Subsidiarity and Medicaid

As part of the counter-attack which Paul Ryan and his allies are conducting against his critics, we are being informed that far from being a Galtian figure championing the virtue of selfishness against the vice of altruism, he is in fact a devoted Christian thinker concerned about how best to help the wretched of the earth.

Ryan himself, in an interview with CBN’s David Brody, made that clear:

A person’s faith is central to how they conduct themselves in public and in private. So to me, using my Catholic faith, we call it the social magisterium, which is how do you apply the doctrine of your teaching into your everyday life as a lay person?

To me, the principle of subsidiarity, which is really federalism, meaning government closest to the people governs best, having a civil society of the principal of solidarity where we, through our civic organizations, through our churches, through our charities, through all of our different groups where we interact with people as a community, that’s how we advance the common good. By not having big government crowd out civic society, but by having enough space in our communities so that we can interact with each other, and take care of people who are down and out in our communities.

Those principles are very very important, and the preferential option for the poor, which is one of the primary tenants of Catholic social teaching, means don’t keep people poor, don’t make people dependent on government so that they stay stuck at their station in life. Help people get out of poverty out onto life of independence.

This heavy thinking really impressed Wall Street Journal columnist Daniel Henninger, which took it as a sort of self-evident refutation of the idea that Ryan might be motivated by something other than tender soliticitude for the poor:

Subsidiarity—an awful but important word—attempts to discover where the limits lie in the demands a state can make on its people. Identifying that limit was at the center of the Supreme Court’s mandate arguments.

The first major use of subsidiarity as a basis for public policy was in Pope Leo XIII’s famous 1891 encyclical “Rerum Novarum” (though the word itself doesn’t appear). Leo was seeking a way to protect the dignity of human beings caught during those years in the tension between unfettered capitalism and unfettered government. “The State,” he wrote, “must not absorb the individual or the family.” Arguments over where the balance sits have raged since.

The American left thinks this debate is settled. So, for example, any hint of Supreme Court dissent from settled doctrine justifies questions about its “legitimacy.”

Oh, really, it’s “the left” that has inflexible views about centralized versus decentralized methods of governing? Let’s take something really concrete, like the Medicaid program, the primary means whereby poor people (and in particular poor seniors) in this country obtain health services. It’s a joint federal-state program administered by the states, with roughly equal financial responsibility. States still make most of the calls about eligibility for the program and the scope of services, though over the years the federal government has used “super-matches” (very generous terms of assistance) to convince states to provide more (and more uniform) coverage.

Seems pretty “balanced” between federal and state responsibilities to me, particularly as compared with, say, the Medicare program, which is entirely federal (aside from a limited state role in provider reimbursement).

Paul Ryan wants to turn Medicaid into a “block grant” while reducing its funding level by about one-third over ten years. The details of his proposal are murky, but from past conservative moves in this direction, it’s likely he’s talking about giving states a fixed, capped sum in federal funds while eliminating most conditions for its use, as a way station to total state assumption of responsibility for low-income health care needs at some point in the future. So being poor in, say, Mississippi, with a large low-income population along with a generally low standard of living and a very conservative political culture, will become–even more so than it is today–a very different proposition from being poor in New York or California.

Does Paul Ryan really think government is “crowding out” civil society, its private charities and hospitals, in addressing the health care needs of the people of Mississippi? Is federal assistance thwarting the natural generosity of the wealthy and powerful of that state, who if left to their own resources, would take care of the problem on their own? Of course he doesn’t. But he probably does truly think block-granting Medicaid would help reduce “dependence on government” by the poor, which is another way of saying they need to learn to take care of themselves, find assistance on their own, or die.

You can certainly make that helping-the-poor-by-abandoning-them argument; people have been making it for centuries. But he shouldn’t try to hide that atavistic attitude behind the skirts of Mother Church, or pretend he is engaged in a conscientious application of Catholic social teaching.

Used the way Ryan and Denninger are misusing it, “subsidiarity” simply means abandonding public responsibilities where possible and dumping them on lower levels of goverment where necessary, with total abandonment the ultimate goal.

And sorry, Denninger is off 180 degrees in his assessment of the debate over centralization and decentralization of governing responsibilities. It’s not “the left” that’s trying to relentlessly increase centralized government power, but the Right that is determined to centralize power in the weathiest regions of the private sector. Disabling public-sector programs that have been in existence for decades based on decades of Supreme Court precedents is part and parcel of that agenda. “Subsidiarity” has absolutely nothing to do with it.

Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.