The Catholic Thing
Misunderstanding Subsidiarity Print E-mail
By Peter Brown   
Thursday, 31 May 2012

A short time ago, I wrote in these pages remarking why invoking subsidiarity in the healthcare debate is problematic. I remain convinced that the concept – at least as popes have articulated it – is useful, but misunderstood.

Initially, subsidiarity was supposed to combat the effects of free market capitalism and head off socialism. Mass production had destroyed many of the guilds and rural networks workers had depended on for social insurance. At issue, also, was the immense concentration of property in the hands of a very few capitalists.

 This was not merely a concern of Marxist theoreticians. In 1891, the year Rerum Novarum appeared, the net worth of Rockefeller, Carnegie, Vanderbilt, and Morgan alone was around 5-6 percent of U. S. GDP. (By contrast, the entire fortune of the top 500 richest Americans today is scarcely more than a rounding error of our GDP.) Unless something would be done to distribute more property to the worker and to improve working conditions, the triumph of socialism seemed inevitable.    

When Quadragesimo Anno appeared in 1931, the fear was no longer theoretical. Totalitarian regimes had arisen in Russia and Italy bent on eliminating or circumscribing any subsidiary organizations that stood between the individual and the state. And with the instability of international finance in 1931, it was by no means clear that the German welfare state could stave off radicalism. Pius’s answer in Quadragesimo was to defend the remaining “associations” and “societies” (unions, guilds, fraternities) that had traditionally served human needs apart from state encroachment.

He wrote:

it is an injustice and at the same time a grave evil and disturbance of right order to assign to a greater and higher association what lesser and subordinate organizations can do.

First, what wasn’t subsidiarity? Pius’s vision was not an economic theory about how to order society more “efficiently.” Clearly larger organizations are often far more efficient than smaller ones (e.g., Wal-Mart vs. the local store). It was not concerned with entrepreneurs and “cost-conscious consumers” making smarter choices than central planners (that’s Hayekian economics, not subsidiarity).

It was not a theory of organizational behavior that local actors make better decisions than do higher ups (sometimes they do, sometimes they don’t). It was not a belief that the U. S. government should stick to its “enumerated powers,” leaving the balance to the states (the debate over federalism has raged since 1789, and the pope surely didn’t intend to weigh in on it).

What it was for Pius and Leo was a belief grounded in truths of the human person. To wit: 1) that the person precedes the state (against socialism); 2) that people have a natural right to property which is necessary for human flourishing (against both socialism and laissez-faire theories); and 3) that people are by nature social beings who exist in families and communities.

           The Roman Catholic Orphan Asylum (Bronx, New York c.1900)

Clearly, there was quite a bit to this concept. Sophisticated thinkers like E. F. Schumacher, Belloc, Chesterton, and Dorothy Day were not content to use the concept of subsidiarity as a cavil against government programs. In fact, they were able to tease out of documents like Rerum Novarum a much more comprehensive social vision – a vision that was neither socialist nor laissez-faire capitalist but could only be described as radically communitarian. And that’s just for starters.

Here’s a thought experiment of what a truly subsidiarist approach to health insurance might look like today. A subsidiarist would not like being part of Medicare, administered by distant, faceless HHS bureaucrats. But neither would he like being part of a large anonymous risk pool administered by distant, faceless insurance company bureaucrats. And let’s be clear, he would feel no better about things if the bureaucrats were in his state capital rather than Washington.

Remember, he is a social creature who wants as little dependence on anonymous sources for his needs as possible. He would want to self-insure where possible and otherwise depend on family and friends. For larger expenses, he’d call upon his trade group, labor union, or fraternal organization.

But alas, most of these groups have been casualties of the relentless quest for capitalist efficiency. The good news is that there is one association left that could conceivably fill the void: the Catholic parish, or better still, the Catholic diocese. We not only have lots of members, but also doctors, nurses, and hospitals that could conceivably become a self-financed local Catholic health network. Our subsidiarist could be treated there.

Of course, we’d have to pay to support the network. A lot! Weekly Mass collections wouldn’t work. It would set up the classic collective-action problem with too many people paying too little. Donations would have to be semi-compulsory and there would probably have to be some means of keeping track of who paid, as well as procedures to deal with folks who have money but tell a hard luck story every time fees were due (while expecting health care when needed).

