A Guiding Principle to the Debate on Healthcare: the Principle of Subsidiarity

We do not need a State which regulates and controls everything, but a State which, in accordance with the principle of subsidiarity, generously acknowledges and supports initiatives arising from the different social forces and combines spontaneity with closeness to those in need.

– Pope Benedict XVI, DEUS CARITAS EST, 28


As a Catholic-American, the most frustrating thing about watching our Catholic public officials in action is that they undoubtedly fail to capture, much less present, Catholic insights that might be helpful to our American society at large. A prime example of a missed opportunity is that Catholic members of Congress have utterly failed to raise an aspect of Catholic Social Teaching that is particularly instructive in the current healthcare debate – the Principle of Subsidiarity.

As a preliminary matter, given the anti-Catholic bias in many circles, I must point out that the Catholic Church has no desire to gain power over the State, or even impose its teachings on those who do not share our Faith. Nevertheless, the Church offers her various social teachings, such as the Principle of Subsidiarity, as guiding principles in order to do Her part to promote reasonable dialogue and to make the Church’s own contribution toward the common goal of a just solution to social issues such as healthcare.

The Principle of Subsidiarity, which has been an integral part of Catholic Social teaching for over a century, states that only things that need to be done at the national or “federal” level should be done by a “federal” government; and allows for things that can be done at the local or smaller level to be done at the more local and smaller units of society. Where individuals, intermediary groups, or small private groups of persons can address the particular exigencies and realities of a given situation, it is best to defer to such smaller groups because human beings need some flexibility and autonomy in order to effectively address their particular circumstances.

As with all things Catholic, Pope Benedict XVI describes it best when he summarizes the Principle of Subsidiarity as “the coordination of society’s activities in a way that supports the internal life of the local communities.” As if he were acutely aware of the genius of our American system (i.e., a system which has successfully balanced federal, state and private initiatives for over two hundred years) the Holy Father observes that the principle of subsidiarity helps governments at the national level “attune themselves to the natural human desire for self-governance.” The Holy Father most recently pointed out that the principle of Subsidiary prevents a completely dehumanizing and “all encompassing welfare state,” which inevitably leads to a form of “paternalist social assistance that is demeaning to those in need.” (Caritas In Veritate, 57, 58)

Thus, the Principle of Subsidiarity can serve as a guiding principle in the Healthcare debate because it comports with our American history of governance and provides a means by which we can somehow find a middle ground between an all encompassing welfare state and a laissez fare system with no safety net for its citizens.

Moreover, the Principle of Subsidiarity provides a refreshingly non-partisan principle, as it is rooted in the common good and thus ultimately transcends political affiliations. If nothing else, the Principle of Subsidiarity offers a means of discussing healthcare in a non-caustic and principled manner. Whether we are really in a “cultural war” or not, we could use a guiding, non-politicized criterion upon which we can ground true dialogue and reasonable discussion about healthcare. Because it is a guiding principle rooted in natural law and the common good it necessarily eschews simplistic slogans and avoids the temptation of prioritizing votes and reelections over principles and justice.

Furthermore, applying the Principle of Subsidiarity to healthcare can also help local communities and smaller governments better coordinate their healthcare issues with other societal issues such as generating sufficient revenue for other societal and human needs. Some local communities might coordinate their approach to healthcare with their approach to immigrant workers who not only thankfully provide value and enrich their communities but obviously greatly increase societal costs such as healthcare.

Although I do not propose to have a prediction as to where the dialogue will end, I do submit that if we apply the Principle of Subsidiarity to healthcare issues, we will most fully ensure that competition in the marketplace, human and charitable initiatives and creativity can all flourish. As Pope Benedict XVI reminds us, when those responsible for the common good allow people to govern themselves and address their own problems, those public officials “leave space for individual responsibility and achievement.”

In sum, the Principle of Subsidiarity should serve as a guiding principle in the healthcare debate. I submit that the Principle of Subsidiarity can serve as our national GPS, pointing out the roads to the countless groups of Americans, who through their genius and hard work, given their own local and unique realities, will yield successful results, true and genuine reform of our healthcare system, meaningfully address the healthcare needs of persons of all ages and illnesses, and yield surprising and innovative solutions that an all encompassing welfare state simply can’t produce.


Charles J. Gernazian
Director, Catholic-American Center on Law and Religion, Inc.

Leave a Reply