The FAQs: The Supreme Court Ruling on Obamacare

Note: The FAQs is TGCs new series in which we answer your questions about the latest news and current events.

The Supreme Court this morning ruled that two main provisions of the Patient Protection and Affordable Care Act of 2010 (commonly referred to as “Obamacare”) were, for the most part, constitutional. How did this happen? What does it mean for our constitutional system? Here’s a few answers.

What did the Court do?

The Court, by a vote of 5-4, held that (1) Congress had the power to impose a tax on anyone who refuses to buy health insurance and (2) Congress could vastly expand the Medicaid program, but (3) Congress could not penalize states that refused to join the expansion of Medicaid. Chief Justice John Roberts joined the four Democratic-appointed Justices, including Justice Elena Kagan (who was the Obama Administration’s Solicitor General at the time the law was written) in upholding most of the law, but joined the four other Republican appointees in limiting Congress’ power to coerce the states into accepting the expansion of Medicaid.

Wait, wasn’t this case about interstate commerce?

That was what everyone had expected. Many Supreme Court decisions are about individual rights to be free of government intrusion, but here the Court’s decision was about what the federal government had the power to do in the first place. Unlike the states, which have general “police power” to regulate anything that’s not specifically protected by individual rights, Congress has only those powers the Constitution expressly gives it. As Chief Justice Roberts’s opinion stressed, Congress’ powers “must be read carefully to avoid creating a general federal authority akin to the police power.” It’s more debatable if his resolution of the case succeeded at that task.

The main argument raised by the challengers to Obamacare was that Congress does not have the power to mandate that individuals buy health insurance. Conservatives argued that this amounts to a federal power to make people do almost anything, including eating broccoli or joining a gym, to be justified on the grounds that it affects people’s health and thus the costs of their care. The Solicitor General, on behalf of President Obama, argued that Congress had this power under the Commerce Clause, which grants Congress authority to “regulate Commerce with foreign nations, and among the several States, and with the Indian Tribes.” But the Administration was unable to explain how its view of the Commerce Clause had any limits, and Chief Justice Roberts joined the four other Republican appointees in concluding that the mandate exceeded the Commerce power.

Legally, this is a landmark victory for judicial conservatives. The Court held in two cases in the mid-1990s that the Commerce Clause does not allow Congress to regulate things like gun-free school zones and domestic violence on the theory that they “affect commerce,” but this was the first time since the 1930s that the Court held that an explicitly economic regulation went too far. The Commerce Clause has already gone very far afield from what the voters who ratified the Constitution thought they were agreeing to: the courts for 150 years had treated “Commerce . . . among the several States” as meaning only commerce that actually crossed state lines or involved transportation networks like railroads and rivers. The very first major Commerce Clause case in 1824—involving New York giving an exclusive steamboat license to Robert Fulton—had drawn a distinction between interstate commerce (which was a federal responsibility) and state “quarantine and health laws,” which “are considered as flowing from the acknowledged power of a State, to provide for the health of its citizens” and thus not a federal responsibility. Even to this day, when deciding when the states are not allowed to regulate interstate commerce, the Supreme Court uses the same basic definition.

Chief Justice Roberts’s opinion does not undo the expansion of the Commerce Clause that began during the New Deal, but it does draw a clear line as a stopping point: Congress cannot “compel individuals not engaged in commerce to buy an unwanted product,” because “[t]he power to regulate commerce presupposes the existence of commercial activity to be regulated. . . . Construing the Commerce Clause to permit Congress to regulate individuals precisely because they are doing nothing would open a new and potentially vast domain to congressional authority.” The Chief Justice noted that “the Government’s logic would justify a mandatory purchase to solve almost any problem,” such as fighting obesity “by ordering everyone to buy vegetables.” He was harsh in denouncing the pervasive nanny-state-ism the Obama administration’s arguments would justify:

People, for reasons of their own, often fail to do things that would be good for them or good for society. Those failures—joined with the similar failures of others—can readily have a substantial effect on interstate commerce. Under the Government’s logic, that authorizes Congress to use its commerce power to compel citizens to act as the Government would have them act.

