U.S. Intellectual History Blog

Health Care as Theodicy

On Saturday afternoon, Vice President Mike Pence tweeted out the following: “Before summer’s out, we’ll repeal/replace Obamacare w/ system based on personal responsibility, free-market competition & state-based reform”.


The invocation of “personal responsibility” led many people to respond with examples of people whose health conditions cannot, under any reasonable set of circumstances, be considered their “personal responsibility.” How, they asked, is taking away Medicaid from children born with underdeveloped organs or costly but ultimately surmountable complications an example of promoting “personal responsibility?”

My son was in the Neonatal Intensive Care Unit for a week after his birth, so this is not a hypothetical question for me. My wife and I would not have been able to afford that week of excellent care on our own, and while my son may have been stable enough to have survived if we had to bring him home earlier, I don’t see how putting him at a heightened risk of dying would have taught anyone involved “personal responsibility,” at least as most people understand the phrase. There must be something else going on beneath this rhetoric. What would Mike Pence have said to me if the worst had happened?

Mike Pence was the Congressman from my hometown district, so I know something of the culture that formed him. In fact, my parents campaigned actively for him during his first runs for Congress, in 1988 and 1990, and I remember walking around with him and his wife at a county fair or something else involving cows and funnel cakes. (In Indiana that could be almost any event.) My parents supported him, as I believe many others did at that time, much more because of his strong Christian faith than because of anything else, perhaps because there wasn’t much else. Pence has over the years broadened his politics, becoming better versed in other areas of Republican ideology and making strong connections in the business community, but he remains, as he is famous for saying, “a Christian, a conservative, and a Republican, in that order.”

Returning to my hypothetical, Pence would no doubt have turned to the formulas of theodicy—the effort to justify the ways of G-d to man. For many Christians—and for many Jews like me—this amounts to explaining “why bad things happen to good people,” why G-d lets the righteous suffer. Typically, people reach for an explanation that has some element of a “trial” to it, or a “cross to bear”—the idea is that this misfortune or this tragedy is G-d’s way of testing our moral fiber and our trust in “His plan.” If we are truly a “good person,” that plan involves a final accounting that will rectify and compensate all our earthly suffering.

When Bad Things Happen to Good People is the title of a 1981 bestseller by the Rabbi Harold Kushner, written in response to the death of his son. But neither Kushner nor any other religious figure has written a book titled “When Good Things Happen to Bad People,” although presumably that is equally a problem for theodicy, for trying to figure out why, if G-d is all-powerful, He allows injustices to occur.[1] A good thing happening to a bad person would seem to be as much a logical problem as its obverse. Even if it can equally be silenced with a “everything will be sorted out after we die,” the itch to understand why some people get better than they deserve is undeniably there.

This uneven development—a robust theodicy for explaining why bad things happen to good people, a lack of any real effort at theological explanation going the other direction—intersects with politics, at least for some people. And rather than using my fancy learning, I’ll be anecdotal here. Growing up, many of the people—especially many of the people of faith whom I knew—were deeply concerned that some people got better than they deserved. And probably because I am a white guy, there has often been an assumption among people who take this perspective that I will share these feelings about welfare or affirmative action or immigration, so I have had many conversations—in Indiana but also elsewhere—where I have been confronted and unnerved by the violence of these people’s anger about people receiving benefits they haven’t “earned.” If they accept the idea of welfare, they’d like to see a welfare system that spends more of its money catching welfare “cheaters” than on actually keeping people from going without food.

Bad things happening to good people, in other words, they can tolerate. They have an answer for it—in their eyes a sound theological answer. It’s part of G-d’s plan and he is testing those good people. But their answer for why good things happen to bad people isn’t that G-d was testing those bad people, giving them something good to see if they’d measure up.[2] G-d really has no place in their explanation. The fault is instead always laid at the doors of some human institution, generally the “government.” It is a kind of Christianized Austrian economics: we cannot possibly know enough about G-d’s plan to copy His desired distribution of good things, so when we try, it is we who introduce imperfections. Good things happen to bad people not because it’s part of G-d’s plan but because we (or rather the state) tries to administer that plan on His behalf.[3]

What is a good person to do, then? Well, as a good person, you are entitled to try to get as much as you deserve—and that means, in this particular instance, that you are entitled to health care. And if something happens and the health care that you have isn’t enough, then you should accept it faithfully as a trial.

