Bowling Together: The Subsidiarity of Healthcare

“Make everything as simple as possible, but not simpler.” – Albert Einstein

The last five decades in America have experienced a decline in every objective measure of participation in community and civic life. In his book Bowling Alone, political scientist and Professor of?Public Policy at the Kennedy School of Harvard University, Robert Putnam documents this unfortunate deterioration of social capital. The headline of his best-selling tome underscores a trivial yet most disturbing statistic. While the number of Americans who bowl has steadily increased during the past fifty years, the number that bowl on teams has simultaneously declined. In fact, the percentage of adults who are members of a bowling league today is less than 25% of what it was in the 1960’s!

Individualism and community are complementary halves of the American character. For every myth of the self-made man and lone frontier cowboy, society simultaneously cherishes the nostalgic image of the small-town benevolent hamlet. And yet, while social, political, and cultural groups have coexisted since the beginning of the Republic, the impulse toward association has weakened and arrogant self-confident individualism now reigns supreme! As a result, the social capital of community life, so critical to democracy, is in danger of dissipating.

The current debate over the nationalization of healthcare exemplifies the aforementioned syndrome. News of the Supreme Court’s decision to uphold the 2010 Affordable Care Act (June 28, 2012) has only intensified the public argument over which legislative option best serves the needs of Americans. The Democratic pollster Douglas Schoen interviewed a sample of 600 likely voters on June 28 to discover the nation’s pulse on this controversial legal announcement.

According to Schoen’s Newsweek/Daily Beast poll, a majority of voters disapprove of the ruling, fearing that health-care costs and taxes will rise. Overall, 50% of those polled said they disapprove of the High Court’s 5–4 decision, while 45% said they support it. Consistently, a majority of voters said that they oppose the individual mandate believing that it will only make their personal health-care costs increase. Only 24% of those polled said that they believe the ruling will make the country better off.

Whatever legal or political opinion is held, the majority of Americans agree that a serious and careful dialogue is necessary. What is required during this most politically charged environment is a thoughtful conversation about the civic imperatives surrounding the healthcare issue that avoids economic hyperbole and the dialectic of conservative/liberal over-simplifications. Politicians, pundits and citizens concur, the nation must put aside its partisan penuries and learn how to once again bowl together as a team!

One of Grimm’s fairy tales illustrates what happens when alliances wane and the consequence of disparate individualism prevails.  The narrative concerns a little boy who lived with his parents and elderly grandfather. The grandfather was feeble and his hands shook. When he ate, the silverware rattled against the plate, food often missing his mouth and drink dribbling onto the tablecloth.

As a result, the boy’s parents decided to move the elderly man away from the family table. He was forced to sit on a stool in the corner of the kitchen and eat from a bowl. “From now on,” insisted the mother, “you will eat over there.” And so he did, siting alone in the corner, yet longing to join his family. One day, as his hands trembled more than usual, he dropped his bowl and broke it. The young father was furious. “If you’re going to act like a pig, you’re going to eat like one!” So he bought a wooden trough and forced his elderly father to eat from it.

Not long afterwards, the couple came upon their four-year-old son playing with some scraps of wood. When his father asked him what he was doing the little boy looked up and smiled. “I’m making a trough,” he said, “to feed you and Mamma with when I get big.” The next day the boy’s grandfather was back at the table eating with his family from a plate. No one ever ignored, scolded or mistreated him again!

What are we teaching our children about the concomitant concepts of personhood, family relations, and civic responsibility?  Most importantly, how do these inter-related domestic concepts influence our approach to the current healthcare debate? At the base of a healthy civil society is the family, the first and foremost social institution. The family is where the individual develops personhood, acquires humility, learns to take personal responsibility, and aspirers to care for others. While voters rightly intuit that a healthy citizenry primarily advances through salubrious relationships with others, scores of Americans tragically spend a majority of their time alone. Technologically linked, yet quarantined in culturally imposed cul-de-sacs of privatization, they are, in a fashion, dehumanized – bowling and dining alone on the forlorn alleyways of an over-privatized society.

The Catholic principle of subsidiarity offers a way out of this harmful dilemma! First recognized in the 1891 encyclical Rerum Novarum by Pope Leo XIII, the Catholic Church has recently reaffirmed this vital social standard, and suggested that it be considered as an alternative to the two most dominant healthcare ideologies.  While, on the one hand, some favor the impact of big enterprises such as the current government-sponsored affordable care initiative, others want to leave solutions up to the individual, to local associations, or to clever entrepreneurs. The social principle of subsidiarity is a “third way,” an option that successfully links the state with the individual by protecting the freedoms that are nourished as people interact with one another around shared interests.

