Misunderstanding Subsidiarity

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.