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Separating Charity and Health Care from the State


One of the most remarkable achievements of our American ancestors was enshrined in the First Amendment — the separation of church and state. Reflecting the notion that religious liberty was one of the natural, God-given rights to which Thomas Jefferson had referred in the Declaration of Independence, the First Amendment expressly prohibited Congress (and implicitly the entire federal government) from supporting, establishing, regulating, or interfering with religious activity.

Later, the Fourteenth Amendment was interpreted to apply the First Amendment’s separation principle to the states, which means that there is also now a constitutionally required separation of church and state at the state level. Thus, if any state or local government supports, establishes, regulates, or interferes with religious activity, people can sue in federal court and secure an injunction against the state.

It didn’t have to be that way. When the American people called the federal government into existence, they could have authorized the federal government to involve itself in religious activity and then relied on elected or appointed people to run the federal church programs or regulate religion in a sound and expeditious manner.

For example, if the Constitution had authorized it, there could have been federal churches, along with compulsory church-attendance laws for all the children in the nation. There could have been subsidies to churches. Or church vouchers for the poor to enable them to attend churches that would be constructed by the rich.

But the American people at the nation’s founding would have nothing to do with any of that. Rather than have a state churching system, which they knew would have inevitably produced perpetual conflict, discord, corruption, and crises, they decided to think at a higher level — toward a complete prohibition on government involvement in religious activity.

Critics could have raised objections to the idea of separating church and state: “Where will the poor go to church if the government isn’t building churches? What if everyone decides not to go to church? What if no one donates any money to churches? How will they survive? How will the ministers get paid? What will happen to moral and religious values?”

Of course, most Americans throughout U.S. history have considered the separation of church and state to be one of the finest gifts that those early Americans bequeathed to succeeding generations of Americans. Religious liberty — that is, the separation of church and state — has long been considered a bedrock of freedom in America.

I submit that that is precisely what Americans living today should consider doing for succeeding generations — thinking at a higher level and bequeathing a grand gift of freedom to them. Rather than remain mired in the incessant and never-ending debate over how to reform the welfare-state way of life in which we have been born and raised or over how to get “better people” into public office to resolve the never-ending conflict, discord, corruption, and crises that have come with the welfare state, Americans of today should think at a higher level, just as our ancestors did, and bequeath to succeeding generations the same type of gift that our ancestors bequeathed to us: the separation of charity and the state and the separation of health care and the state, both of which could be modeled on the First Amendment’s separation of church and state.

Separating charity and the state

I propose the following amendment to the U.S. Constitution: “No law shall be enacted by either the federal government or the state governments respecting the establishment, support, or regulation of charity, or abridging the free exercise thereof.”

Such a constitutional amendment would mean that both the federal government and the state governments would be prohibited from involving themselves in any charitable activity.

Such an amendment would constitute a revolutionary change in the nature of our political and economic system because it would necessarily mean the end of all welfare-state programs, including Social Security.

The welfare state is founded on the concept of coerced or mandatory charity. Everyone’s income becomes subject to the majority vote of people’s elected representatives in Congress. The members of Congress enact laws that take money from people, mostly in the form of taxation on income, and then give it to seniors, the poor, farmers, corporations, foreign regimes, and many others.

The notion is that welfare-state programs reflect the goodness and compassion of the American people. The members of Congress are considered good and caring people because they enact the laws. The same for the president and his welfare-state bureaucracies, who administer the welfare. The same for federal judges, who uphold the constitutionality of the welfare-state programs. The same for taxpayers, who send a portion of their hard-earned money to the Treasury.  The same for the voters, who elect the officials who bring the programs into fruition. Indeed, the same for all the American people, who are citizens in a country that has seen fit to establish a system of mandatory charity.

But important questions naturally arise: Why should people be forced to be good and caring? Why should money be forcibly taken from them and given to others? Why shouldn’t people be free to decide for themselves what to do with their own money? Given that we don’t force people to go to church, why should we force them to share their money with others? Isn’t what a person does with his own money as much a natural, God-given right as what he chooses to do with respect to religious activity?

Critics respond: If people weren’t forced to donate money to others, no one (except possibly the critic) would donate to worthy causes. The poor and the sick, they say, would be dying in the streets from starvation and illness. There would be no hospitals, schools, museums, concert halls, or charitable organizations because no one would be willing to donate to them.

