Maybe it is because I have been working on a policy paper addressing the need for Affordable Care Act revisions to more specifically move forward with the goals of providing affordable, high-quality care to all Americans that I am thinking in terms of accountability to others when I reflect on the readings for today.  One of the articles I reviewed was published by Tom Baker in the University of Pennsylvania Law Review (Vol. 159 No. 6 June 2011).  It discusses the Affordable Care Act as “a new social contract of health care solidarity through private ownership, markets, choice, and individual responsibility (p. 1577).”  The article argues that the new responsibility we all have as citizens to be as healthy as we can reflects the influences of both health economics and health ethics.  This article informed my discussion of what accountability means in this social contract.  It is this framework that has challenged my thinking this week and informs my reflection on the readings for today in terms of accountability to others.

In the new social contract of health, we not only all have a responsibility to ourselves and to each other to be as healthy as we can be, we also have the responsibility to remove as many barriers as we can that are placed before others in their quest to be as healthy as they can be.  Because our risks and our responsibilities vary depending on our situations, The Affordable Care Act was designed to redistribute these risks and responsibilities through a social solidarity contract that also maintains the integrity of markets, private ownership, choice, and individual responsibility.  Addressing all of these social and economic priorities in the ACA was an amazing accomplishment in American democratic processes.    

I also think trying to live our lives as Christians in American society is also an amazing challenge in our society.  How is the social contract we made in the ACA similar to the covenant we have with the Lord?  How is it different?  I think it is similar when we consider that in many ways it reflects the command to love.  It is different when we consider that it reflects the need to please people focused on actuarial economics.  It was certainly a form of deliverance for many people, but it also preserved the high profit structure of the health care industry.  While studies reveal that for the time being, we can do both, there are challenges to creating a sustainable, equitable, high quality, cost-contained  health care system that preserves the high profits of some sectors of the health care system.  Defining a shared set of values and a coherent vision for the future is very difficult.   One thing does seem to be certain, and that is the vision must include the value of accountability to society for every American. 

How can we focus our faith on being more accountable in doing the work of this world?  I think the readings today point out that in seeking to be accountable to the Gospel, we need to keep focused on the truths revealed through Jesus Christ.  That means being accountable to our neighbors.  Accountability means demonstrating love in seeking truth and equity.   Today I pray for all of the Americans who labored long on the writing and enacting of the Affordable Care Act and for those who continue to work to make it both sustainable and more effective.  There are many debates and disagreements about how that should be done, but I pray those conversations will not run counter to the Gospel message to love the Lord our God with all our hearts, all our beings, all our strength, all our minds, and our neighbors as ourselves.  As Christians, we have a responsibility to love.