That is not the country the Framers of our Constitution envisioned. . . . Accepting the Government’s theory would give Congress the same license to regulate what we do not do, fundamentally changing the relation between the citizen and the Federal Government.

. . . The Commerce Clause is not a general license to regulate an individual from cradle to grave . . .

So, why did the Court uphold the mandate?

Instead of the Commerce Clause, Chief Justice Roberts and the four Democratic-appointed justices found that the mandate could be justified because the penalty for violating it was a tax. This was something of a surprise: President Obama had loudly denied that the mandate was a tax, Congress had not treated the mandate as a tax, the Court refused to treat it as a tax for purposes of a jurisdictional statute that would have postponed decision on the issue to 2014, and the Chief Justice’s own opinion admits that the “most straightforward reading” of the statute is to treat the mandate as a mandate, not a tax. But, straining to find some justification for what Congress had done, the Court decided that it was a tax because the payment of a penalty to the IRS (determined in part by reference to your income) was the only consequence for ignoring the mandate; you can’t be sent to jail or face any other consequences as long as you pay up. In this sense, the taxing power is more limited than the Commerce Clause, which is routinely used to justify enacting criminal statutes and forests of regulation.

It’s also a politically explosive way of justifying the mandate. It flies in the face of President Obama’s famous campaign promise not to raise any taxes on anyone making under $250,000 a year, and the opinion is quite explicit about the fact that the burden of those taxes will fall heavily on young people, who are less likely to buy or need insurance. But it also places Republican presidential nominee Mitt Romney in an uncomfortable position, since his own Massachusetts health care plan had mandates that he has taken pains not to characterize as taxes. It is for precisely this reason that Justice Scalia’s dissent took issue with recharacterizing the mandate as a tax after it was passed through Congress under the pretense of being something else.

The Chief Justice concluded that, unlike the Commerce Clause, “the Constitution does not guarantee that individuals may avoid taxation through inactivity,” wryly citing to Benjamin Franklin’s observation in 1789 that “Our new Constitution is now established . . . but in this world nothing can be said to be certain, except death and taxes.” Unlike the Commerce Clause, the Court’s opinion was much vaguer in explaining what limit there may be on taxation, simply noting that at some point, punitive taxes become more “regulation and punishment” than taxes. The Court thus left open the possibility that if the mandate (or any other regulatory-minded tax) is widely ignored and Congress tried to increase the penalty, it could be declared unconstitutional in the future.

What about Medicaid?

Obamacare’s vast expansions of the multi-trillion-dollar Medicaid program are arguably much more significant than the mandate. Medicaid is jointly funded between the federal government and the states, and already consumes an ever-increasing share of state spending. Some states projected that under the new rules, which make many more people eligible for the program, Medicaid would consume around a quarter of their budgets (the average state’s share is already 20 percent). In theory, state participation is voluntary, but in practice, every state is currently in the program. Many governors, especially Republicans, balked at a huge expansion of their budgets by a program outside their control at a time when state budgets are already deeply stressed, but Congress threatened in the bill that any state refusing to agree to the new eligibility rules would lose every penny of their funding. They complained to the Court that this was a threat to independent state self-government.

The Court has warned for years that, while Congress could attach strings to federal spending, it could not simply coerce states into doing its bidding. Chief Justice Roberts, joined by Justices Breyer and Kagan and with the agreement of the four Republican-appointed Justices, finally put some teeth in this warning, holding that the size of Congress’ threat amounted to “a gun to the head” of the states that Congress could not be permitted to use. But Roberts, joined by Breyer and Kagan, concluded that Congress could reasonably threaten to withhold only the funding for the expansion of Medicaid and not pre-existing funding for the entire program. That split decision may allow some governors the wiggle room, if they want it, to say no to Congress, but it allows the budget-busting expansion of Medicaid to go forward in any state that accepts the new rules.

