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A provocative piece Mr. Warren. My "prebuttal" ran almost exactly 1 year ago in these very pages called "Limits of Subsidiarity." Shorter version: health insurance today is a practical necessity--assuming people want to avail themselves of the wonders of modern medicine. This implies large risk pools which have to be at least somewhat regulated and subsidized in order to prevent people from being excluded by adverse selection--by which insurance companies (just like the old friendly societies before) had trouble resisting the temptation to offer much better rates for younger healthier people. (This is great if your young and healthy but bad if you are old and/or sick or even if you are like my wife who had cancer 15 years ago and would be uninsurable without a pretty heavily regulated insurance market.) And many societies have found that simply enrolling everyone in a universal risk pool eliminates the selection problem completely as well as the free rider problem and allows the government as the monopsony buyer to drive provider rates way down...just as Walmart can get a better deal on TV sets. This is how social insurance has come about. It was not by conspiracy or historical accident. Naturally there are disadvantages to both the single payer idea as well as the patchwork private/public idea we have in the US. But they are somewhat irrelevant for this discussion because we'll never go back to a world where health care is mainly financed by families, communities, churches friendly societies etc. Modern medicine is just too expensive, communities are too frayed and churches and private institutions don't have taxing power. It's an unfortunate tradeoff of modernity but there's really nothing we can do about it as far as I can see. Which is why it would probably be more productive to focus on how we can preserve Christian ideals (charity, family, community, responsibility for self and one another) within the logic of a world in which it is inevitable that the state is going to be a big player in financing health care no matter what. For instance, the Catholic Church is still an enormous provider of medical care even though medicare and medicaid are their biggest revenue sources. Could we make hospitals even more Catholic in this world? How? That's what we should be thinking about. And just because Medicare and Medicaid are here to stay does not mean that more care could not be family based. Could Medicare partly reimburse families, say, for taking care of their own parents with Alzheimers? Would this be better than warehousing the parents in institutions? Let's think about it. From where I sit this is a more realistic answer to some of the corrosive effects of statism you rightly complain about. - petebrown