The wealthy would have to pay much more so that the poor could pay less, just as singles would have indirectly to support big families. And what to do about the young and healthy who have a habit of moving away for school and jobs? Their participation would be vital to help keep the network affordable for the older members, as well as to care for older family members, to the extent possible, to defray costs. And it would be hard in areas where there were many elderly whose children had moved away.

Would it work? That would depend in the end on how strong our “Catholic solidarity” was. I have grave doubts about that solidarity at the present time. But in the end, it really is about us. It’s not enough to invoke “subsidiarity” every time a government program is proposed. If we really want government to do less, we have to create “lesser organizations” to do more – and commit ourselves to making them work.

Peter Brown
is completing a doctorate in Biblical Studies at the Catholic University of America.
The Catholic Thing is a forum for intelligent Catholic commentary. Opinions expressed by writers are solely their own.

Rules for Commenting

The Catholic Thing welcomes comments, which should reflect a sense of brevity and a spirit of Christian civility, and which, as discretion indicates, we reserve the right to publish or not. And, please, do not include links to other websites; we simply haven't time to check them all.

Comments (14)Add Comment
written by Lauri Friesen, May 31, 2012
Whiel I think this shows an improved understanding of the Catholic principle of subsidiarity, I think Mr. Brown misses the single most important element: all we do for one another, we must do from love. "The government" cannot love nor can "society". Only individual people can love. And love is first experienced and shared between individuals and within families. The first question that should be answered, then, is: Can this family provide what its individual members need to be healthy? Or, does this individual have a family which can provide what he needs to be healthy? If it can, then no intervening organization is required.

What I guess I am getting at is that subsidiarity should always first regard the individual as an individual. We don't all need the same things to live life as God wills for each of us. In fact, to participate in God's plan, it seems far more likely that we all are in need of different things. The centralization and universality of government action seriously undermines our abilities to live the life we were each given by God.
written by John H., May 31, 2012

Firstly, thank you for actually attempting to propose a solution. It's a rare quality.

Second, as you hint in your article, this solution will of course not work. Here's why:

Your conclusions as to how we got to this point are very suspect. You say, "If we really want government to do less, we have to create “lesser organizations” to do more." How has this ever worked? Our government has not once yielded an ounce of power back to the people. You can establish as many guilds, trade-unions, Churches, and charitable outreaches as you want. You will not, by doing so, convince the government that it's services are no longer needed. And because of that, you will never get the government to lessen the tax burden it places on individuals and businesses. Government HAS to be gutted. We have to clean-out the power-hungry bureaucrats who dictate our lives. Government IS the problem with healthcare. Give the government money, power, responsibility, and watch your money disappear, their power increase, and their responsibility decrease. Government is the worst place to invest your money.

How do you solve the "healthcare" problem in this country? First, you begin by ceasing to define healthcare as health insurance. This is the ridiculous ideology that has brought us to this point in the first place. Second, you must address the "cost" of healthcare. This is the primary issue affecting our ability to receive adequate medical treatment. The "cost" of it is a sham perpetrated by the insurance companies, lawyers, government officials, and hospital system. Look at a medical bill sometime. Look at what the insurance actually paid, and look at what you contributed. The costs are a fraction of the overall total.

If cost is not addressed, it does not matter which organization pays for healthcare, no one can shoulder that inflated economic burden. It will cripple our already over-indebted nation if the government takes it on. It will cripple any Church that takes it on. It will not work if cost is not addressed.

How do you address cost? Tort reform. I know, I know, this is the same old conservative canard that has been used to put-off healthcare reform for decades. It's also the thing "progressives" have not even considered yielding to conservatives. But seriously, if people are given fair settlements, and doctors aren't forced to spend a million a year in malpractice insurance, you're going to see a dramatic shift in costs. Of course, the insurance companies and lawyers don't want that, and they lobby hard to make sure it doesn't happen. They want doctors paying exorbitant insurance fees, they want you paying exorbitant insurance premiums, and lawyers of course want to continue collecting exorbitant settlement checks. It's got to stop. Talk about capitalism running and ruining the individual. The greedy capitalistic tendencies of ambulance chasers "progressive" politicians, and banksters are at the heart of the healthcare issue. That has to be addressed first before we decide who pays for it.
written by John Powers, May 31, 2012
Interesting article, but I think you have a few things out of context. The Subsidiarity principle has a longer history, at least back to Aquinas and the Spanish Scholastics, than your article states.

There is also the relative viewpoint within Subsidiarity, as to who is best able to make decisions. For example, the State of Illinois has determined that government run schools are mandatory for children, regardless of the input of the parents and children.

