Each year, Americans "render to Caesar" ungodly sums to pay for federal health insurance programs funded with taxes and increases of national debt. These programs overreach the proper role of government revealed by Scripture, which is to administer justice and deter violence.
It is easy, and right, to blame profligate politicians for squandering our children's inheritance on bad health insurance programs. But how many Christians hold themselves to an equally high standard as stewards of the dollars they spend on health care?
Increasingly, Christians are discovering the "good and faithful servant's" approach to paying for health care differs radically from the approach widely endorsed by elected officials, insurers, hospitals, providers, and patients. Meanwhile, untold numbers of Christ-followers fail to do their duty, as stewards, to eliminate wasteful health care spending from their own budgets—and from their fellow believer's budget.
Where stewardship starts
Biblical stewardship over the dollars we spend on health care starts by viewing God as the ultimate owner and supplier of wealth. Jesus said to "render to Caesar the things that are Caesar's, and to God the things that are God's" (Luke 20:25, ESV). More than a call to pay taxes, tithe or give to the needy, this is a call to steward well all that God has entrusted to us.
"The earth is the LORD's and the fullness thereof, the world and those who dwell therein," David wrote (Psalm 24:1-2). Hannah, after giving her son Samuel to serve in the priesthood, knew that the God who makes humans also "makes poor and makes rich" (1 Samuel 2:7). It was the Lord's blessing—not luck, chance, or ingenuity—of "all the work of [their] hands" that enabled the Israelites to "lend to many nations" without themselves borrowing (Deuteronomy 28:12). Surely the Lord of all, who made all, remains Lord over all he entrusts to his servants.
Viewing ourselves as stewards instead of owners doesn't take special revelation. Herman Melville's self-occupied character Captain Ahab—no servant of God, true to his biblical name—understood "I owe for the flesh in the tongue I brag with." In other words, men could not even boast, had not the Creator enabled them to speak. Similarly, every dollar banked represents an overcredit by God to creatures he created naked and from dust. (This same math, applied to our canceled debt of sin and our riches in Christ, is called the Gospel.)
Sick? Welcome to Sodom
As stewards, we should think twice before loosening our purse strings simply because providers and insurers, goaded by our elected officials, tell us to. Unfortunately, purchasing health care services today less resembles charging up God's holy hill than it does sitting, like Lot, in the gates of Sodom (Genesis 19:1). Opportunities to take and be taken from—usually the latter, for patients—abound.
Instead of offering themselves as pawns to a thieving system, faithful stewards display diligence and vigilance. Diligence means shopping around for the best value among health care providers before obtaining treatment for less urgent medical needs. Vigilance means negotiating discounts during or after the treatment of time-sensitive medical needs.
The temptation to let diligence and vigilance slack is high, regardless of whether people use insurance as their primary means of paying for health care. When sloth displaces stewardship, the result is mismanagement and waste.
An unfinished tower
For insured patients, diligence begins with counting the cost of insurance. Believers should carefully weigh the wisdom of paying insurers thousands of dollars per year just for the privilege of paying health care providers thousands of dollars per medical need.
In 2017, Obamacare Silver Plans required insured families to pay an average maximum of $13,810 toward their medical needs—in addition to paying premiums totaling $6,648 per person per year. In October, the analysis group Avalere projected average Silver Plan premiums would increase in 2018 by 34 percent, to $8,916 per person annually.
Today's health insurance model increasingly resembles the unfinished tower Jesus spoke of: "For which of you, desiring to build a tower, does not first sit down and count the cost, whether he has enough to complete it? Otherwise, when he has laid a foundation and is not able to finish, all who see it begin to mock him, saying, 'This man began to build and was not able to finish'" (Luke 14:28–30).
Understandably, believers are tiring of "building" toward insurance premiums and deductibles that never "finish" and seldom benefit them. Blindly reupping with such a system invites waste.
The price is wrong
Most members of health care sharing ministries probably exhale in relief when measuring the above insurance premiums and deductibles against their own net health care spending. But judge not. The burden of stewardship is higher for the savvy self-pay patient who "knows the right thing to do and does not do it, [because] to him it is sin" (James 4:17, NASB). As Jesus said, "From everyone who has been given much, much will be required" (Luke 12:48).
You may have a story like this one: A hospital staffer quoted me $5,000 for an MRI of my swollen knee in 2015. Had I been insured, paying this price would not have met my deductible, so my insurance benefit would have been zero. When I asked the staffer to print on paper her lowest upfront cash price for the MRI, she cut it down to less than $500—a savings of 90 percent! (Since then, doctors have informed me about facilities offering $300 MRIs).
It's not always so easy. Diligently shopping around for the best value in health care can be a chore, if only because we know most patients, and most believers, don't do it—so why should we have to? (To be good stewards.) Most Americans compare more prices Christmas shopping in December than when purchasing health care services year-round. It is easy to obtain treatment now and ask prices later.
There's the rub. Because I am a member of Samaritan Ministries International, a health care sharing ministry, failing to pursue a $4,500 discount on my MRI would have caused my Christian brothers and sisters to pay a hospital 10 times more than what the hospital needed. This would have wasted the $495 monthly shares of nine families, or the $220 monthly shares of 20 individuals. Laziness in deal-shopping and price negotiation wastes believers' money.
Ears to hear
Who knew paying for health care could be so sanctifying? Praise God it is so. For what, other than obedience, can one give to Him who owns all things—to Him who turned five loaves into a feast for 5,000?
Alas, Congress cannot perform similar miracles with its entitlement programs. A government can give to some only what it takes from others. Voters should hold elected officials accountable for overspending and underdelivering. But Christians should hold themselves accountable as well. As Jesus asked his followers, "Why do you see the speck that is in your brother's eye, but do not notice the log that is in your own eye?" (Matthew 7:3).
When it comes to purchasing health care services, the diligent deal-shopper and vigilant price-negotiator is the steward striving to hear from the Master, "Well done, good and faithful servant" (25:23).