But you shouldn’t be so passive about bad people getting good things through state intervention. This you should stop. You should not support any program that might give good things to bad people, because that is a human error, and not a part of G-d’s plan. And that includes quality health care, which for some people would be better than they deserve.

I tend to distrust binaries—all those semesters of reading poststructuralism, I suppose—but it does seem to me fairly clear that there are some people who fixate on this problem of “cheaters”—that is, people getting “better” than they deserve—much more than others. This problem to them is where good people must intervene. It’s up to G-d to raise good people up to the level that they deserve, but it is in the hands of the good people to make sure no one gets more than they merit and, if they somehow do rise above that level, to knock them back down again.

Even the devil, it is said, can cite scripture for his purpose, but perhaps we can consider Luke 7:41-42. “A certain creditor had two debtors; the one owed ten times as much as the other.  When they were unable to pay him back, he canceled both their debts. Now which of them will love him more?” Mike Pence, that silver sepulchre, ought to read his Bible less selectively. 

[1] Sensing a good marketing opportunity, a cartooning pair did cash in on Kushner’s success with a 1983 book of caricatures titled When Good Things Happen to Bad People. But as far as I know, there isn’t a theological book with the title.

[2] Sometimes there was a tangled line of thinking that led back to a trial, but it was always the good people being tested: G-d was allowing bad people to succeed in order to test the faith of the good people: would we still believe in His plan when we saw the bad people doing well?

[3] How this all works with a strong theory of divine omnipotence is pretty murky: if G-d’s plan encompasses everything, then it already accounts for our maldistributions, our bumbling interventions. So by necessity, even if we’re the proximate cause of bad people getting good things, it’s still being allowed by G-d. But as I said, there’s not a lot of rigorous thought that goes into this side of the theodicy problem.

6 Thoughts on this Post

  1. As you might expect, I love this post.

    The very resentment against the “undeserving” is itself a serious moral problem, and one that has gotten much more ink over the centuries (starting with the gospels) than the “problem” of blessings raining down upon those who (in our judgment) don’t deserve them. (The parable of the workers in the vineyard is my favorite here.) The latter sensibility suggests a less-than-thorough grappling with the concept of grace.

    I think I’ve mentioned at this blog (or maybe elsewhere) how salient the absence of a sense of or commitment to grace is in academe, given the religious roots of our secular enterprise. (Of course, one wonders where the sense of grace is in religious communities that purportedly exist to extend its reach!) At some level, institutions and bureaucracies all sort of look alike — people are people, hierarchies are hierarchies. But the absence of a robust sense of grace has always struck me as an important locus of distinction. I’m not sure academe — or the church, for that matter — would be “improved” by an embrace of grace so much as utterly shattered by it.

    Sorry to wander afield. To bring it back home: people invoking “personal responsibility” as a justification for the ungenerous withholding of help or aid or benefits that they themselves have enjoyed might indeed be a sign of an under-explored theological problem or at least an underdeveloped theology of grace.

    I don’t know that academics need a “theology” of anything — what the hell would we do with theology anyhow? — but I do know that in a (purportedly) meritocratic system, where intrinsic worth and professional position are supposed to track together, there’s a tendency to stew over why rewards or honors are going to some “undeserving” person (instead of to me or my friends, who are of course deserving!). Left to simmer, that turns out to be a pretty bitter stew.

  2. Several things quickly came to mind for me: first, there is a conspicuous display of hubris that nonetheless serves as a veil for mendacity (and a practical ethical strategy steeped in self-deception) in the claim to “know God’s plan [i.e., mind],” as it were (time to read Job afresh). Second, the misplaced value accorded the meaning of suffering, whether one’s own or that of others, is psychologically and ethically disturbing, at least from the outside looking in. It seems to this reader that there is a much more plausible understanding of suffering within, say, the Buddhist tradition, where a fundamental aim is to understand the myriad causes of suffering and the overarching end is to eliminate (here and now) this suffering: it is true that we often are in some sense causally responsible for our own suffering, but this does not serve as either an ex ante or ex post excuse for such suffering or render it necessary, because it is in principle eliminable and we are under a spiritual obligation, first and foremost, to eliminate the suffering of others.