Are the lawsuits over Obamacare over?

The Court has spoken on the first round of challenges to Obamacare. The voters still get a say: they have already thrown out the Democratic majority in the House that voted for the bill, and if a Republican president and Senate are elected and they follow through on promises to repeal Obamacare, that will be the end of this chapter of the story. But if the statute is not repealed in its entirety, more legal challenges remain in the pipeline. Many religious organizations, led by Catholic hospitals and universities, are presently challenging on religious freedom grounds the Obama administration’s mandate to provide coverage for contraception. There are also challenges to the Independent Payment Advisory Board (IPAB), colloquially referred to as the “death panel.” The courts will still have to grapple with these challenges, and they may be resolved very differently from today’s result. Perhaps Franklin should have added that, besides death and taxes, we can be certain of more litigation.

Other Posts in this Series:

Southern Baptists, Calvinism, and God’s Plan of Salvation

Are Mormons Christian?

The Contraceptive-Abortifacient Mandate

Do Muslims and Christians Worship the Same God?

  • Joshua

    Thank you for your helpful explainations, Dan.

  • Robin

    Dan, thank you so much for simplifying the decision that was made today.

    First time visitor to this website…have it bookmarked now. Great to see a religious site focusing on current events!

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  • marylou sundt

    Why not have the top 2% pay their fair share of taxes to cover the expense of providing health insurance to all those in society that need it. Just have the top 2% pay an effective tax rate at more than the 17% that they are currently paying.

    • Ron

      The reason that the top 2% pay 17% is that most of that income is from dividends (investment). The money put into those investments are AFTER TAX income. They pay a lesser rate because the risk IMO. We want investment. It is how our economy grows. Taking more from these investors to fund another program is going to hamper growth. Without solid growth, we end up like Greece.

  • CW

    Thanks for the detailed explanation, it was very helpful to understand.

    To take a step back, what is the position of the gospel to giving medical care to more people? Is position of the gospel against additional taxes to help others in need? What scripture references can we rely on to make a sound judgement?

    • JB

      I would also like to know what the Gospel has to say about this subject

      • Joe Carter

        While there is much that could be said about the issue, I think one of the starting points is the “render unto Caesar” question. Does God consider providing medical care something that individual Christians and the church are responsible for or is it the duty of the state.

        Historically, the church has viewed that helping the sick and poor were under its sphere of influence and has taken that duty upon itself. But since the early 20th century, with the rise of the modern state, we have tended to assume that the government should take a larger role. My personal opinion is that this the wrong approach. Relying on the state to pay for healthcare means that health services are primarily “secular.” That means a holistic, gospel-centric approach to health is all but excluded from consideration.

        • vj

          Historically, the church ‘took upon itself’ the duty of caring for the sick *because* the ‘government’ of the day was authoritarian, selfish, and conducted for the benefit of the elite (think North Korea) – there was NO concept of the ‘government’ caring for all it’s citizens. However, in a modern democratic state, where ‘government’ is ‘by the people, for the people’, there is a strong case to be made for ALL citizens to be cared for…

          And what, exactly, is a ‘holistic, gospel-centric approach’ to health? How is the gospel served by NOT providing affordable (not necessarily free) healthcare (including preventative, basic, proven treatments, not just experimental and excessively expensive ones) to the people that Scripture repeatedly calls us to care for: the poor?

          • Joe Carter

            ***And what, exactly, is a ‘holistic, gospel-centric approach’ to health? ***

            A holistic, gospel-centric approach is one that considers that humans aren’t simply physical bodies but spiritual beings. The ramifications of that are hard to outline in a blog comment, but one thing it would mean is that people would be encouraged to forgoe sinful behaviors that are destroying their health.

