From Faith in Healthcare (https://faithinhealthcare.org):
A more detailed version of this article was previously published by our editor in the magazine Commonweal. You can read the full version on their website here.
When I worked for our local legal services program here in Indiana, we often represented clients who had profound disabilities or severe illnesses but were unable to obtain the medicine and care they had been prescribed. At the time, our state government provided very limited access to Medicaid, so these clients’ applications were routinely rejected.
Once, when one of my colleagues helped a client file an appeal of such a decision, he groaned when the case was assigned to a judge who was known for his outspoken contempt for “welfare.” After listening to a full hour of evidence about the woman’s chronic pain and her struggles to afford medication and therapy, the judge promptly denied her request for Medicaid coverage. The woman left the courtroom in tears.
As her lawyer started packing up his files, the judge lingered for a moment, and broke from his stoic demeanor. “It really is too bad what she is going through,” he said to my colleague. “Isn’t there some kind of program out there to help people like her?”
The judge did not see the irony in his remark: he meant a charity program, not the comprehensive, effective government system of care he had just blocked the woman from accessing. As for his question about the charity program, the answer was and is no. The woman was in need of years of assistance with expensive health care, not to mention housing and food she could not earn wages to pay for. No charity program could substitute for a reliable social-safety net or a job with a living wage. But that judge is just one of many people who assume that there must be a “program out there,” a charity that will come to the rescue of whoever needs rescuing.
It turns out this is a peculiarly American illusion. Most other rich countries devote far more government funding to programs that meet social needs; they do not expect charity to replace state assistance. Over the past seventy-plus years—beginning with the post-World War II Universal Declaration of Human Rights, followed by the adoption of the International Covenant on Social, Economic, and Cultural Rights—much of the world has embraced the idea that basic life necessities are a human right. Today, many countries officially recognize the rights to food, housing, and health care in their constitutions. But Americans largely shun what we call not rights, but “entitlements.” The United States has refused to ratify the social and economic rights covenant.
Private Charity as a “Moral Safety Valve”
It is not that Americans are hardhearted. We give more in private donations than the citizens of other rich nations. On average, Americans donate more than 2 percent of our overall income to nonprofit organizations, and more than half of all people in U.S. make donations.
This has been part of our culture for generations. In the early nineteenth century, Alexis de Tocqueville wrote admiringly about the eagerness of Americans to form voluntary organizations. In the years since, our country has developed a loose network of thousands of individual charities funded by tax-deductible donations.
But the private generosity of Americans, impressive though it is, does not meet the needs of America’s poor. Despite our overall wealth, we have higher poverty rates than virtually every other developed country, and millions of Americans lack access to necessities like food and safe, affordable housing. Even when charitable organizations aim their resources directly at these challenges, they tend to be more effective at responding to emergencies than at solving structural economic problems. Content with charity, we do not heed the call to justice—a call that echoes from the prophets of Jewish scripture to the Koran to modern-day popes. Soup kitchens and short-term homeless shelters proliferate, while long-term nutrition assistance and housing support are comparatively scarce.
Of course, one of the most stark failures of our charity-focused U.S. approach is in healthcare. As we have discussed in Faith in Healthcare several times, every other nation with anywhere near our resources commits to their governments guaranteeing healthcare for all. Only in the U.S. do we have millions of our sisters and brothers with no health coverage at all, or so poorly insured that the are still unable to afford medicines and care.
In her 1998 book Sweet Charity?, the sociologist Janet Poppendieck points out a more broad problem with our American preference for charity over public welfare programs. “The growth of kindness and the decline in justice are intimately interrelated,” Poppendieck writes. “This massive charitable endeavor serves to relieve pressure for more fundamental solutions.” Poppendieck extends the metaphor to argue that broad participation in—and awareness of—charitable efforts act as a “moral safety valve.”
Participating in a walk-a-thon for the homeless or clicking a box for an online donation may keep us from confronting the underlying injustice of a society where great wealth exists alongside grinding poverty. Charity may not be very effective at alleviating long-term poverty, Poppendieck says, but it is quite good at relieving our sense of guilt about it.
Until we finally catch up to our sister nations and guarantee universal healthcare, not to mention living wages and affordable housing, we owe deep gratitude to all those who provide charity help. But they are usually the first to tell us that it is not enough. Front-line heroes like Dr. James Trippi, who founded Gennesaret Free Clinics in 1988, see first-hand how their best efforts leave many, many needs unmet. “I was hoping we would be out of business by now,” he told Faith in Healthcare. “Call it what you will: Medicare for All, healthcare for all, universal healthcare. We need to get to a place in this country where medical and dental needs are taken care of.”
Leave a Reply