The Good Samaritan, Medicaid, and healthcare reform

Donald Trump is no biblical scholar, but he seemed to be drawing from the Gospel during the campaign when he laid out his healthcare policy.

“I will not allow people to die on the sidewalks and the streets of our country,” Trump said during the GOP debate, trying to distinguish himself from Ted Cruz and his understanding of conservative ideology. Trump was also, wittingly or unwittingly, channeling the teaching of Jesus Christ.

When a scholar asked Jesus to put some meat on the bones of the commandment to “Love thy neighbor,” Christ turned to the topic of healthcare — even health insurance, you could say.

Jesus tells the story of the Good Samaritan, who saw a man who had been beaten and left bleeding on the side of the road. Two men passed the victim by, but the Samaritan stopped, bandaged him, and brought him to an inn. When the Samaritan left, he left behind money for the innkeeper to continue tending to the man, and promised to pay more if that’s what it took.

This parable reflects a widely held moral sense that makes healthcare so different from other sectors of the economy: We should care for those who need it, even if they can’t pay. Similarly, it seems wrong that someone should go poor because she gets cancer or has a disabled baby.

Americans generally feel this way, meaning a pure market-based healthcare system won’t work. That’s why we have a federal law that requires an emergency room to treat a patient regardless of ability to pay.

Conservatives don’t always acknowledge this moral intuition. Some may not share it. Certainly, conservatives generally reject liberal lines like “healthcare is a human right,” which are used to argue for socialism. But acknowledging the basic moral intuition here is a crucial first step in proceeding on the healthcare debate.

We all owe it to our neighbors to provide healthcare when possible, regardless of ability to pay.

Where to go from there is the hard question.

Trump embraces conservatives as their interests align on healthcare

Also from the Washington Examiner

But his alliance with the right could fray if future deals call for moderation.

03/15/17 12:01 AM

Medicaid is supposed to address this moral obligation on the national level, guaranteeing that poor people will have passable healthcare. But does Medicaid actually count as giving people the healthcare they need? When Oregon awarded Medicaid coverage by lottery, thus creating something of a natural experiment, the results were shocking: Those with Medicaid saw no improvement in physical health over those left without it. They were a bit better off financially, though.

Medicaid, of course, isn’t free. It’s financed by federal and state tax dollars, and in effect by the national debt. Liberals present this as a simple tradeoff: Rich people give up some of their riches, and poor people get some healthcare. But taxing and borrowing hurts more than simply the rich, and the Oregon experiment showed us that the upside of this deal isn’t as high as promised.

There are plenty of other unintended consequences to a robust federal role in healthcare and health insurance—consequences that muddy the moral calculation. The Congressional Budget Office’s report on the Republicans’ new bill brought some of these problems to the fore.

The Republican bill would cut federal subsidies to Planned Parenthood, the leader in the abortion industry and also a provider of contraception. (Those subsidies, implicating taxpayers in abortion, are in themselves a massive moral cost of federal healthcare funding.) Savings from cutting Planned Parenthood subsidies would be partly offset, the CBO argued, because with less Planned Parenthood we would have more babies. “CBO estimates that the additional births stemming from the reduced access under the legislation would add to federal spending for Medicaid.”

It is morally corrosive when policymakers try to prevent babies from being born because babies cost us all money. You see this mindset more starkly in Europe, where healthcare is more socialized, and where abortion of the disabled is the rule. The disabled, you see, are costly to the collective.

The return of the debt ceiling

Also from the Washington Examiner

When Wednesday ends, the federal government won’t be able to go any further into debt until Congress gives its permission.

That permission will only be granted after several months of agonizing among Republicans, many of whom don’t want to increase the debt at all and want to start making real cuts to spending. In those months, Democrats will argue that Republicans are putting the U.S. at risk of default by not allowing more borrowing.

The debt ceiling has returned.

But unlike past debt crises, deficit hawks are hoping this new chapter ends differently — not with more unrestrained borrowing, but with some kind of commitment to reverse decades of habits that have allowed the national debt to hit $19.9 trillion.

03/15/17 12:01 AM

Government control of insurance or healthcare delivery poses other moral harms, such as creating a fertile ground for cronyism and nanny-statism. Some health-related federal safety net programs, such as Social Security’s disability insurance, have truly pernicious consequences at times, such as paying people who could work not to work.

So the person who takes Christ’s teachings to heart, and who wants to imitate the Good Samaritan has to ask himself if the Good Samaritan can be made into a federal program. Maybe the duty to love your neighbor cannot be outsourced to the government.

Timothy P. Carney, the Washington Examiner’s senior political columnist, can be contacted at His column appears Tuesday and Thursday nights on

This post originally appeared on Washington Examiner


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