Since the first decades of the last century, Catholic social teaching has used the concept of “subsidiarity” to respond to this overlapping of interests. At a time when the totalitarian twins of Fascism and Communism threatened to swallow up all independent civil institutions, Pope Pius XI issued the encyclical Quadragesimo Anno in 1931. Although it sounds like a highly complex term, subsidiarity is based on common sense: “If it ain’t broke, don’t fix it.”

If parents can take care of the health needs of their children, there is no need to create governmental agencies to interfere with family relationships. However, when the family does not have the resources for health care, then it falls to the community of the larger society to provide for care. So goes the Church’s teaching from the 1930s down to the present day.

What is changing is the inadequacy of the modern family to supply for the complex, sophisticated and usually expensive aspect of health care. For example, there was a time in which family meant grandmoms, uncles, aunts, cousins and in-laws. The family had day care attendants, people to come in and cook or clean for the bed ridden, and chauffeurs to drive patients to hospitals during the work week. Members of the extended family did all these things. Among many ethnic cultures such as my own, this is still an active set of values.

However, we live in a different time. Blessed Pope John XXIII wrote Mater et Magistra in 1961 to shift more responsibility for social needs onto government while balancing that trend with an assertion of family values. This was because in the 1960s as today in the 21st century, people increasingly turn to government to take up the functions of the fading extended family. This is OK in my book. In a democratic society, the government is supposed to represent the people. In principle, there is nothing contradictory for the people to assign tasks to that government, especially when pooling resources makes something like health care more efficient and less costly.

One of the great concerns of people of faith is how to confront the uneven record of government agencies. While they can supply better resources than the family on matters like health care, the agencies do not always act in loco parentis. Instead of providing care as if it were the extension of a mother’s and father’s concern, it sometimes happens that the government agency usurps the prerogatives of the family. This is not an easy conflict to resolve.

For instance, a 14 year old girl requires permission from the parent to have her ears pierced at the mall, but an 11 year old can get birth control pills at school without the agency advising her parents. Something is wrong here. Moreover, it is not just a religious issue. I want to focus in on things that are different from, let us say, the objection of a Jehovah’s Witness to having a child make the pledge of allegiance or receive an emergency blood transfusion. Some parental health questions are particular to a denomination or faith: the more difficult task is reaching agreement on the proper roles for families and governments in terms of general principles.

It is worth noting that papal encyclicals are different from pastoral letters, precisely because they are addressed to “all the world” and not just to Catholics. In other words, whether Catholic or Calvinist, atheist or wiccan, the issue of subsidiarity is a useful one in harmonizing the responsibility of the family with the concern of the larger society. In today’s political climate, when the US is finally being confronted with the need for a radically new approach to health care and health insurance, it is worth revisiting the common moral ground traced in the wisdom of the past.