            ***How is the gospel served by NOT providing affordable (not necessarily free) healthcare***

            I doubt you will find any TGC readers that aren’t in favor of providing affordable healthcare. But I think many people (e.g., me) recognize that the only possible way the government can make healthcare affordable for all is to ration health services. As we see in Europe, that tends to lead to worse healthcare and even immoral consequences, like the encouragement of euthanasia.

            How is the gospel served by NOT providing affordable (not necessarily free) healthcare (including preventative, basic, proven treatments, not just experimental and excessively expensive ones) to the people that Scripture repeatedly calls us to care for: the poor?

            • Nightman

              Many europeans country have longer life expectancy rates, lower infant mortality rates, less chronic diseases and do provide this care at a fraction of the cost per person. And it’s think that the governments encourage euthanasia as a way to save money.

              Health care is always rationed. It’s rationed right now, the only difference is that it’s done by your insurance company.

        • Robb

          Does the church have enough resources to fill the void of the government’s role in healthcare in a modern state? What would it look to rely on “individual Christians and the church” for healthcare?

          • Joe Carter

            I think so. The problem, though, is that it would require self-sacrifice on the part of Christians—something we are often unwilling to do. Throughout history, when Christians were much poorer than we are in America, they provided for the basic healthcare needs of their neighbors. If we really wanted to, we could do the same.

        • The Janitor

          Rather than simply asking if we should, as Christians, provide for the sick, what about whether we should require secular society to come under the Christian ethic of caring for the sick?

          The same Christians who are pro-Obamacare are usually the same ones who say that Christians should not impose their ethic or agenda upon the people through the government (gay marriage, abortion, etc). But isn’t this exactly what support for Obamacare does, when you justify it by appealing to Christian principles? Many people in our nation do not want a heath-care system with more regulation (I say more because our old and current system were never really free-market). Why are we forcing it on them with the premise that it’s “gospel-centric”?

          There are many other issues involved besides “should we care for the sick?”

          There is the issue of: will this type of healthcare decrease the quality of our health services?

          There is the issue of: is this type of healthcare even feasible for a nation carrying so much debt? (Is it fiscally responsible or irresponsible?)

        • Jay

          Relying on the state to pay for healthcare means that health services are primarily “secular.” That means a holistic, gospel-centric approach to health is all but excluded from consideration.

          Are you saying the church should help provide healthcare to all, regardless of their religious beliefs? Or that the government should provide gospel-centric health care? Clearly neither of these options are tenable.

          Apart from what the church should do, there are obviously problems with the health care system in the U.S., cost, value, equity, etc. While the current affordable care act may be flawed and could be improved upon, replaced, etc., the *secular* government will need to have a role in that.

          • Joe Carter

            ***Are you saying the church should help provide healthcare to all, regardless of their religious beliefs? ***

            My view is that Christians should help those who are too poor to pay for their own basic healthcare needs. The reality is that most Americans could pay for healthcare they just think it is something that should be paid by a third-party (either insurance or the government). We treat healthcare as a special good whose cost should be shared—forcibly as in the case of Obamacare—by all.

            ***Or that the government should provide gospel-centric health care?***

            No, that would be a role for the Church, not the State.

        • Phil


          Your approach would require that we get rid of Medicare, Medicaid and the entire VA healthcare system. I’m willing to bet there is virtually no one who wants that (even Christians).

          • Joe Carter

            Actually, my approach would alleviate much of the need for Medicare, Medicaid, VA hospitals, etc.

  • Michael Swart

    Jesus is clear that a government collects tax to do the necessary work God expects it to do. Jesus is also clear that the commandments of God, including the eighth, “You shall not steal,” have not been abolished. I wonder if when a government has raised sufficient taxes, it mismanages and squanders these and then imposes further taxes, if this is not in fact “legalized theft” and to be vigorously resisted by Christians.

    Back to medicine for the poorest. I lived in a country where “Christian” or mission hospitals with very limited resources astonished by their achievements. The government took control and now, even though the socialist government has a massive health budget, the hospitals are in a shocking state of disrepair and the various medical services dismal or non existent.