The social principle of subsidiarity builds upon the classical Greek understanding of the Polis (State). According to Plato and Aristotle when government properly focuses its attention on the dignity and competency of smaller societal units, it fosters a more effective social authority and a happier and more industrious citizenry. On the other hand, inattention to local/familial matters impedes prudent and effective allocation of greater societal obligations.  However, great care should be assumed when providing services that may, in fact, make the family obsolete by providing necessities of life traditionally provided by a nurturing environment of love. The family must be helped and defended by appropriate social measures. Larger communities should take care not to usurp the family’s prerogatives or interfere in its life. Only when local communities face problems beyond their means, does the principle of subsidiarity advocate that higher-level government should provide help, but only as a temporary “subsidium” to address them.

Catholic social teaching builds on this core classical understanding by adding three interrelated principles: (a) stewardship, (b) solidarity, and (c) subsidiarity. While the values of stewardship (universal destination of goods), and solidarity (participatory collective responsibility), have long been emphasized, the critical logic of subsidiarity has been missing from the marketplace of public discourse.  In short, the principle of subsidiarity is opposed to all forms of oppressive collectivism. It sets limits to centralized governmental interventions by striving to harmonize more local alliances and relationships between individuals and societies.

The principle of subsidiarity upholds the notion that nothing should be done by a larger and more complex organization that can be done, just as well, by a smaller and simpler association. While it does not stand in opposition to government, the theory of subsidiarity does argue that the institution most competent to deal with a problem should handle it, giving priority to the institution that is closest to the problem.  Moreover, subsidiarity requires that those who are affected by policies have a voice in developing those policies. In other words, any activity that can be performed by a more decentralized entity should be welcomed. The principle of subsidiarity is a bulwark of limited government and personal freedom and includes the following four significant tenets:

  1. The person should exercise as much control as possible over his/her own destiny.
  2. Human needs should be met at the lowest possible level in the social order.
  3. Higher level governing systems should be temporary.
  4. Government should intervene only when necessary to compensate for deficiencies at lower levels.

Accordingly, as the family is considered the primary (simplest not simple) social unit in society on the subsidiarity scale, it should be given the opportunity to take care of it self. It should be allowed to develop creative solutions for living in community that will be qualitatively better than the resolutions proposed by larger disembodied institutions.  When more complex organizations begin to provide services that smaller social units are accustomed to providing and, arguably, should be providing, those lesser groups can eventually begin to atrophy. If they are not careful, the unused muscles of such smaller entities may one day require them to dine alone at the corner pig troughs of society!

Although American legislators rarely invoke the concept of subsidiarity it has been noted that the principle is deeply ingrained in the structure of our federal system. According to Lincoln, “the legitimate object of government is to do for a community of people whatever they need to have done, but cannot, or cannot so well do for themselves in their separate and individual capacities.” The 16th President of the United States insisted that government “ought not to interfere with activities that people can individually do as well for themselves!”

Experienced bowlers know that the odds of rolling a perfect “300” game are about 225,000 to one.  Imagine what it would be like to increase this difficulty by forcing a player to bowl without the ability to see the pins! In 1933, Bill Knox bowled just such a game.  He did so by pungently demonstrating the technique of “spot bowling,” the method of throwing a bowling ball at a nearby mark on the floor just beyond the foul line. A screen was placed over the farthest portion of the lane obscuring the pins, but not the closer floor indicators. Knox validated that a bowler can throw more accurately when he did not aim at the pins (further away) but at a closer mark. He proved his point by bowling a perfect game, 12 strikes in a row!

The nation’s health care debate should be similarly addressed – through the principle of subsidiarity. In fact, the current legislation should be assessed with a keen focus on the family – arguably the “closest mark” to the problem. The family is a most important societal linchpin . . . not because it is perfect, but because God’s Grace is at work within it, refining the character and dignity of each of its members. In the final analysis, civil society has a God-prescribed duty to ensure the dignity, development and care of its citizenry. The question, therefore, is not whether it should strive to do so, but rather, what is the best way for providing such a vital stewardship?

Should healthcare be distributed through private means, through local and state levels, or should it be distributed through the expansion of the national government? Whatever the outcome, a viable solution must certainly include a serious consideration of the family, as it is the most vital unit of American society – the place where each and every one of us learns and appreciates the value of bowling together.


Dr. Frank Marangos is CEO and Founder of OINOS Educational Consulting. He received a Doctors Degree in Adult Education (Ed.D.) from NOVA Southeastern University (Ft. Lauderdale, FL) and a Doctorate in Ministry and Childhood Education (D.Min.) from Southern Methodist University (Dallas, TX). He is also a Certified Charitable Estate Planner (FCEP).

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