Healthcare and Income Redistribution

"He went to him and bandaged his wounds, having poured oil and wine on them. Then he put him on his own animal, brought him to an inn, and took care of him. The next day he took out two denarii, gave them to the innkeeper, and said, “Take care of him; and when I come back, I will repay you whatever more you spend.”
Luke 10:34-35

Maybe it’s not always about the money, but it’s about the money often enough to suggest that’s always a good place to start.

In Jesus’ famous parable, the last thing the Good Samaritan does for the man who was beaten and robbed is to leave money with the innkeeper for his continued care, and promise the innkeeper that if it costs more he will repay “whatever more you spend.”

In an article in Friday’s New York Times, Thomas B. Edsall outlines the effects of the American Health Care Act recently passed by the House of Representatives, and he begins with the money.

The bill cuts more than $800 billion from Medicaid over ten years and basically redistributes the money from those at the bottom of the income pyramid to those at the top. “By 2022, when the provisions of the AHCA would be fully effective,” he writes, “those in the bottom two quintiles would pay higher taxes, up to $160 annually, according to the nonpartisan Tax Policy Center. Those in the middle of the income distribution would get an average annual tax cut of $240; those in the fourth quintile, a cut of $510; and those in the top 20 percent, an average tax cut of $2,830.”

“The distributional impact of the tax provisions is most apparent in the highest income brackets: those in the top one percent, whose household income is more than $770,000, would get an average tax cut of $37,220. Those in the top 0.1 percent, who make $4 million or more, would get an average reduction of $207,240.”

“According to the nonpartisan Center on Budget and Policy Priorities, at the highest point of all, the 400 households with annual incomes exceeding $300 million apiece, the tax cut would be worth an estimated $7 million.”

The combination of repealing billions of dollars in taxes that were used to pay for the Affordable Care Act, and slashing the subsidies provided to those on low incomes means that when we compare the economic impact of the ACA with the AHCA we see huge redistributions of income in the House plan that flow from the poorest to the richest Americans. 

The politics in this are not nearly as clearly delineated as one might assume. Donald Trump was elected by white working class voters who voted for him overwhelmingly. That constituency was critical in Wisconsin, Michigan, Ohio, and Pennsylvania, the key states in his electoral college victory. But the voters who put him in office are the very ones who will suffer the most under the repeal of the ACA and the implementation of the AHCA.

Senator Joe Manchin, a conservative democrat spoke with Mr. Trump about his home state of West Virginia, where Trump carried every county and won the state vote with 67.9% compared to 26.2% for Hillary Clinton. According to Manchin’s account, he told Trump:

“Mr. President, 172,000 West Virginians got insurance for the first time. These are working people, but they’ve got something they never had before. They don’t know how they got it, they don’t know who gave it to them, they don’t know the Democrats, nothing about, ‘It’s Obamacare.’ They don’t know any of that. All they know is they’ve got it. And you know what? They voted for you, Mr. President. The Democrats gave it to them but they voted for you. They’re going to know who took it away from them.”

One of the strangest observations in all of this is that so many Americans voted against their own self-interest. Lower income voters were overwhelmingly for Trump, while upper income voters were solidly for Clinton.

One of the reasons that working class white voters supported Mr. Trump is race. In his Times article Edsall cites a piece in the March 23 issue of Rolling Stone in which Bridgette Dunlap points out that manipulating racial and ethnic animosity is a tried and true political strategy. She called it “divide and rule.”

“The rich guy convinced much of the white working class that he would ‘take back’ the country from the rest of the working class and other undeserving non-white and non-Christian people, as well as the coastal elites giving those folks jobs and handouts at the expense of ‘real’ Americans. It’s a strategy as old as this country.”

Healthcare Is a Universal Human Right

Thus says the Lord GOD: Ah, you shepherds of Israel who have been feeding yourselves! Should not shepherds feed the sheep? You eat the fat, you clothe yourselves with the wool, you slaughter the fatlings; but you do not feed the sheep. You have not strengthened the weak, you have not healed the sick, you have not bound up the injured, you have not brought back the strayed, you have not sought the lost, but with force and harshness you have ruled them.

Ezekiel 34:2-4

Healthcare is a universal human right.

The libertarians will disagree, but from a Christian perspective there is broad consensus that the conclusion is unmistakable.

Healthcare is a universal human right and most Christian denominations would agree with the United Methodists that, “it is a governmental responsibility to provide all citizens with health care.”

The United Methodist Discipline states:

“Providing the care needed to maintain health, prevent disease, and restore health after injury or illness is a responsibility each person owes others and government owes to all . . . Like police and fire protection, health care is best funded through the government’s ability to tax each person equitably and directly fund the provider entities.”

In case you missed the meaning of that statement, we are talking about single payer insurance.

On the other side of the argument, writing for Freedomworks, Julie Borowski makes the libertarian case against the Affordable Care Act. “The dangerous philosophy behind the law,” she argues, “is that too many Americans now see health care as a human right rather than a good.”

