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The healthcare problem markets and charity can’t fix

May 12th, 2017 | 2 min read

By Matthew Loftus

My internet friend Ian Barrs, a conservative dude who originally hails from the UK, has written a moving post about Medicaid and his son Hugh:

I’ll be honest: when I read of “per capita limits on MedicAid spending”, I ask myself “do they mean lifetime? Or annually? Or…? What is the limit?”, but what lies behind that is the question “how serious are they about killing my son?”

[…] the “free market” and charitable institutions you believe would lower costs and fulfill the needs of the charity cases like my son (it will never, ever, make economic sense to keep my son alive…) aren’t currently in place. If you remove or drastically weaken the current government safety net before that has happened, thousands of people (minimum) will die, and hundreds of thousands or millions will suffer.

And my son will be one of them.

His post highlights the wrench in the gears of any conservative health care reform measures: there exist a small number of people who will die unless we spend gobs of money to take care of them. There exists a much larger number of people who will die or suffer greatly unless we spend slightly smaller gobs of money to take care of them. No insurer could ever take them on because they will always take more out of the system than they pay in. No church or foundation could ever provide for them out of charity because the costs of caring for a dozen of them would quickly bankrupt virtually any non-government entity.

These are not folks who are dying and are unnecessarily kept alive on life support—I think people who are in the process of dying should be allowed to die without having their orifices invaded and their ailing organs flogged with medications that are normally used for emergencies. These are not folks whose illnesses could be ameliorated with a better diet and some regular exercise. No, these are folks who have suffered from some natural (or occasionally unnatural) harm and can live a flourishing life with a natural trajectory, albeit a different sort of flourishing than fully able and autonomous persons.

There are a lot of things that the government is bad at. Every time that the government does something that could be better done by a family, church, business, or neighborhood association, inefficiencies and failures will undoubtedly occur. The state by definition creates the environment in which all other actors and institutions exist and act and thus we have to think carefully about how it does that, but the government is really only good at three things: killing people, keeping people from dying, and collecting money to do the first two things.

The first and third directives are fairly well agreed upon, and I have written elsewhere about the second. There really isn’t any analogous situation in terms of our willingness to spend money in order to keep people alive except for, well, the military. There are a variety of ways to go about ensuring that human beings in any particular nation-state don’t die unnecessarily, though I’d like to highlight some other conservative arguments for single payer here and here. At the very least, we have to be willing to corporately share the cost of keeping our fellow citizens alive.


Header image is from Tim Lowly, “Carry Me”

Matthew Loftus

Matthew Loftus teaches and practices Family Medicine in Baltimore and East Africa. His work has been featured in Christianity Today, Comment, & First Things and he is a regular contributor for Christ and Pop Culture. You can learn more about his work and writing at