07 September, 2017

Subsidiarity vs. Single Payer 2

Unfortunately, the circumstances of life prevented me from addressing Jack Quirk's response to my previous article on this topic before now. Given the amount of time, I considered moving on to other topics, but there were several points he claimed that I think really need to be addressed. Therefore, with apologies to our readers, and to Mr. Quirk and his readers, here is the much delayed response.

To begin with, we must remember that Mr. Quirk and I are in agreement on the validity of and necessity of the Church's teaching on subsidiarity. The issue of this exchange has been on the application of that teaching to today's society in terms of assisting those who need help in acquiring necessary health care services.

Subsidiarity and Competence vs. Federalism and Jurisdiction

This is the dichotomy Mr. Quirk has tried to establish for us, but he also defines subsidiarity as defining the relationship between the State and subordinate groups, “that is, groups that are part of the private sector.” It seems as though Mr. Quirk goes straight from the highest level of government to the private sector with nothing in between. He seems to equate the mere existence of multiple levels of government with federalism, and I think this is an error.

To begin with, we must go beyond the mere dictionary definition of federalism as a political system in which power is divided between a central authority and “constituent political units.” If this definition were truly complete, then feudalism could be considered a federalist system, which is nonsense. History clearly shows that political systems with more or less divided powers existed long before the idea of federalism came to being. What is missing from the standard definition, because it appears to be assumed, is the acceptance of Lockean political philosophy. This is the true heart of federalism and the true dividing line between federalism and subsidiarity. Subsidiarity is part of a philosophical view that stands in opposition to Lockean political philosophy, not on the grounds of how political power is divided, but on the grounds of the source and nature of political power itself.

Mr. Quirk claims that subsidiarity “is nowhere articulated to set standards for the relations between governments in a federal system.” This is true, but only because subsidiarity and federalism have contradicting views about the nature of government authority. Federalism didn't exist when the principles of subsidiarity were formulated, so those principles don't specifically address a federal system. They do, however address political systems that include multiple layers of government. After all, division of political authority existed in the feudal age and during the Catholic monarchies of the High Middle Ages, and the Church certainly posited the application of subsidiarity to those political systems. Therefore the dichotomy presented by Mr. Quirk is wrong. The issue isn’t between competence and jurisdiction. These are actually complementary features of subsidiarity. The division between subsidiarity and federalism actually lies in the philosophical foundations that separate the two ideas.

While the above is the basis of my previous statements that we can discuss jurisdiction without necessarily discussing federalism, we also have to understand that any attempt to implement subsidiarity in our society today means that we have to start with the federalist system under which we are currently governed. We cannot simply expect that everyone will accept subsidiarity as a substitute for federalism over night. However, the fact that subsidiarity can apply to a system of government with power divided among different levels of government means that we can work to change our currently federalist system to be more consistent with subsidiarity.

Jurisdiction and Competence as Complementary Ideas

Many people would consider jurisdiction as an exclusively political concept, however that is also based on the prevalent view of our Lockean federalist society. An older view is that jurisdiction exists both in the political and private realms of society. Parents establish the laws of the family. When the guilds existed, they were private sector institutions that established legally enforceable business laws. Churches establish the religious laws. City government (whatever its form) establishes the laws of the local community. State government establishes the laws of the greater community, if you will, the community of communities. Unlike federalism, subsidiarity is based on the idea that the jurisdiction of these various levels of society is based on human nature, the nature of each level and the societal need for which the level has come into existence.

When families live in community, no one family has any natural authority over the members of another family. However, the common good necessitates some level of authority to deal with the issues that arise when families live in community. How fast should people be allowed to drive in residential areas where children are likely to be playing outside? No single family has the natural authority to dictate the answer to this question to the other families of the same community. The existence of the community necessitates an authority with the jurisdiction to address community issues. The existence of the community and its necessary government is also a part of human nature and not a merely social construct. Neither the form of the authority or the means of selecting who exercises it matter. What matters is that human nature makes the authority necessary and subsidiarity defines that authority’s limits according to its nature rather than the federalist idea of authority being granted by its constituent members. Subsidiarity certainly does not require the multiple levels of government we currently have, but it is just as certain that it is not incompatible with their existence and it absolutely can and must be applied to them if they do exist.

Competence is a concept which is much more tricky to address because it must be presumed. Those who hold positions of jurisdictional authority, both in the public and private arenas, must be presumed to have the necessary competence to exercise that authority. This is similar to the concept of those accused with crimes being presumed innocent until proven guilty. In order for society to work, parents must be presumed as competent to head their families, the leaders of private organizations must be presumed competent to do their jobs, and government officials must be presumed competent to govern.