The Subsidiarty question is *who is in a better place to make that decision..the parents or the politicians* not *is it better to send children away for education rather than educate them locally*


written by mike flynn, May 31, 2012
this thesis speaks to a medical insurance plan run by the knights of columbus, instead of gov't plans or big business sponsored for-profit insurance. it comes from a better place, but fiscal realities he speaks of renders it nearly impossible to execute (can i get relief from paying taxes on "contributions" and will my employer raise my gross pay by the amount of premium it is not paying for me so i can make the "contribution"?

logic tells us the system must collapse of its own weight. devolution is inevitable. doctors will take payments in chickens and pies once again. and charge better off patients more to recover from indigent. then the market will be ripe for ground up plans described here.
written by Nick, May 31, 2012

While I think what you said is extremely critical to this discussion, I think it belongs in the 'companion' principle of Solidarity (not Subsidiarity).

I think the article got to the heart of the problem, which is that Subsidiarity is a principle grounded on Natural Law, not some political theory. It is grounded on the fact that there are natural hierarchies to society that precede any (modern) political ideology.
written by Tony Esolen, May 31, 2012
1. Tort reform is a great beginning. My sister, a highly esteemed doctor with an unusually heavy burden of responsibilities, tells me that if her name appears on a patient's chart, even if it is but to approve of an aspirin, and that patient is the object of malpractice, then she is named in the suit along with everyone else. That, of course, is flagrantly unjust, but so it is. It is also a breach of public trust for lawyers to advertise their services as they now do, in particular lawyers who trawl for clients for class-action malpractice suits against makers of drugs or medical devices. It is really an extortion racket. If a company produces a medical device, tests it for ten years, has it reviewed by all the government agencies, and still somebody somewhere can be shown to have suffered by it (and that's almost certainly going to happen, in a large pool of users), then the company can be sued. So the company buys expensive insurance policies, and passes the costs on to everybody else.

2. The government has to be gutted. The government also runs a protection / extortion racket. Look what it has done to our schools. Washington raises our taxes so as to "give" sums back to the school districts, and for this "largesse" it demands that the schools dance to Washington's tune. The same principle applies to state taxes, too.

3. The AMA has long held a labor cartel, making it very difficult to enter the medical profession. Why? To keep prices high; that's the purpose of any cartel.
written by Chris in Maryland, May 31, 2012
Among the steps - The Church should annul its marriage with BIG BROTHER. If, as is alleged, Catholic Charities is primarily a conduit of federal money for "poverty programs," then the Church should stop pretending that "CATHOLIC CHARITIES" is about dispensing Catholic money to charitable purposes. Real Catholic charity should flow Catholic money toward Catholic charitible needs, such as Catholic education, insurance, etc.

Why are we cooperating with Leviathan, who is out to destroy us?
written by petebrown, May 31, 2012
Thank you all for your great comments. Regarding tort reform, I think the problem here goes back to a lack of solidarity. In a tightly knit health network of co-religionists lawsuits should be extremely rare.

But in a way I also think medical malpractice insurance is the least of the problems for why something like a Catholic health network wouldn't work. It would be only as strong as its weakest link. As soon and the docs and nurses began to leave for more profitable work elsewhere, as soon as wealthier Catholics began to seek more expensive treatment options outside the network, as soon as the young and healthy began to see it as a raw deal for them in which they have to contribute much more than they need (at the moment), the whole thing would unravel. Moreover even if such a network did work for a time, how would it scale out to the whole populace? Is there really enough solidarity for something like this to work in the whole country? We can't suppose that the welfare of people outside the hypothetical network is a matter of indifference to us.

I would challenge those of you who claim to want no state involvement in health care to say specifically what you would put in its place. As you can see my own thought experiment has lead me to a dead end.

I think Lauri makes a great point in disagreeing with me (though she really isn't). Yes ideally love would be at the center of health care provision. But think of what that would mean in practice; a person unless he dies in an accident, will suffer from exactly one terminal disease and maybe many other lesser ones, in which he will need the services of many people he does not know (and thus cannot love) and who don't know him (and cannot love him.) Love requires knowing the person...this gets to the heart of the subsidiarist vision in which a man trusts as many of his needs as possible to people who do know and love him.

