novelty of [their] situation.” They had a weapon that was so powerful it had no legitimate usage other than nuclear armegeddon. It was that realization that kept the Cold War from going nuclear.
Coronavirus has a lot in common with the atom bomb. The issue is not simply the reality of death; it’s the prospect of death on a scale so vast that what was lost could not be recovered. For all the expressions of concern about the economic and societal consequences of the corona quarantine, I haven’t heard anyone express the same concerns about the consequences of not doing enough. Mass death, after all, isn’t good for the economy, and the sudden loss of thousands of parents, pastors, writers, teachers, and elders would be an irreparable loss for a society. Just as Cold War leaders knew the consequence of nuclear war wasn’t just death, but the end of modern civilization, we need to recognize that coronavirus doesn’t just threaten death, but social and cultural collapse if it isn’t properly dealt with.
I’m sure nobody in the White House or the Kremlin had a good night’s sleep after 1945. The novelty of their situation in a nuclear world probably ruled that out, and I’m grateful for that. Maybe we should make sure we’ve acknowledged the full novelty of our situation before we accuse anyone of fearing the wrong thing.
Thank you for sharing this challenging essay. One point of dissonance for me is the call to radically ponder the restructuring of American life answered with an anemic resolution for consolidation of healthcare payment schemes. This is not a radical solution to our broken systems of health. To radically rethink our system would involve questioning the value and application of consolidated systems of ‘care’ in the first place. The system derived from a Marxist critique would likely produce equal, but anonymised, militaristic, impersonal action on objective measures of biomedical disease. This may be desirable for a crises, but it is likely not a foundation that would result in flourishing. I would invite the author to first ponder what flourishing would look like and then consider means that may address those ends. My suggestion is that flourishing and healing require not only systematic, objective interventions on biomedical aspects of disease, but also critically include addressing subjective aspects of illness and social determinants of wellness. I suggest that these ends are met by neither our current system, nor the system driven by technique proposed by this author.