Health money can't buy: Beyond the purview of the market

September 22, 2009

The intense debates over health-care reform have brought to mind some poignant memories. When my father was in his early 40s he was diagnosed with terminal cancer. Our entire family was shaken, but perhaps no one more than Granddad and Grandma Clapp. Moving into their elderly years, they had to watch a son die.

To eke out a living, Granddad Clapp had left his family when he was 15 or 16. Coming of age during the Great Depression, he cowboyed and hired out as a farmhand. Over time he scratched together enough money to buy cropland in the Oklahoma Panhandle. He stuck with it through the monstrous dust storms of the 1930s, plowing down sand dunes on an iron-wheeled tractor. After decades of sweat and the good luck of finding oil beneath their land, Granddad and Grandma finally learned what it was like to live with plenty rather than scarcity.

So you can see why, before those terrible days of my father’s illness, Granddad Clapp in my eyes had always been a tough, stoic man of the soil. And you can understand why I was surprised that, one day when we got a few minutes alone, Granddad cried. I had never seen him weep. He put a labor-weathered hand on my knee and said, “Now I’ve got all this money. And there’s nothing I can do with it to make your dad well.” I wouldn’t have put it this way then, but Granddad had come eye to eye with the truth that many human goods—and health is one of them—cannot be comprehended or determined by money. There are limits to the reach of the market.

I was reminded of Granddad’s hard lesson in July when the Republican leader in the House of Representatives, John Boehner, railed against reform legislation that he said would force health-care professionals “to provide their Medicare patients with counseling on ‘the use of artificially administered nutrition and hydration’ and other end-of-life treatments.” This might pressure seniors “to sign end-of-life directives they would not otherwise sign.” Boehner may have spoken disingenuously, since the legislation he protested would not have mandated end-of-life counseling; instead, it would simply have had Medicare cover the costs of any such medical counseling sought by a patient on Medicare.

Whatever his intentions, Boehner issued a salutary reminder that health-care policies should not simply or primarily be decided on a monetary basis. In this regard he helpfully quoted Joseph Cardinal Bernardin’s caustic 1977 comments against policies that would “subject” human life “to a utilitarian cost-benefit calculus,” bowing before “the sacred imperative of trimming a budget.”

As Cardinal Bernardin recognized, Christians confess an ultimate economy that is not limited to commodities that can be marketed and sold. In the Christian economy, we are saved by grace, which cannot be earned or stamped with a price tag. We live by covenant rather than contract. Our highest good, to live in community as redeemed creatures, is not a good that is subject to market exchange and the laws of the marketplace.

These, surely, are basic Christian convictions. But they are not convictions easy to embrace and live out in the era of consumer capitalism. My grandfather was shaped by the ethos of a different kind of capitalism, what we might call producer capitalism.

As much as it esteemed the market, producer capitalism recognized that a number of excellent goods thrived outside the orbit of the marketplace. Many fewer practices and material goods were commodified. Relationships and other goods were priceless—that is, beyond pricing—and it was said that the best things in life were free.

The affluence following World War II began the era of capitalism centered on consumption rather than production. Promising to satisfy all desires (including many that it creates itself), consumer capitalism has assumed the status of a quasi-religion. Consumer capitalism wants all goods and relationships to come under the sway of the market. It reconfigures marriage as a contractual partnership and worshipers as church shoppers. It turns physicians’ patients into health-care consumers.

Whatever shape the legislation on health care finally takes, the debate over it occasions an opportunity for the church to recognize how much consumer capitalism pervades and rules over all our lives. It challenges Christians to put our lives (and our deaths) beside our confession that many human goods stand beyond the purview of the market and monetary valuation. Meeting these challenges would be hard work and would shatter some of the central illusions of our time. But working hard and facing illusions are building blocks of the truly good life. That’s one thing my grandfather taught me.