“The Declaration of Independence states that we have an unalienable right to life, liberty and the pursuit of happiness. That doesn’t mean that other people should be forced to sustain our life or make us happy,” she writes. “These legitimate rights do not place obligations on anyone except to not infringe on the rights of others.”

Of course, when you boil it all down, the issue is money.

On Vox.com, Matthew Iglesias characterizes critics of the ACA this way:

“They think it taxes rich people too much, and coddles Americans with excessively generous, excessively subsidized health insurance plans. They want a world of lower taxes on millionaires while millions of Americans put ‘skin in the game’ in the form of higher deductibles and copayments. Exactly the opposite, in other words, of what Republican politicians have been promising.”

“What they fundamentally did not like is that the basic framework of the law is to redistribute money by taxing high-income families and giving insurance subsidies to needy ones.”

This, they believe, is immoral. The ACA, they argue, was never about healthcare, it was about the redistribution of income.

Whether intended or not, the ACA does redistribute income as this chart from Gary Burtless and Henry Aaron of the Brookings Institution shows, the Affordable Care Act enacts substantial income redistribution in the United States.

For those who care about economic justice and narrowing the gap between rich and poor, the redistribution does benefit the bottom two-tenths on the income chart. The bad news is first that it does not help a great deal. And second that as a percentage of annual income, the gains at the bottom come at the expense of the middle class. In raw dollars, of course, those at the top contribute the most, but the highest percentage is borne by those at the lower end of the middle class.

The ACA made some real gains in healthcare by making health insurance available to more than twenty million Americans who previously were uninsured. And it did modestly affect the distribution of income.

The plan presently being considered in congress will decrease Medicaid funding, throw millions of people off of insurance plans, make insurance more costly for those who are least able to afford it, and give tax breaks to those who need them least.

We can do better.

Thank you for reading. Your thoughts and comments are always welcome. Please feel free to share on social media as you wish.

The ACA Has Achieved Something Significant

Five Year Old James Cook of Cleveland, Ohio

When he returned to Capernaum after some days, it was reported that he was at home. So many gathered around that there was no longer room for them, not even in front of the door; and he was speaking the word to them. Then some people came, bringing to him a paralyzed man, carried by four of them. And when they could not bring him to Jesus because of the crowd, they removed the roof above him; and after having dug through it, they let down the mat on which the paralytic lay. When Jesus saw their faith, he said to the paralytic, “Son, your sins are forgiven.”

“I say to you, stand up, take your mat and go to your home.” And he stood up, and immediately took the mat and went out before all of them; so that they were all amazed and glorified God, saying, “We have never seen anything like this!”

Mark 2:1-5, 11-12


Modern readers tend to focus first on the miracle.

They may believe it literally, or they may see it as a metaphor. They may rationalize it, or they may see it pointing toward larger truths about healing and wholeness and forgiveness, they may focus on sin and guilt in relation to physical health.

But there is something else, central to the story, which is easily missed. What impresses Jesus is the four friends carrying the paralytic. “When he saw their faith” he offered the forgiveness that led to healing.

They picked him up and carried him.

When Jesus saw them carrying the man, he called that “faith.”

Over the past eight years of our national debate about the Affordable Care Act, one of the most contentious questions has been about whether or not healthy people have a responsibility to carry those who are ill.

And the good news is that we have made progress.

In September of 2011 CNN anchor Wolf Blitzer was moderating a Republican Presidential Candidates debate in Tampa Florida. He posed a hypothetical question to Dr. Ron Paul. If a healthy thirty year old man with a good income chose not to buy health insurance and then became catastrophically ill, what should happen? Paul tried to dodge the question by recalling (incorrectly) that years ago the churches took care of people who had no insurance, but a significant portion of the audience could be heard chanting, “Let him die! Let him die!”

Not our finest moment, though the Ayn Rand crowd must have rejoiced in the triumph of “the virtue of selfishness.”

No one is really happy with the individual mandate requirement of the Affordable Care Act. But without some means of requiring everyone to buy coverage it is impossible to pay for the very popular provisions protecting those with pre-existing conditions and eliminating the lifetime limits on coverage.

The ACA is far from perfect. But it has achieved something significant. It has shifted the terms of the debate.

When we first began discussing the ACA, one of the primary objections was that “we can’t afford it.” In other words, we won’t carry sick people. If people need to be carried they will have to pay for it on their own.

In the initial debates and in subsequent attempts at repeal, those against the ACA did not mention the folks without health insurance. And they did not seem worried that repeal would take away insurance from twenty million people who were previously uninsured and now have health insurance through the ACA.

But now that has shifted.

President Trump’s official position is that the ACA should be repealed and replaced with Health Savings Accounts, which is not really a viable alternative to insurance. But in his public statements he has repeatedly said that we can’t have twenty million people losing health insurance. And other opponents of the ACA have said the same thing.

In the long run we need some version of single payer health insurance like almost all of the developed world. And we could do this using the present Medicare model.

But for now at least we seem to have taken a small step toward.

Thank you for reading. Your thoughts and comments are always welcome. Please feel free to share on social media as you wish.