But how hard is that to live in a modern capitalist economy in which nearly everything we get, we get from people whom we do not know and love and people who don't know and love us. Of course, we do have a lot more and better stuff than we would have if we had to depend on everything from known and trusted sources of people we knew. Whether we like it or not we live in a society that is profoundly unsubsidiarist, and health care is only the tip of the iceberg. We all depend on goods and services provided by strangers with long supply chains and social circles far removed from us. This was not true in antiquity. But it is true now.

This is one key tradeoff we've all made implicitly in modernity, without often knowing that we've made it. We tend to focus on the stuff we have, where it is worth at least briefly pondering the kind of world we left behind.

written by jsmitty, May 31, 2012
I have to agree with Nick's comment. Most of the other comments frankly sound more like Republican health care talking points than serious attempts to wrestle with the subsidiarist vision of the Church, which should not be reduced to a political ideology.

That said I don't hate the government but I really don't like the Church's relationship with government either. We have the illusion that the Church puts a charitable face on the secular goals of the state, but more often I think its the reverse. Over time it risks corroding the mission of the Church, which is not always the same as the state.
written by Frank, June 01, 2012
On this issue, I will quote Hayek.

Nobel Prize-winning economist F.A. Hayek, in his trenchant 1976 book Law, Legislation and Liberty: The Mirage of Social Justice, perhaps channeling the willingness of Luther to challenge the conventional wisdom of the day, wrote this:
The commitment to "social justice" has in fact become the chief outlet for moral emotion, the distinguishing attribute of the good man, and the recognized sign of the possession of a moral conscience…. But the near-universal acceptance of a belief does not prove that it is valid or even meaningful any more than the general belief in witches or ghosts proved the validity of these concepts. What we have to deal with in the case of "social justice" is simply a quasi-religious superstition of the kind which we should respectfully leave in peace so long as it merely makes those happy who hold it, but which we must fight when it becomes the pretext of coercing other men. And the prevailing belief in "social justice" is at present probably the greatest threat to most other values of a free civilization.
Most people are still unwilling to face the most alarming lesson of modern history: that the greatest crimes of our time have been committed by governments that had the enthusiastic support of millions of people who were guided by moral impulses. It is simply not true that Hitler or Mussolini, Lenin or Stalin, appealed only to the worst instincts of their people: they also appealed to some of the feelings which dominate contemporary democracies.
Whatever disillusionment the more mature supporters of these movements may have experienced as they came to see the effects of the policies they had supported, there can be no doubt that the rank and file of the communist, national-socialist or fascist movements contained many men and women inspired by ideals not very different from those of some of the most influential social philosophers in the Western countries. Some of them certainly believed that they were engaged in the creation of a just society in which the needs of the most deserving or "socially most valuable" would be better cared for. They were led by a desire for a visible common purpose which is our inheritance from the tribal society and which we still find breaking through everywhere.

In short, "social justice" is all about not Christ but moral tribalism, coercion and control. Specifically government control. It is about imposing the will of the left on you -- and your task is to sit down and shut up.

written by Sue, June 01, 2012
It sounds like you're trying to say why the Catholic Church can't emulate the Amish in opting out of Obamacare - basically because we're too big and it would take too much bureaucracy. Bureaucracy and cost does indeed seem to be why the American Church establishment is trying to get out of healthcare (by throwing it to Obamacare), but if they don't want to run healthcare themselves, they should at least protect individual Catholics from the punitive effects of Obamacare by tilting things towards the Amish, subsidiary model.

A big part of the deal is for USCCB to get out of bed with Leviathan. And for Big Church Charity to stop taking money from Gov and start taking it from the Little People she is supposed to represent. So many people fail to contribute to the Catholic Charities because they sense a loss of mission and they don't want to throw good money after gov's. Purifying the charity so that it runs only on church-donated fuel would make it much more efficient. Even if it's not tax-deductible.

Also, getting out of the insurance business would make a big savings - getting rid of the third party payor makes people responsible for tracking their own costs and risks. If the services are dispensed as charity rather than an entitlement, there is more likely that a client will care about his benefactors and not look to game them. Look for a big decline in teen premarital sex, for example, if the fornicators have to face their congregation for help instead of getting their foodstamp charge-card from the anonymous welfare complex.

We do need tort-reform. The only reason Obamacare doesn't have to worry about tort reform is because they get rid of liability the same way government schools do - voila, it's gone! Noone can sue a public school - they are immune by government fiat. So yes, we need to fix tort reform, perhaps by allowing individuals to waive away some rights to sue for mega-billions.

