Most ideas work in theory (i.e., in a perfect world). The question is, how do they interact when they bump into reality?
Take the idea of small government and low taxes: we should all be responsible for our own lives and fix our own problems. It makes perfect sense. In theory.
But here’s an example that shows things aren’t so straightforward when ideas butt up against reality.
For years, my daughter required extremely expensive orthotics to try to correct the “pronation” of her feet resulting from low muscle tone and loose ligaments. This is very common for people with Down syndrome. And when I say expensive, I mean $2000-$5000 per pair. Now, we never had to pay that bill, for two reasons: 1) we have great public insurance through my husband’s work, and 2) the county where we live has a dedicated tax to fund benefits for people with disabilities. Between those two realities, we were covered. Yay for us.
But what about the vast majority of people who have neither of those advantages? They just have to figure out how to pay $2-5000 for a pair of shoes, because individuals, unlike doctors’ offices and hospitals, aren’t allowed to negotiate lower rates with insurers.
It’s a heavy burden, and it’s only one example among many, where disability is concerned. Therapies are expensive, too. OT, PT, Speech. Heart surgery. Gastrointestinal surgery. The need for adult supervision long past the age it would normally be necessary.
You can see how easy it would be to receive a prenatal diagnosis of Down syndrome and be overwhelmed by the financial burden of raising this child. How easily these realities–which simply ARE; you can’t argue them away because they’re inconvenient–can be used to justify terminating a pregnancy. The burden is real.
This was one of the first realities that made it clear to me that the idea of small government, low taxes, and personal responsibility is not necessarily conducive to a culture of life. Sometimes, in fact, it will push us the opposite direction. This example shows how a centralized, universal health care system could, in fact, support a culture of life.
Countless Church documents over the years have stressed that government is meant to be a force for good. That it has a real role in making God’s justice manifest on earth. For generations, popes have been saying this.
But the modern counter-argument is that individuals and private charity can meet this need without requiring government intervention. So let’s take a look at how that idea plays out in reality.
First: outside of the families directly impacted, who even knows this need exists? (Did you?) How is the knowledge of that need going to reach the individuals and charities who might be able to meet said need?
But, for the sake of argument, let’s say someone does learn of the need, and creates an organization to meet it. The likelihood that they’re going to create a big charity with a wide reach is extremely low; the need is too specific. So at best, they’ll probably set up a charity that deals with their particular region. Yay for the kids in that region, but what about those in the next region over?
Best case scenario, someone else hears about it and sets up an organization there, too. Which means now we have two organizations, with two different leadership, doing the same job, competing for the same pot of charitable money. And meanwhile, the people three regions over still aren’t getting any help at all.
On the other hand, if this need were acknowledged and met through a publicly-funded entity–whether that’s something like the system in place in my county, or through a “Medicare for all” kind of national system–then we are actually being MORE efficient, because we have one administration, one funding stream, and one source.
Plus, we as a society are standing up and saying–with our pocketbooks–why yes, in fact, children with disabilities DO have value, they DO a right to be here, and to live fully.
It’s human nature to want to simplify the world, but the Gospel call has to be lived out in a messy reality. If we want to make any headway at all, we’re going to have to recognize that our ideas have to be “worked out,” as Pope Francis says, in the context of an immutable reality. That means being willing to listen to and learn from those impacted by any given issue, and to compromise with those who have different ideas on how to address the same problems.