The more we learn about the implementation of the Affordable Care Act (called “Obamacare” by the popular press), the more we realize that the act ignores the core principles of solidarity and subsidiarity that make organizations and systems function effectively. Initiatives that reject these principles are rarely successful. Consequently, I don’t hold much hope that Obamacare will ultimately accomplish its goals of improving access and reducing costs.
Brian Engelland, Ph.D. (Solidarity, Subsidiarity, and the Problem of Healthcare)
Professor Engelland’s criticism of Obamacare is more interesting than the run of the mill despite the fact that he so completely mischaracterizes Obamacare that one is hard put to believe he is acting in good faith. (No, Obamacare is not a system of price and cost controls and no it does not reorganize the entire health care system and no the government is not reasoning that it can dictate what medical procedures are covered and how much reimbursement is paid out.) Still, his argument is such that his own substantive criticisms of Obamacare are basically irrelevant. All that really matters to him in terms of his main argument is that Obamacare is a government program.
As Catholics we need to take seriously any accusation that a major social program violates the principles of solidarity and subsidiarity. Our first question should be how does Engelland define these? He gives us a hint in the first few sentences quoted above when he says that Obamacare “ignores the core principles of solidarity and subsidiarity that make organizations and systems function effectively”. To him, the principles are functions that promote efficacy. He is in dangerous territory, because stated this way, the “principles” become part of the group of functions of the system or organization and the goal of the organization becomes the primary thing to which the functions are subordinated. Let’s see if this is what Engelland really means.
His definition of solidarity starts out well enough:
Solidarity is the principle that recognizes that individuals are happiest when they develop lasting personal relationships with other humans. We develop the bond of brother hood (sic) when we recognize that another needs help and we sacrifice our talents, time and treasure to assist that brother in need through a personal connection. Solidarity is not simply a feeling of compassion or concern towards those in distress. Rather, solidarity is a call to action and a personal commitment to provide assistance.
But his example of solidarity is:
Think about the greeter who welcomes you to Wal-Mart… (The greeter and the customer) are edified through the practice of solidarity: the receiver obtains needed assistance; the giver obtains the merits of Christian charity. Both come away with greater respect and love for the other. When these individual bonds are multiplied by the millions of such solidarity interactions, society as a whole becomes better connected and the common good is served.
How do we know that solidarity (thus defined) improves the efficacy of the transaction?
Research by marketing scholars has long demonstrated the power of this personal connection. Companies have prospered by developing good customer relationship strategies that put an individual face on customer contact.
Solidarity, then, has nothing to do with the actual condition of the two parties involved. Rather, the appearance of solidarity which in this case is the product of a corporate script is an actual manifestation of solidarity. Since solidarity is something that arises out of a simple (if ersatz) face to face interaction, Obamacare is doomed to fail because:
…a government entity stands in the middle of the exchange, breaking the connection between the giver and the receiver. The giver never receives the merits of charity and the receiver never gets to know the benefactor. Without this connection, society is broken into distrusting factions.
It’s interesting that Engelland should choose a company like Wal-Mart as his example. Wal-Mart is the largest company in the United States and dwarfs in size many governments. It is a bureaucracy engaged in the selling of merchandise. But since it creates a front-end “relationship” between the greeter and the customer, a relationship that incidentally breaks the connection between the producer of the goods it sells and the customer, it becomes a model of solidarity (and profitability).
Now it could be that Engelland is simply using the case of Wal-Mart as an example and that he doesn’t mean to say that solidarity is a means to support the efficacy of commercial transactions. Let’s see what he says about subsidiarity:
Subsidiarity is the principle that respects individual freedom, initiative and control of one’s own sphere of responsibility. The principle recognizes that humans to not react well to conditions in which individual and local autonomy is replaced by higher level mandates.
What is a good example of this? Once again, we look to the commercial sector:
Years of management research, for instance, has shown that individual workers are happier and produce more effectively in situation where higher-level management provides the necessary production resources and cedes responsibilities to local-level control. Under these conditions, the individual worker is respected as an intelligent, decision-making partner in the enterprise, not as a faceless cog in the production machinery.
Once again, he is talking about the illusion of control, since actual control would be something very much like socialism or syndicalism. The requirements of Catholic subsidiarity are therefore met by a (relatively) decentralized management style. Obamacare fails this test too, because:
…individuals are much happier when they can make (their health care) decision(s) in conjunction with their own selected physician rather than have the decision forced on them by some distant insurance company, assigned medical provider, or government bureaucrat.
Putting aside the fact that what he is describing here is pretty much our current medical system (that he wants to keep), one wonders what the difference is between an insurance company or a government bureaucracy putting a friendly front-line face on the interaction and a large faceless private company doing the same thing? One can easily get the impression that to Engelland, 1) laissez faire capitalism is the most efficient bearer of the Catholic principles of solidarity and subsidiarity and 2) the appearance of a personal relationship meets the principles as long as the real underlying relationship is properly hidden. For Engelland, solidarity and subsidiarity don’t rest on one person’s actual (economic, social, or structural) relationship with another. Rather, it’s a feel good transaction. Obamacare fails because Engelland thinks that it doesn’t have a good Catholic customer service model.