    That a kind of spiritual or psychological understanding or wisdom can be the result of suffering is fairly commonplace (as in the title of Jonathan Lear’s latest gem, Wisdom Won from Illness, in this case various sorts and degrees of mental disquiet or illness), but that hardly means we should welcome such suffering or see to it that others experience this suffering in order to achieve such understanding or insight, for that’s placing the proverbial cart before the horse, or an attempt to desire or will a state of affairs that should not be the product of an intentional act, a direct act of willing (unless one is ill-intentioned or evil). The wisdom that results from suffering is the by-product of efforts to give coherence to one’s experiences, experiences that have not been the sole product of our solitary efforts, however well-intentioned and often forged in conditions that are considerably bereft of full self-awareness and understanding. These conditions and circumstances are, typically, only understood by “looking backwards,” as a result of sustained self-examination or systematic reflection, or some sort of philosophical or spiritual therapy (whereby we fashion biographical narratives) that enable us to make sense of the whole picture as it were, to reveal the true cause and nature of such suffering, and the very real possibility of its transcendence, at least in the sense that it no longer crowds out the ability or capacity to view our lives in the light of those sundry values that make life worth living: “freedom, happiness, reason, love, truthfulness, being in touch with reality, and self-consciousness” (this list is from Lear, and is illustrative not exhaustive).

    If only because of genetic endowment, the constituents and plasticity of human nature, the arbitrary nature of historical circumstance and social-psychological conditions, we are never the sole author of our biographical narratives, as circumstance or situation, good and bad luck, the actions of others (and so forth), all impinge on the trajectory of our lives in such complex and often dimly grasped ways that it ill behooves us to think that others necessarily create or deserve all the suffering that comes their way or that they are constitutionally capable of “dealing” with it, or that it should serve as the requisite test of goodness or character. I believe that much of the (both blatant and pernicious) nonsense that results from what you fittingly term “Christianized Austrian economics” has its roots in the substitutionary “theory” of atonement, in other words, that horrible image or model of Christ’s redemptive suffering (‘Passion’) and Anselm’s clever but convoluted theological rendering of same (sin, guilt, and the value of redemptive suffering serve in theo-ideology and praxis to displace the Golden Rule and the double commandment of love insofar as it provides a perverted ex ante warrant for sinful behavior and ex post excuse for the failure to approach, let alone attain, the heights of love exemplified by two persons—God and Jesus—of the Trinity).* Alas, theologically, historically, and sociologically, substitutionary atonement doctrine trumped Anselm’s more Christ-like exemplary model of atonement (although it stubbornly persists if not flourishes in some quarters), the latter being intrinsically if perhaps inadvertently designed to make it difficult for us to succumb to the all-too-commonplace effects of self-deception, wishful thinking, and states of denial.

    That the Beatitudes hold out the promise of compensation for suffering after death does not mean that we should welcome the suffering of others, it rather gives spiritual meaning to or provides some solace for the unmerited or undeserved suffering that befalls us in our efforts to do good, to behave righteously, efforts that may often appear otherwise absurd, futile or fruitless.

    There are so many Gospel sayings and teachings (i.e., parables) of Jesus that are in manifest contradiction in letter and spirit to both the specific beliefs (theology, theodicy, etc.) and behavior of putative Christians like Pence that one begins to imagine the deity is playing the role of the trickster well-known to folklore and mythology. Jesus, in his life (what little we know of it) and teachings endeavored to show what it means to live with God: yet there is such a chasm between that exemplary model and the lives of more than a few (and not only) evangelical Christians in this country that I suspect this is best explained by the aforementioned irrational psychological mechanisms (i.e., self-deception, etc.) that act to construct and then fortify the power of Conservative ideology.

    * For an accounting of this doctrine’s baneful effects on Western judicial theory and criminal law, please see Timothy Gorringe’s God’s Just Vengeance: Crime, Violence and the Rhetoric of Salvation (Cambridge University Press, 1996).

    [At times above I am speaking as if I was a (what I believe to be, a true) Christian, which I am not.]

    • Excellent comment (on an excellent post)!

      I agree wholeheartedly with your distaste for the celebration of suffering. Two thoughts:

      1) In practice, Buddhism, despite its emphasis on the cessation of suffering, can often be all too accepting of the suffering of others. The traditional Buddhist universe is, in a sense, more mechanically just than the Abrahamic one(s). Karma operates automatically, like the laws of physics. There’s no higher being with a mysterious plan. In some traditional Buddhist societies, the suffering that individuals experience is seen as the playing out of karma. Things that happen to people happen to them because of things they have done in this life or earlier lives. That doesn’t make their suffering good (no suffering is). But in that view, it literally cannot be unjust.