    Will Obamacare offer adequate medical cover for the poorest and be sustainable? I doubt it but I wonder if Christians should not be pointing the way to workable and compassionate alternatives.

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  • steve

    On the comment about the church’s role in healthcare, it should be noted that many denominations have done an exceptional job throughout our history of providing care to the neediest citizens. Many hospitals today were founded by Christians to serve their community.

    What the bill did not even attempt to tackle in any meaningful way was the sharply rising costs of healthcare. These rising costs will be passed on to us (both in taxes as well as insurance premiums). The healthcare question is only going to get bigger, regardless of what happens in November.

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  • Corey

    Make no mistake. This is not a “landmark victory for judicial conservatives.” While the decision to limit the commerce clause is a conservative leaning move, this is a classic activist decision. The court rewrites the statute to find the “penalty” as a tax…for the first time ever (irrespective of the fact that both Congress and the President both went on record saying it was not a tax).

    The Chief has a strategy to return the real decision making power to Congress, for sure, but this case is not an example of judicial restraint. Quite the opposite. If Roberts is correct in his gamble, citizens will revolt against this “tax,”(the largest regressive tax in the history of the world) and reform Congress. That is his plan. If it works, he will be seen as brilliant.

    In the end, if his plan does not work it will not matter that the commerce clause has been limited because now Congress can exact penalties and it will be upheld as a tax. There will be no meaningful difference between the old commerce clause of Wickard v. Filburn and the new Penalty as a tax jurisprudence.

    Could be a brilliant move but could be disastrous. In any event, this cannot be seen as an example of judicial restraint.

  • TMS

    For those of you out there saying the “church” or “Christians” should be taking responsibility for healthcare instead of the government stepping in because its what “being the church” is all about. Are you willing to chip in some extra money to ensure that is done? In other words, a self-imposed tax (or “donation” to soften it a bit)….because that is what it would take.

    What I have found is that all the people who want the government to step out and Christians/church to step in, arent willing to really do what it would take to get the job done. Therefore, the “church” isnt capable. We are to self-interested and selfish to actually make healthcare for others work.

    Time to start talking real alternatives instead of blanket, broad, unhelpful rhetoric that “the church” should do it.

  • David Baker

    Here in the UK, most evangelicals would look on with complete bafflement that any US evangelicals could be opposed to a government plan to help ensure the poorest and most vulnerable in society have adequate medical care. We are constantly amazed that the richest nation on earth, and one with the highest percentage of active Christians, is so poor at caring for its most vulnerable.

    The US currently spends roughly twice as much per capita on healthcare as the UK (source: The Times, 29.6.12) but “with no better outcomes overall.” Whatever the faults of our British National Health Service, which as a concept I should think 99.9% of UK evangelicals support, it does at least ensure some measure of care and co-ordination for the medical needs of all.

    Government is a God-given tool which can do good or evil. If it can alleviate the medical needs of the poorest and most vulnerable in society, then praise God.

    • Andy

      Similarly here in Australia, even among the most ardent capitalists and politically conservative evangelical christians it would be considered strange to not have a universal level of healthcare available to all citizens. To christians outside the USA, it seems that your theology of individual rights trumps anything about neighbourly care.

      people are encouraged here by tax penalties to take out private cover in addition to the medicare provided healtcare, but there is also a private benefit in having far shorter queues in the private system. If a country can obtain (at a far lower price than is presently possible) an excellent level of health for its citizens by engaging in a level of collective purchasing of health services, is there not some benefit in banding together?

      The UK, Australia and New Zealand all have universal medical coverage, and private property still exists there, and they aren’t bastions of communism.

      • Michael Swart

        David and Andy,
        do socialist governments across the world have a good track record of providing adequate medical services to the poorest and most vulnerable? It would appear to me that what they often offer is declining standards of treatment, longer waiting periods and the disappearance of caring. I wonder if the fact that some hospitals in the UK, Australia and New Zealand provide better medical care than many others is not due to other factors and despite socialism.