Mr. Quirk maintains that the principle of subsidiarity is based on competence and not jurisdiction. He has not convinced me. I maintain that competence as he has applied it to the principle of subsidiarity is not based on proven ability, but must be presumed based on jurisdiction. This is necessary for any type of society to function. Jurisdiction is not strictly limited to political government. Within the framework of subsidiarity it also applies to private areas of society. Subsidiarity is the just method of determining what authority rests with the all the different orders of society.

When May a Higher Order Legitimately Override 
a Lower Order?

The statement of Mr. Quirk's which I found most interesting had to do with this question. He wrote, “If the children in a family are being severely abused in some manner, the State intervenes when it is discovered, and this often results in the termination of parental rights.” He seems to view this as somehow demonstrating that the implementation of a state run single payer health care system is compatible with the principle of subsidiarity. I must admit that I am baffled by this because I just don’t see how the one demonstrates the other.

The example provided is one of criminal activity. In this case, the action of the state is not justified on the grounds of subsidiarity, but on the fact that the parents, by their criminal act toward their children, have forfeited their natural rights over their children. To equate subsidiarity with this is not comparing “apples to apples.” It isn’t even comparing apples to fruit. It is more like comparing apples to C-4. It just doesn’t work because the state’s action in these cases is just like that of putting someone in prison for other crimes; it is based on the idea that those who commit crimes against society forfeit rights they have within that society because of their criminal acts. Not having the means to pay for needed health care services is not a criminal act and should not be treated like one or even equated to one.

Another case where a higher order of society may legitimately override the authority of a lower order is, as Mr. Quirk pointed out, when the lower order refuses to act. I would also add to this those cases where the presumed competence is proven to be absent. However, as I pointed out in the previous article, justice demands that this usurpation of authority be temporary. It is an assistance rendered, but part of that assistance must include helping the lower order of society to resume its natural role in the matter, at which time the higher order must withdraw. In other words, the principle of subsidiarity requires that the higher order not only assist with the situation, but also offer any necessary assistance to reestablish the rightful role of the lower order.

Another aspect of this is that these may never be blanket acts. Whether we are discussing providing disaster relief, food assistance, or assisting with covering health care costs, these acts of assistance must be done on a case by case basis in order to protect the natural rights and order of society. Higher orders do have the right, and indeed the moral obligation to step in when necessary, but only when necessary and only as far as necessary. They also have the moral obligation to assist the lower orders to resume their natural function and authority, and to step back out as soon as they practically can.

Subsidiarity vs. Single Payer

I admit that we live in times and circumstances where many people need government assistance with accessing health care. I even admit that there are areas where the federal government may need to step in to assist with correcting this situation. However, a single-payer system, as I have seen it presented, represents nothing less than the highest level of government overriding the authority and ability of lower orders of our society from providing assistance and from deciding how best to address the issues. This overriding of natural authority extends to the family itself. Mr. Quirk points out that subsidiarity allows the family to choose the best method or option, but that is precisely what proponents of a single-payer system would deny them – the choice of which method or option for covering health care costs is best for their own family.

The principle of subsidiarity and the teaching of the Church are clear; it is an act of grave injustice to assign to a higher order of society responsibilities and functions that can and rightfully should be fulfilled by a lower order. Accessing health care and assisting those who need help accessing health care can be achieved by lower orders of our society than the federal government. If I were to accept Mr. Quirk's position, I don't see how it wouldn't also justify establishing other one-size-fits-all federal solutions for societal issues we currently face today. Nearly every argument he made to justify a single payer system for covering the costs of health care would also apply to covering the cost for food and housing - not just for those in need, but for everyone! That is what is being proposed for health care costs.

What I have outlined as being compatible with subsidiarity isn't perfect, but neither is any single-payer system. I also don't believe any single-payer system to be the best option. Even if we can presently justify federal assistance, the principle of subsidiarity and the teaching of the Church are clear that this assistance needs to be both in specific cases of need and temporary. Single-payer is proposed as a permanent solution to the entire question of accessing any health care service, run at the highest level of government. To me, it is a case of the "absent or insufficient recognition" of the initiative and capabilities of the lower orders of society, and the Church teaches that this undermines the principle of subsidiarity. Based on this, I still conclude that we not only can, but must argue against this type of system on the basis of subsidiarity.

Title photograph from Wellcome Images. Licensed under the Creative Commons Attribution 4.0 International License


  1. Sound reasoning. Thanks for the article, David.

  2. I agree with you David. As members of a healthcare sharing ministry, my family participate in subsidiarity at its best. Millions of dollars are shared every month among families that need assistance paying medical bills. I would like to see healthcare sharing ministries entered into the debate.

    Ben Haring