      2) There are also Western philosophical traditions that focus on the elimination of suffering, most notably Epicureanism. It has always struck me as a more attractive Hellenistic school than Stoicism, which often seems to get better press these days.

      • First, thanks for the kind words. However, I beg to differ with you about what occurs or has occurred (generally speaking) in Buddhist societies, as the characterization of karma you make here I think better applies to (the history of) Hinduism than Buddhism (especially in societies where Mahayana, including Zen, and Vajrayana forms prevail), as karma has indeed often been viewed in mechanistic if not fatalistic terms in the former, at least up until the struggle against British colonialism (as Gandhi reminded us). Because of the understanding of the mechanisms of rebirth and causal role of karma in same in the Buddhist traditions (which, apart from Patañjali’s Yoga system, differs significantly from predominant Hindu conceptions) with respect to mental predispositions (karma being the psychological impulse, for better or worse, behind an action), it is analogous, generally speaking, to a genetic endowment conceived in non-deterministic terms, thus there is ample scope for “free choice,” albeit within constraints, no choice being absolutely free, as Sartre reminds us (‘karmic results may influence the type of action that a person tends to think of doing,’ owing to the character of mind at that point in time).

        While it is sometimes true that people (literacy and education playing a role here) think of karma in rather crude or even fatalistic terms (as in Melford Spiro’s classic study of Buddhism in Burma), by way of rationalizing passivity, for example, these views are not at all normative, doctrinally speaking. After all, the Four Noble Truths are all about how we can eliminate or transcend (overcome the causes of) suffering, as is the Eightfold Path (that is, the fourth Noble Truth, the three parts of which involve knowledge, ethics, and concentration/meditation); and the earliest analogies used in Buddhism are significantly medical or therapeutic (hence the ‘Medicine Buddha’ and Buddhism’s extraordinary influence on the Ayurvedic medical system), strikingly similar in fact to those found in some of the Hellenistic schools (as discussed by Martha Nussbaum). Peter Harvey notes that “a person never knows what aspect of any situation may have been determined by karma” (cf. the notion of ‘dependent origination’ or ‘conditioned arising’).

        Furthermore, the emphasis on the causal analysis of suffering and the capacity to counteract the causal factors (ignorance and inordinate desire or craving, i.e., ‘thirst’), are only part of the basic doctrines of Buddhism, the other two being notions of impermanence and ego-lessness.

        Finally, for ample reason there are more than a few titles exploring the compatibility of Buddhism and Psychoanalysis, where relief of suffering and achievements in self-awareness have therapeutic value and consequences for individuation that are a far cry from karma conceived in fatalistic or deterministic terms.

        Incidentally, there are therapeutic aspects to medieval scholasticism and philosophers as diverse as Spinoza, Nietzsche, James, and Wittgenstein thought of philosophy as “therapeutic,” and thus we have, so to speak, a model of philosophy that is, refreshingly, neither peculiarly Western nor Eastern. (I happen to prefer Stoicism to Epicureanism, but that’s a discussion for another time and place!)

  3. Andy, excellent questions. The political position is very much the product of a theological view as it always is in my estimation. Theodicy has been a thorn in the side of theologians since Leibniz conceived it (1710) and tried to offer rational arguments for why there was evil in the world. Voltaire satirized it his wild adventure tale Candide (1759). More recently, black theologian trying to maintain the integrity of their faith have asked if God is for black people, as they claim, why have they suffered consistently and disproportionately more than their privileged white masters. The question of theodicy became a very live idea for black intellectuals in the 1970s trying to reconcile black Christianity with black suffering. I got a chance to look at this question in my forthcoming book and found that it became a chief way for many to exit the black religion which they saw as offering a salve for suffering and not an answer. There was no answer. Philosophical humanist proposed that black suffering was brought on by people and people could solve it. No need for a theological explanation. Which gets us back to responsibility, human agency, and resistance. The question of who’s responsible is present in the healthcare debate. Thanks.

  4. Pence’s words are an abomination.

    Since my wife just delivered a pair of premature twins last week, we’ve been spending our days in our local university hospital’s neonatal intensive care unit. If it weren’t for our insurance, we’d be absolutely fucked, and so would our kids.

Comments are closed.