        • Andy

          Adequate: yes. Paying for every latest drug that is produced no matter what the cost and how little benefit there is in comparison to older medicines: no.

          If the USA was getting superior value for money in terms of years of life per dollar spent on healthcare, you’d expect there to be some shining difference in the demographics of the US compared to the rest of the english speaking world. Why is it that despite spending 2x the amount the british spend, americans aren’t held up as the bastions of good health?

          What is your evidence of declining standards elsewhere? Longer waiting periods than… (never getting treated as you don’t have insurance and don’t have the means of funding it yourself?)

        • David Baker

          Andy – yes, you are quite right.

          Michael Swart – the UK does not have a socialist government, and it is doubtful that any of the Labour (which is how we spell it!) governments since the 1970s have even come close to anything that a political scientist would describe as remotely “socialist” – and yet EVERY mainstream political party – Conservative, Labour, Lib Dem – and pretty much EVERY evangelical Christian group would be massively in favour of the National Health Service.

          Indeed, I can think of no Christian group or organisation I am aware of in the UK, of any denomination, which believes state provision of healthcare to be intrinsically wrong, unscriptural or ungodly in any way.

          As Andy rightly says: “If a country can obtain (at a far lower price than is presently possible) an excellent level of health for its citizens by engaging in a level of collective purchasing of health services, is there not some benefit in banding together?”

          • TPM

            Pardon me, but you guys might be missing the bigger point. Jesus said, “For I was hungry, and you gave Me something to eat; I was thirsty, and you gave Me something to drink; I was a stranger, and you invited Me in;” (Matthew 25:35 NASB). He didn’t say, you found some government worker and they helped me. He didn’t say, you voted for so and so and they helped me. He said, I was hungry and YOU gave me! It us, Christ’s followers, who are biblically responsible for caring for the poor.

            • David Baker

              @ TPIM:


              But we cannot all feed all the poor, or all help all the sick, individually. Our family sponsor a child in a poor area of the Far East through school, but we cannot, ourselves, offer medical care to all the sick of the world.

              We need to do these things together.

              This may be through individual churches, denominations, church agencies, relief agencies, and, yes, government, which is after all a God-given institution.

              The perplexity of those of us outside the US, looking in at you, is the intrinsic hostility there seems to be among Christians to seeing government as having the potential to do good in this way.

            • DRT

              We live in a democracy which means the we are the government. That is very different than in Jesus day.

        • Nightman

          how is america’s track record on providing care to the poor and vulnerable?
          Have you received treatment in one of these socialist countries where you perceived they didn’t care about you?

  • Nightman

    As we say in America “god helps those who help themselves.”

  • TPM

    I have several comments to make here but I’ll start with my main comment about the article itself:

    1) One of the big mistakes of the article is that the majority opinion was not, in fact, the opinion of the majority. It was Chief Justice Roberts’ opinion. That’s why Justice Ginsberg, in the majority, wrote a dissent to the opinion. The four Lib judges on the court (Ginsberg included) wanted to expand the Commerce Clause to allow government to force the citizens to buy anything. That’s why they voted in the majority. Roberts stands alone in his twist that this is a Tax Powers issue.

    2) The Bible is written to instruct people, not governments. It is not intended to be a manual on governing, except that it is a manual for people on how to live, and people form governments. The Bible guides our hearts and our minds on how to act and think as God wants us to act and think. So when the Bible instructs us to care for the poor, God really wants us to care for the poor. But who is us? It is those who believe in God and believe that the Bible is the Word of God (and I include my Jewish friends in that group). So the primary responsibility for caring for the poor falls to us, the Believers. We cannot abdicate that responsibility to a government. By doing so, we place the burden on people who don’t want to follow God and we also place the responsibility on people who won’t use the Bible as their motivation and guide for carrying out the care. We, the Believers (Protestant, Catholic, Jewish) must step up and do it.

