Paying Others' Bills

Who pays the bills for the Peter Pans - those who refuse to grow up and accept responsibility? Is it fair to make everyone to pay for those choosing destructive behaviors?  Do those paying the bills have any standing to influence or control unhealthy choices? Is there a moral hazard that subsidizing consequences enables self-destruction, or that bill-payers will be tempted to play God? How can we address the root causes of self-destructive addictions? These are broad questions, so let us start with the payment aspect of this issue: Bills are paid by insurance companies (costs borne by the general class of insured), the government (taxpayers), and uncompensated victims and service providers. Make no mistake - institutions who pay collect funds from others or shift the burdens to others.

A CDC study estimated that excessive alcohol use cost the U.S. approximately $249 billion in 2010, of which 72% was lost productivity, 11% was healthcare, 10% was criminal justice, and 5% was motor vehicle crash-related costs. The study estimated that this averages to $2.05 per drink. A 2011 DOJ study of the economic impact of illicit drug use on American society, based on 2007 data, estimated criminal justice costs at $61 billion, health care costs $11 billion, and productivity costs of $120 billion, totaling $193 billion. Since these data are ten years old, it seems likely they have increased. A recent CDC fact sheet estimates that nearly $170 billion is spent annually on healthcare costs attributable to smoking, plus $156 billion in lost productivity due to premature death and exposure to secondhand smoke, totaling $326 billion. With an estimated 271 billion cigarettes sold in the U.S. annually, this averages to $1.20 per cigarette. A study by the Robert Wood Johnson Foundation and the Trust for America's Health estimated that the annual healthcare cost of obesity is somewhere in the range of $147 to $210 billion. The causes of obesity include diet, exercise, genetics, and disease. The annual total of all these is just under $1 trillion.

Given these costs to society, what is an appropriate response? The primary option to the status quo would be to encourage, incentivize, or force people to change their behavior. Public service announcements abound.  Some vices are taxed although perhaps not to the level of their social costs, and seldom are those tax revenues used to offset the costs of the use of the products. Higher taxes could potentially further discourage costly behaviors, but not illegal activities, such as use of non-prescription narcotics. The "war" on drugs over several decades evidences that laws and law enforcement can only go so far. In some states, death from opioids exceed deaths from motor vehicle accidents. Because of the multiplicity of causes, no simple tax levy could be tied to obesity, although a tax on dietary sugar and fat, or a subsidy of healthy foods such as fresh produce might be partly relevant.  If society as a whole pays these bills, does it subsidize and enable self-destructive behavior? Should freedom allow individuals to do things that are self-destructive regardless of whether they pay the whole freight or are not held accountable for the consequences?

Turning to the spiritual realm, how does God encourage, influence, or coerce our behavior? In the Bible, God pleads with us to walk with Him and do the things He asks. These are for our own best interests. He often rescues us from our follies. But there comes a point, if we do not listen, at which He allows us to reap what we have sown. God does not enable sin, but tries to deliver us from it. Jesus' parable of the prodigal son (Luke 15) epitomizes that He also allows us the freedom to choose poorly.

When the Israelites failed to obey God after leaving Egypt, He sentenced them to wander in the wilderness for forty years.  The entire generation of adults (except Joshua and Caleb) lacked the faith to respond to what God had already done in delivering them out of Egypt. (Numbers 14:29-35) He trained the next generation by feeding them manna daily for forty years, and they entered and conquered the promised land. (Joshua 24) After the reign of Solomon, the Israelites rebelled against God. The prophets warned and pleaded with them. Ultimately, the Israelites were taken into captivity and learned through hard labor to take God's words seriously, just as the generation that left Egypt did. (2 Chronicles 36:13-21) As Matthew Henry observed in his commentary on Nehemiah 10:31, "Those are stubborn children indeed that will not amend the fault for which they have been particularly corrected."

In the Sermon on the Mount (Matthew 5-7) Jesus invited His listeners to enjoy blessings that appear esoteric because they are spiritual. He gave approximately twenty commands, most of which are impossible for us to perform on our own. Jesus described the blessedness of those who are in God's kingdom, which is only possible by the empowerment of the Holy Spirit. The book of Acts shows the early church struggling to establish the kingdom of God against tremendous opposition. Sadly, some chose to live in the flesh. Ananias and Sapphira experienced what seems like an Old Testament judgment for their conspiracy to lie to the Holy Spirit. (Acts 5:1-10) Where was God's grace in their situation? In 1 Corinthians 5 Paul dealt with a situation of brazen immorality: Sin has consequences. Those outside the church God deals with, but sin tolerated within the church was a cancer that must be surgically removed. It was for the sake of the church, but he also directed them to deliver this brother to Satan so that his spirit could be saved.

This saga of truth or consequences is incomplete without the capstone of Paul's theological explanation. "There is therefore now no condemnation for those who are in Christ Jesus, for the law of the spirit of life in Christ Jesus has set you free from the law of sin and death." (Romans 8:1-2) Empowerment by God to do things that are good and true and holy and loving has no worldly counterpart. The world may encourage, exhort, educate, train, punish, coerce, or incentivize people to do the right thing, but only God through the Holy Spirit comes Himself inside the Christian believer to give the power to do so. Since this is voluntary, Paul pleads with his readers to allow God to do this. (Romans 12:1) We have been given a glimpse of heaven, and are invited to enter. Who paid the bill? Jesus. Jesus is not going to fix our healthcare system, or miraculously deliver from their folly those who reject Him. We can spend enormous amounts trying to alleviate consequences and reform others, but until we begin building the kingdom of God, we will not have the wherewithal to pay the bills. This does not mean political rule by believers. The kingdom of God is built in our own lives when we cooperate with God to allow the Holy Spirit to make us like Him.