I pondered last month about why political Evangelical Christians seemed to be against the government’s involvement in healthcare, especially since Jesus espoused some pretty explicit positions on caring for the poor and the less fortunate. Courtesy of the Washington Post’s David Waters, I may have an answer. In a recent column on Bob McDonnell, the GOP candidate for Governor of Virginia, Waters dug up McDonnell’s thesis from his college days at Regent University (whose motto is “Christian Leadership to Change the World”). The thesis outlines the Evangelical position on the relationship of family, church and government and the limits God has imposed on those institutions.

“Each institution in society has been instituted by God for specific, limited purposes . . . Family arises out of this divinely created covenant of marriage between and man and a woman, the terms of which can neither be originally set nor subsequently altered by the parties or the state. … the family as a God-ordained government has an area of sovereignty within which it is free to carry out the duties it owes to God, society and other family members under this covenant . . . As the mouthpiece of the creator to be salt and light to individual souls and other social institutions, the church has the teaching to expound upon the scripture and along with the family to care for widows, orphans, the poor and the disadvantaged. It should be the primary source of support, counsel and restoration in the event of family dysfunction . . . The civil government was ordained to secure the inalienable rights of individuals created in the image and likeness of God, and to facilitate a society in which other institutions are free to perform their covenant duties to God and others . . . Government at all levels must ‘support family parenting as the first premise of its social, economic and fiscal policy’ . . . These three institutions interact with the compatible goal of serving other human beings and of glorifying God.”

Based on McDonnell’s thesis, it seems that it’s not that Evangelicals don’t want everyone to have healthcare. Rather, they feel it is the role of the family to provide that, and failing the family, the church should step in. In fairness, I’ve heard several conservatives make the argument that they are pro-reform, but against government intervention. I just never really understood what that meant.

The trouble is, while this may have been a good structure 2000 or even 100 years ago, it’s positively unsustainable with the costs of modern healthcare. Prior to the 20th century, if you were sick or injured, it was your family or your church that looked after you. A doctor might come in, offer some first aid and a prognosis, but after that you mostly required TLC until you either died or got better. It not only wasn’t required that you spend the family nest egg on a single member’s healthcare, it wasn’t even possible to spend that much.

Today, a single catastrophic injury or illness can easily cost 6-figures and up. A price beyond the means of most all families, and frankly, most churches as well. There are a couple of interesting examples of Christian Health Co-Ops that have been set up, but that is extra expense to the members and certainly the exception, not the rule for Christian organizations. The bottom line is that for today’s costs to be viable, they have to be spread over a very large population. Certainly a group larger than even the largest religious congregations.

While extrapolating the thesis would tend to suggest the existence of 40 million uninsured Americans is a failure of families and churches, not the state, that wouldn’t be fair. Healthcare costs cannot reasonably be borne by families or churches, which only leaves the state. Reading between the lines of McDonnell’s thesis, I would conclude that the institutions of family, church, and state form concentric support rings around an individual. It is not that they are three separate entities relative to their responsibilities to the individual. Rather they just exist at different distances from the individual, and each encompassing larger and larger groups to which they must be beholden. When you are in need, turn to the family first. They are likely to be most interested in your well-being, and will sacrifice the most to insure it. If the burden is too great for them to bear, or if they drop the ball, turn to the church. Then finally, turn to the state as a last resort.

I would argue that healthcare is a sufficiently large burden to warrant it falling on the state. It certainly exceeds the capacity of the church or the family. So arguing that healthcare is the responsibility of families or churches and not the government is essentially the same as arguing that not everyone should get healthcare—not a very Christian position.

But what about private insurance? Where does that fall? I would assert that private companies are orthogonal to the support structures we’re talking about here. Your family, your church, even your government feels an obligation to you based merely on your existence. Meanwhile, a company’s obligation to you extends only as far as your wallet. If you’re out of money, they are out of compassion. There is no such thing as the moral obligation of a capitalistic entity. The people running it may have moral obligations, but he institution does not. Private companies may be used as instruments by family, church, or government, but they are not a substitute for any of them. For example, the church might obtain a group policy and help it’s poorer members pay the premiums, but the support group in this case is the church, not the insurance company.

Based on this, it’s difficult to see why there is so much fear and loathing over government involvement in healthcare or other matters of public welfare. That is, unless you consider that these folks no longer consider that the government is ultimately them. Perhaps they believe the government is no longer an extended family of sorts, but is more of an occupying force, interested only in its own self interest rather than in the well-being of its citizens. In their world, it is the family, the church, and then nothing.

Perhaps the teachable moment from all the healthcare hullabaloo is not that there is disagreement over policy points, but that a non-trivial portion of the population feels disconnected and disenfranchised from the state. It is not enough to make people who feel that way a part of the discussion. Rather, they have to be made to feel a part of the family. Only then will they trust your motives enough to listen.