Beneath the Healthcare Wars: Difficult Questions about Living and Dying

Although the ongoing healthcare wars between Democrats and Republicans have been raging for some time now, the recent HHS mandate has ignited a more direct and particular conflict. Whereas the former was and is primarily political, the latter seems to be cultural. Regardless of what we call it, this recent battle in the healthcare wars amplifies a longstanding tension between secular/American and religious/Catholic cultures and worldviews.

Leaving aside policy issues and the constant stream of news—none more interesting to me, an alumnus of Franciscan University of Steubenville, than this report about my alma mater’s quixotic decision to discontinue student health insurance altogether—it might be worth considering a more fundamental human condition: the ways in which we live and die in the modern world.

A Hospital Is Not a Home

In modern nations, people live and die in modern institutions, ruled by modern policies, according to modern processes. While the quality of modern institutions does vary, they all share this simple fact: they are modern institutions. The rare exceptions prove the rule.

For example: my grandfather wanted to die in his house, not a hospital. His resistance to dying a hospital death, lasting until he could die at home, is not unlike the impulse of women who opt to bear their children at home or parents who choose to school their children at home. Qualitative questions aside, there is a palpable, descriptive difference between a home and a hospital (or a school).

“Home” is not a romantic exception to modernity, of course. Dying, birthing, and schooling at home are still regulated by policies and processes and are not wholly removed from modern institutions. (For example: home schooling is still a form of compulsory schooling.) After all, the most ubiquitous, totalizing modern institution is the modern nation-state; precious few, if any, homes escape the reach of this modern institution.

What the contrast between hospital and home does show is this: there is something about the way we live and die in modernity that is mediated by more than the perennial, ordinary whims of fortune. In modern society, there are no exits from living and dying as a distinctly modern person, a person who, ironically, guards and sterilizes herself from the whims of fortune through science and technology.

The question of health and healthcare, then, is not a generic question. It too is a question about who we are and what our living and dying is, exactly, under the inescapable specter of a modern institutions and worldviews.

Two Modern Healthcare Narratives

If we look closely at the healthcare wars, we see two narratives at work, narratives that reveal the natural tension between the United States and the Catholic Church. These narratives only compete at the surface; beneath their superficial disagreement we find an acceptance of the modern conception of the human person (the autonomous individual) and a modern, institutional, and an exclusively medical understanding of what “health” and “healthcare” are.

On the Right, we see a rugged individualism that was the hallmark of what was once called “liberalism.” By this libertarian logic, our health is not the same thing as our life—although the fact that most healthcare insurance pays for childbirth—and we are responsible for our health privately, outside the public responsibilities of the modern nation-state.

On the Left, we see an equally modern communitarianism that was the hallmark of the 19^th century’s objection to the political liberalism that founded modernity. By this logic, the modern nation-state has a public duty to provide healthcare for its citizens. When we look deeper, we must realize that this modern, institutional form of “health” and “healthcare” is in one sense more ambitious and technologically robust and, in another sense, deeply limited in its medical and physical breadth and scope. This notion of healthcare has many of the same individualistic consequences when it is carried out. For one, it is incredibly “sophisticated,” expensive, and universally unsustainable. Communities cannot provide this program of healthcare.

In my view—influenced by a Catholic worldview—the Right is wrong to suggest that life and health can be separated from each other and that persons can exist as individuals first and foremost. (This reveals my basic agreement with the Left about the communal nature of the human person, and all of creation for that matter.) But it is equally misguided and counterproductive for the Left to think that the modern kind of care it advocates is sustainable and, more importantly, good for persons who are living and dying together.

Difficult Questions

Perhaps we ought to consider a question like the following: How can we live and die as fully human persons, communal beings who live in a fragile ecology, and not only enjoy a certain, reliable amount of physical health, but also experience other forms of health? Cultural and spiritual health, and more. Even if we are physically healthy, doesn’t it matter that we are living in a culture that is sick—and contagious? Can we finally separate our “health” from our moral and cultural environment?

The recent and ongoing healthcare wars all lead to—and originate from—mutually flawed conclusions. Even worse, they make us sick from their antics and their deep, philosophical agreement: they both believe in the project of modernity in ways that other worldviews do not. Herein lies the natural tension between the United States and the Catholic Church.

Beneath these predictable wars, packaged and sold as “news,” we might find unifying yet difficult questions about how we want to live and die—none more terrifying to the modern imagination than the question of suffering.