Is it possible that in the absence of coerced charity everyone would be unwilling to help others in need? Of course. Indeed, it’s even possible that everyone who voluntarily donates to churches today could suddenly stop doing so, which would mean that most of the churches would have to shut down.

But what is the likelihood that those things would happen? I would argue that it’s nil, especially given the fact that there are millions of Americans who believe in the idea of a welfare state. Their concern for the less fortunate in society would not suddenly disappear simply because the government would lack the power to force them and others in society to care for others.

Moreover, if we consider the number of critics who say, “I would help but no one else would,” surely that would add up to tens of millions of people who would retain their sense of care and compassion in the absence of government force.

However, even if people suddenly became selfish, uncaring, and self-centered once the welfare state was dismantled, the fact is that free will and freedom of choice necessarily entail the right to make the so-called wrong choice. When people are forced to make what is considered by the government, the majority, or anyone else to be the right choice, then how can they truly be considered free?

The basic problem is that because Americans of today have been born and raised in a welfare state, they cannot imagine life without coerced charity. Many welfare recipients have become so dependent on governmental largess that they have convinced themselves that they would die without it. The idea of separating charity and state absolutely frightens many Americans to death.

The best example of this phenomenon is what may be called the crown jewel of the welfare state, Social Security, which is a classic example of coerced charity. Money is taken from the young and productive and given to seniors. The idea is that Social Security reflects the fundamental goodness and compassion of the American people. At the same time, people are ingrained with the notion that without Social Security, seniors would be dying in the streets in droves.

Many seniors have convinced themselves that Social Security is really a retirement program rather than a welfare program. Since they were forced to pay FICA taxes during their working years, they believe that they are simply getting their own money back with this welfare-state program.

Of course, that is totally false. Social Security is no different from any other welfare-state program, including food stamps, which many seniors find objectionable. From the very beginning, Social Security was established as a welfare program. The fact that people are forced to fund the program through some sort of special tax on their income does not affect the nature of the program. It remains a welfare program even though people are being forced to pay FICA taxes to fund it.

One of the most fascinating aspects of this is that nearly everyone in the United States, including many seniors, knows the tremendous financial difficulties that young people today are experiencing. They can’t buy homes. They can’t start families. They can’t save any money. Many of them are living at home or with roommates in their late 20s and even into their 30s.

One of the primary reasons for that is the enormous amount of money that is taken out of their income to fund welfare-state programs, especially Social Security, which, as the welfare-state’s crown jewel, is the most expensive welfare program of them all.

Many seniors steadfastly maintain their support for Social Security, notwithstanding the horrible things it is doing to the younger generations. Some Social Security recipients even have plenty of money that they have accumulated over their lifetime. Though not needing Social Security, they maintain their support for the program, notwithstanding the horrible tax burden on young people.

Would seniors be dying in the streets if Social Security were suddenly abolished? Nonsense!

Would some seniors have to go back to work? Undoubtedly, but that’s not necessarily a bad thing. In fact, recently the New York Times published an article about women in their 60s and 70s who were willingly going back to work even though they didn’t have to. Their reason? They wanted to feel like they were in the mainstream of life, interacting with others, rather than, I suppose, staying at home with nothing to do.

What about those seniors who, because of health problems, could not work and who lacked the resources to survive? That’s where voluntary charity comes into play. Private individuals and charitable organizations, including children honoring their parents on a voluntary basis by helping them out, would have to step up to help out those who are truly in need.

And isn’t that what charity and compassion are ultimately all about — the choice that comes from the willing heart of the individual rather than through the mandatory apparatus of an IRS-enforced income tax and bureaucratic welfare system?

The idea of separating charity and the state necessarily requires a radical change in thinking among the American people, one that entails a restoration of faith in freedom and free will, as well as an understanding that freedom of choice necessarily entails the right to make choices, right or wrong, when it comes to charity.

Separating health care and the state

I also propose the following amendment to the U.S. Constitution: “No law shall be enacted by either the federal government or the state governments respecting the establishment, support, or regulation of health care or abridging the free exercise thereof.”

Such an amendment would necessarily entail a separation of health care and the state, just as our ancestors separated church and state. That would mean an end to all governmental involvement in health care.

Medicare, Medicaid, and Obamacare? The amendment would automatically abolish them. With a totally free market in health care, people would be free to handle their own health-care decisions.