    3) Most of the hospitals in this country originally were started by the Church. That is their origin. And they took care of the poor, because the Bible instructed them to. These days, most of the church-run hospitals have been bought or replaced by private, for-profit companies, and they won’t take care of the poor because it is not profitable. I am all for open commerce but it is not going to take care of the poor. Believers will need to do it by building or buying back the hospitals again.

    4) To my UK friend, yes, healthcare in the US is too expensive, but the reason for that is because of the insurance companies, not because it is an open system. What we need in the country is insurance reform, not healthcare reform.

    5) What we need even more is heart reform. We need more people to come to Christ and be transformed, stop committing insurance fraud, and start helping us take care of the poor. So let’s get out there and preach the Gospel and make disciples!

    • David Baker

      If the Bible is so clear, and there are so many Christians in the US, why are Christians not doing what you suggest already?

      And while you get yourselves organised, is it okay to dismiss the best viable alternative, ie Obamacare, and let the poorest continue to suffer ill-health and die?

    • Steve

      TPM – I could not agree with you more! The problem we have in the US and for that matter throughout the world is a heart problem. Paul in Romans 3 says it best – we have a sin problem – and not just sort of a sin problem a Romans 3:10-18 problem –

      The fact that our healthcare system is not “better” then the rest of the worlds is a sin problem. It’s not the carrying out of that healthcare, it’s the people that are a part of that healthcare. We are a gluttonous society. We are an entitled society. The US has forgotten about Jesus. NO we are not majority Christian – as a matter of fact there’s a possibility that we are one of the most secular societies in the world. Sometimes we are really good at hiding our sin.

      We, myself included, are selfish wretches that without Christ have no other choice but to go down the path of sin. Yes, the Bible is clear on caring for those who have less and are struggling. The reason why that help does not happen in the US is because often times people that call themselves Christian are too busy fighting about whether I should baptize my baby or baptize a believer or whether I should watch this movie or not this movie; or whether some notable speaker in our country or abroad is truly a Christian or not.

      It’s safe to have those battles in the media world of today. It’s not that safe to get into the life of a person who has lost their job, lost their house, lost their family and/or many of those other things.

      The Gospel says this – we are all sinners, Jesus Christ came 2000 years ago to pursue us sinners (by the way, of whom I am the worst) and to make a way for us to have a relationship with our Daddy in heaven. Who has mercy and brings calamity for His glory and His good purposes.

      I will leave you with these words from Thomas Sowell, “It is amazing that people who think we cannot afford to pay for doctors, hospitals and medication somehow think that we can afford to pay for doctors, hospitals, medication and a government bureaucracy to administer it.

      There is a reason why Christ said more about money during his time here on earth than anything else!

      • Andy

        and yet, at ~50% of the per capita investment, the far more secular, and far more antagonistic towards christian UK manages to look after its poor and marginalised. they manage to pay for their doctors, pills and the govt system to manage it all. imagine the good that could be done at the current USA investment per capita if it was used as efficiently as it could be. you could be providing healthcare to another ~350million people outside the USA. That would be a wonderful witness to the care for others that the gospel calls us to.

        I genuinely believe that it comes from americans far too often holding their individual liberties far tighter than the collective interest of their country might demand. even if the poor and downtrodden are dying in your own country, there is a sense of individuality that comes through even in many christian circles that trumps neighbourly care.

        It’s one of those situations where everyone outside the states shakes their head in bewilderment and says “only in america”

        • David Baker

          @ Andy

          Yes, here from the UK, may I add an almighty “Amen” to that…

          Well spoken!

      • Nightman

        You alone cannot afford to pay for doctors, hospitals, medication. We together can afford to pay for doctors, hospitals, medications.

        Why do you get health insurance in the first place? Because you can’t pay for it out of your own pocket, so you join an insurance company to distribute the risk and negotiate the cost. So if you have health insurance, you already admit you can’t afford it.

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