Health Policy in the Margins
Grant Martsolf, PhD, Professor, University of Pittsburgh, School of Nursing
The American healthcare system faces many challenges including escalating costs, uninsurance, inconsistent quality, and opioid addiction. In recent years, health policy scholars and practitioners have devised various payment and delivery system innovations such as pay-for-performance, accountable care organizations, prospective payment, and patient-centered medical homes. Despite many years and billions of dollars, improvements in cost and quality have been small and incremental while broad system changes have proven elusive. Advances in the well-being of the populace have been harder still. Deep and lasting changes in healthcare may require a radical shift in the very conceptual structures that guide the solutions imagined by the health policy community.
Wendell Berry has spent his career critiquing the de rigueur conceptual foundations of United States’ agricultural policy. He has argued that the field is imprisoned by a sort of “policy orthodoxy,” which he described as “science as superstition, by which one clings to the assumption of the goodness of one kind of knowledge out of fear of another kind of knowledge.” Berry argued that new approaches to agriculture can be found by examining farms found “in the margins,” those that exist in rocky soil or on hill sides. It is from these settings that new and innovative solutions can emerge.
Likewise, health policy is imprisoned by its own policy orthodoxy which focuses on leveraging the tools of social science to efficiently distribute healthcare resources to achieve improvements in physical and mental health and just income distribution. In this way, health policy orthodoxy is materialist and utilitarian to the bottom, taking little account of the deepest interior and subjective motivations and desires of the contextualized human person. Although material concerns are necessary to live a flourishing life, an exclusive focus on materiality in health policy explicitly excludes interior aspects of human experience and action such as character, meaning, and love. Given little agreement in a pluralistic society about terms like character, meaning, and love, even attempts to integrate the important role of interiority often treat interior motivations and desires (i.e., “spirituality”) abstractly and instrumentally, as factors that can exploited to achieve materialist ends. They are not treated as proper ends in themselves.
However, Catholic personalism, in the tradition of Maritain and Wojtyla, understands that interior motivations and desires are not instrumental but essential to the vision of the flourishing human person. To the extent that the health policy community desires to contribute to human flourishing, health policy must take account of the entire human person. In this paper, we examine the unique contribution that Catholic personalism can provide to health policy in United States.
For purposes of exploration and illustration, we describe one particular Christian community that works “in the margins” of the healthcare delivery system and implicitly employs a personalist vision of the human person. Specifically, we discuss the community-based healthcare delivery model practiced by the Bruderhoff, a global community of Anabaptist communitarians. We discuss how the Bruderhoff’s deeply personalist approach to health care delivery can both inform and implicate United States’ health policy.
Wendell Berry has spent his career critiquing the de rigueur conceptual foundations of United States’ agricultural policy. He has argued that the field is imprisoned by a sort of “policy orthodoxy,” which he described as “science as superstition, by which one clings to the assumption of the goodness of one kind of knowledge out of fear of another kind of knowledge.” Berry argued that new approaches to agriculture can be found by examining farms found “in the margins,” those that exist in rocky soil or on hill sides. It is from these settings that new and innovative solutions can emerge.
Likewise, health policy is imprisoned by its own policy orthodoxy which focuses on leveraging the tools of social science to efficiently distribute healthcare resources to achieve improvements in physical and mental health and just income distribution. In this way, health policy orthodoxy is materialist and utilitarian to the bottom, taking little account of the deepest interior and subjective motivations and desires of the contextualized human person. Although material concerns are necessary to live a flourishing life, an exclusive focus on materiality in health policy explicitly excludes interior aspects of human experience and action such as character, meaning, and love. Given little agreement in a pluralistic society about terms like character, meaning, and love, even attempts to integrate the important role of interiority often treat interior motivations and desires (i.e., “spirituality”) abstractly and instrumentally, as factors that can exploited to achieve materialist ends. They are not treated as proper ends in themselves.
However, Catholic personalism, in the tradition of Maritain and Wojtyla, understands that interior motivations and desires are not instrumental but essential to the vision of the flourishing human person. To the extent that the health policy community desires to contribute to human flourishing, health policy must take account of the entire human person. In this paper, we examine the unique contribution that Catholic personalism can provide to health policy in United States.
For purposes of exploration and illustration, we describe one particular Christian community that works “in the margins” of the healthcare delivery system and implicitly employs a personalist vision of the human person. Specifically, we discuss the community-based healthcare delivery model practiced by the Bruderhoff, a global community of Anabaptist communitarians. We discuss how the Bruderhoff’s deeply personalist approach to health care delivery can both inform and implicate United States’ health policy.