What about the longtime health-care crisis, which entails ever-increasing health-care costs that threaten bankruptcy for people? The health-care crisis that has besieged Americans for so long is rooted in Medicare and Medicaid, the two welfare-state health-care programs that were adopted in the 1960s. Prior to the enactment of Medicare and Medicaid, the United States had the finest health-care system in history. Health-care costs were reasonably priced. To insure against a major illness, people would buy an insurance policy for catastrophic-type illnesses.

What about the poor? Doctors and hospitals provided their services to the poor for free, especially since they were earning large amounts of money from the wealthy and the middle class.

I grew up in Laredo, Texas, which the Census Bureau in the 1950s said was the poorest city in the United States. Every day, the doctors’ offices in Laredo were filled, mostly with poor people. Not one doctor ever turned away any person for inability to pay. They treated them all, even knowing that they would never collect from many of them. Nonetheless, the doctors were among the wealthiest people in town from the money they were receiving from people who could pay.

Today, there is no Medicare or Medicaid program for dental work for seniors or the poor. Several years ago, my dentist told me that he and other dentists entered into an arrangement by which they would treat the poor for free one day a week on a rotating basis. It was entirely a voluntary arrangement. No government coercion whatsoever.

That is undoubtedly what would happen if Medicare, Medicaid, and Obamacare were abolished. These socialistic programs succeeded in destroying the best health-care system in history. And the crisis in health care is only going to get worse, as long as the American people choose to keep those welfare-state programs in existence.

On the supply side of healthcare, state governments have long maintained a health-care racket in favor of doctors and other healthcare providers in the form of occupational-licensure laws. Such laws limit the provision of health care to people who have received licenses from the state. No license, no providing of health care.

An artificially limited supply of doctors and other health-care providers necessarily means higher incomes for those who have been licensed by the state. It also means that people who choose to secure alternative methods of health care are precluded from doing so.

Why shouldn’t people be free to get any type of health care they want? Why shouldn’t they be free to provide any type of health care they want? Why shouldn’t such decisions be left to consumers and suppliers rather than the government?

Critics say, “I don’t want a quack to be doing brain surgery on me.” The response to that criticism is: Then don’t. Under a free-market health-care system, no one is forced to undergo brain surgery at the hands of a quack. Instead, people are free to get brain surgery and any other type of health care they want from whomever they want, including competent brain surgeons.

In a free-market health-care system, countless suppliers and providers would be competing in the provision of health-care services, which would tend to drive health-care prices downward. At the same time, consumers would be free to select which ones they believed were the best. That would necessarily entail research, referrals from friends and doctors, and reliance on private certifying agencies, including the American Medical Association and magazines listing the “Top 50 Doctors.”

As scary as that might sound to some people, it’s really not much different from what goes on today. It’s highly unlikely that people rely solely on the fact that a doctor has a medical license in choosing to seek his services. Usually, they rely on recommendations from their friends, other doctors, and research they conduct, especially on the Internet.

A separation of health care and the state would also entail the end of all insurance regulation, thereby enabling insurance companies to freely provide services across state lines without having to concern themselves with the burden of complying with the detailed regulations of each state. Of course, consumers would bear the responsibility of determining which insurance companies were sound and which ones were not.

A separation of health care and the state would not only restore what was once the finest health-care system in the world, it would also be a giant step in the restoration of a free society.

To those who might assert that the ideas of separating charity and the state, and health care and the state are impractical and wouldn’t work, I would remind them of the United States of America, a country in which there was an absence of Social Security, Medicare, Medicaid, medical licensure, and other federal programs entailing mandatory charity and government involvement in health care for more than a century.

In fact, that is part of what our American ancestors celebrated as freedom for more than 100 years, just as they celebrated the separation of church and state as a part of freedom. The result was the freest, most prosperous, and most charitable nation in history. What’s impractical and unworkable about that?

This article was originally published in the May 2015 edition of Future of Freedom.

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    Jacob G. Hornberger is founder and president of The Future of Freedom Foundation. He was born and raised in Laredo, Texas, and received his B.A. in economics from Virginia Military Institute and his law degree from the University of Texas. He was a trial attorney for twelve years in Texas. He also was an adjunct professor at the University of Dallas, where he taught law and economics. In 1987, Mr. Hornberger left the practice of law to become director of programs at the Foundation for Economic Education. He has advanced freedom and free markets on talk-radio stations all across the country as well as on Fox News’ Neil Cavuto and Greta van Susteren shows and he appeared as a regular commentator on Judge Andrew Napolitano’s show Freedom Watch. View these interviews at LewRockwell.com and from Full Context. Send him email.