Your supply-chain argument is novel, but unconvincing. Big Pharma, Big Ag, Big Education, Big Health, and Big One-World Government have made things more expensive and more harmful than they need to be, only seeming to be cheaper. Problem is, when you offshore your production capacity, you are at the mercy of others as we are now with China. There *is* a globalist agenda to worry about, and we can fight it with subsidiarity. Buy locally, learn how to garden and care for your family. Help other do so, as well - that's real charity (Big Love).

Out of the ashes of Rome, grew the monasteries. Against the flames of Islam, grew the universities and the caritas of Catholicism. Out of the ashes of Robespierre, will grow the homeschools and (real) nursing homes.
written by Peter Mains, June 01, 2012
There are many problems with this essay, but here's a glaring one.

"2) that people have a natural right to property which is necessary for human flourishing (against both socialism and laissez-faire theories)"

You don't expend any energy explaining how you separate laissez-faire economics from a right to property. Statements like this usually assume a grotesque, invented right to the property of others when it suits the ever-elusive common good. If wise men in ivory towers or the halls of government really knew what constituted the common good, then the Soviet Union would have been a smashing success.

Also, it does not necessarily follow that larger expenses can be paid for if we move to a higher level of government, civic association or church community. You have more sources of money, but also more needy people to spend it on. This type of thinking encourages the creation of flimsy pyramid schemes disguised as economic stabilization programs, requiring ever more "investors" to keep the scam going. The longer these scams last, the more devastating the effects to the citizens forced to "invest" in them.

Finally, your belief in the effectiveness and necessity of coercion to build a healthy society is misguided. Americans give huge sums of money to charitable organizations, which reflects well on us as a people. People in the heartless, laissez-faire Red States give far more than the compassionate social justice folk in the Blue States. Nevertheless, we also have huge sums taken from us on the basis of promises to take care of each and every hungry or poor person in the United States. Yet, there are still hungry and poor people who go uncared for. For all of the violence and coercion, which you endorse, we can't seem to solve the problem that you believe these evils will solve. The obvious solution is not to try to achieve good ends by evil means.

We could build a society based on love, mutual respect and personal responsibility. That would allow peaceful, civil society to fill the spaces that government so inadequately fills today. Rather, we have built ours on the exaltation of a neo-pagan state which promises to replace God as our provider. And we're surprised that this doesn't produce the desired results. We are like the boy who murdered his parents and then pleaded for leniency because he was an orphan.
written by Dan C, June 01, 2012
We have a clear view of Dorothy Day and Peter Maurin's exercise of subsidiairty. While some calls for subsidiairity are merely to substitute Big Mother Church for Big Brother government, Day and Maurin promoted "Christ rooms" and that individuals were to care for the poor.

We don't have that contact anymore. My grandmother, raising a family in the Depression would feed "the Men" off her back porch before the children got breakfast. These men were vagabonds who knew to come to her home for food, living "roughly"- drunk, high, prostitutes, etc. but welcomed at her home.

Today, we don't know the poor. They are excluded geographically from the middle class. The dioceses shut down their Churches starting 25 years ago. The poor are not in our national Church membership anymore.

This is why we are losing our faith. We have banished the poor, who have been revealed to us as Christ, from our communities and Churches.
written by petebrown, June 01, 2012
@peter Mainz.

There's only so much one can say in 800-900 words. If you read the Encyclicals I referenced or for that matter most any commentary on the period, the concern was that laissez faire was leading to excessive concentration of wealth in the hands of too few individuals. And quite pervasive was the fear (on the right) and the hope (on the left) that this would lead ultimately to the radicalization of the working classes and the establishment of new regimes which would abolish all private property. Subsidiarity is to be understood in that framework; protections rooted in natural law to the working classes squeezed between big business and the looming threat of socialism and by 1931 fascism.

I never used the terms "violence" or "coercion." I'm not sure what article you read. The "semi-compulsory" nature of a hypothetical Catholic health network would be necessary because otherwise it wouldn't work. But it would not be govt. doing the compulsion--it would be nothing more than the inner compulsion of Catholic solidarity that would be needed to get people to lay aside their own self interest on behalf of the welfare of the larger community. Much the same way as small intentional groups such as the Amish are "compelled" to take responsibility for one another by their personal investiture in their community.

The minute the young and healthy, the wealthy, and the docs and nurses began to look for better deals elsewhere, the whole thing would come apart. This is basically why the old health networks of the 19th century died out, or else just evolved into insurance companies.

Write comment
smaller | bigger

security code
Write the displayed characters


Other Articles By This Author