Health Care, Race, and the Role of Government

By Efrem Smith 10-01-2009

I was recently talking with a European-American friend of mine who is also an evangelical. I am African-American and evangelical. We were talking about the tense debate going on right now about health care when he raised an interesting question about race. He told me that his big concern about the potential passing of a health-care reform bill was a government run health-care system, which would lead to bigger government. I responded by agreeing with his concerns, but stating that he should have been concerned about big government militarily during the George W. Bush years as well.

I then asked the first question: "Why do some conservatives so easily see the threat of big government when it has to do with health care, but can't see big government when it's running an expensive war in Iraq? Not many conservatives complained about how much money the war in Iraq was taking out of their pockets, but now they're angry about how much the potential passing of a health-care reform bill would. Both the management of war and health care are types of big government, leading to spending money we don't have as a country in debt."

My friend responded by asking this question: "Why do so many African-Americans trust government with health care? Why are so many not concerned about big government in this way?"

I thought this was a great question that gets to the racial divide around how some African-Americans and some European-Americans see government and corporate America from different perspectives. One of the reasons some European-Americans would rather see health care worked out in the private sector and not run by government has to do with how this country started. For many European-Americans, life in the U.S. began with a seeking of independence from European government systems and the pioneering of a new way of living based on democracy -- and maybe more importantly, the development of an economic system called capitalism. This history sheds light on why conservatives and many evangelicals today would be concerned about big government.

For African-Americans there is a history in this country which begins with slavery. The African-American begins his or her experience in the economic system of capitalism and free enterprise as the slave. From there, the experience with the economic system for many African-Americans is within a race-based, sub-system called Jim Crow Segregation. Primarily, government has been the catalyst to open the door to freedom from slavery and Jim Crow Segregation comes mainly from government. The Civil War, the Voting Rights Act, and the Civil Rights Act are all government-led realities.

Could this be the foundational reason why, in this society still influenced by race, many European-Americans are concerned about big government while many African-Americans embrace it? I believe the Church in the United States of America must rise out of being the most racially segregated institution in this nation so that it can lead conversations and forums on reconciliation. At the church where I serve as Senior Pastor, we have a class called City Matters, which seeks to raise awareness and spark reconciling discussion. We've also hosted an initiative called The Invitation to Racial Righteousness, developed by the Evangelical Covenant Church of which we are a part.

We need more churches to lead these types of initiatives. These conversations and forums could help us understand one another better. We need to move from demonizing those with different perspectives than ourselves and seek to understand the historical roots of our differences. It is possible to love God, follow Christ in a radical way, and have conversations about differing perspectives on how we view the role of government.

Efrem Smith is the senior pastor of The Sanctuary Covenant Church, with the vision to be an urban, multi-ethnic, relevant, holistic, and Christ-centered community. He has held leadership positions in organizations such as the Boys and Girls Club of America and Fellowship of Christian Athletes, and is the author of numerous articles and books, including The Hip-Hop Church. He blogs at

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