Steeple

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"Responding to the Crisis of Institutions:
Christian Vision and Politics"

Lecture for the
Paul B. Henry Institute for the Study of Christianity and Politics
Calvin College

March 8, 1999

Clarke E. Cochran
Professor of Political Science and
Adjunct Professor of Health Organization Management
Texas Tech University

1998-1999
Senior Research Fellow
Erasmus Institute
University of Notre Dame

 

Introduction

I am deeply grateful to Corwin Smidt for the invitation to speak with you today (and for the opportunity to talk to Center for Public Justice members and friends this evening; a different topic, by the way, so you can attend both!). It is a profound honor for me to speak under the auspices of the Paul B. Henry Institute. Paul and I were graduate school colleagues at Duke University in the 1960s. We both studied with the great Christian political theorist, John H. Hallowell. I kept in touch with Paul and Karen Henry as they came to Calvin College and as he forged a career in politics. His Christian witness in Congress was cut tragically short, but his legacy lives on in this Institute named for him. I am honored to be associated with it today.

{I do have a handout with an outline of my remarks, so you can follow along and gauge how soon you can either ask your penetrating question, or make your escape.}

Why should we care about institutions? Especially when we know in advance that they'll disappoint us and break our hearts?

You grow up in a congregation; learn the Bible there; find inspiration in the Youth leader. But you learn the leader is having an affair with one of the teens. The pastor and elders cover it up for the "good of the church."

Or you look to the denomination's hospital chaplain to help you through the lonely night of waiting as your father lies in ICU after very chancy surgery. The chaplain comes in, says a few prayers and a few cliches about all being in God's hands, and goes back to bed.

So, why should be we care about institutions? I'm spending the current academic year at Notre Dame on a research fellowship trying to figure out the answer to this question. Of course, behind framing the question the way that I did is the assumption that in fact we should care! The question is why? You may think otherwise, think that it is a mistake to invest any emotional capital in institutions. It's my job today to sketch some reasons why institutions matter to us, matter in ways deeper than accidental sentimental associations.

I have used the pronouns "we" and "us." Who is hidden within that vagueness? Christians, of which I am one, and Political Scientists, of which I also am one. So my task translates into giving reasons why Christians should build, and political scientists should study, institutions.

I will speak frequently (though not exclusively) of Catholic institutions, especially Catholic health care institutions, and for three reasons: (1) I'm Catholic, and I know these institutions best; (2) they are the focus of my particular research this year at that Catholic university down the road; and (3) other Christians can take lessons from their failures and successes.

Catholic Healthcare is Emblematic

Let me start with some examples from Catholic healthcare as a way of opening up my larger topic. Never have Catholic healthcare institutions been more resilient. They are the dominant institutions in the United States' not-for-profit hospital sector. They are among the most financially stable and the most active in mergers and acquisitions. Catholic organizations are significant players in home health, nursing homes, urban and rural clinics. In state and federal policy-making, Catholic institutions are active advocates, routinely testifying and regularly influencing legislation.

Here's a paradox. At the time of its greatest vibrancy, Catholic healthcare is preoccupied with its future, indeed with its very identity. A constant stream of articles, memos, brochures, and leadership workshops pour out of the Catholic Health Association and centers for Catholic ethics focusing on what makes Catholic healthcare "Catholic." What makes it unique? How can Catholic healthcare be preserved in the future?

There is a paradox within the paradox. As Catholic organizations and leaders struggle to define Catholic identity and the future of Catholic healthcare, they continually cite the same principles of Catholic social thought and ministry (principles, by the way, that all Christians care about): human freedom and dignity, commitment to justice and serving the poor, the common good of society, stewardship of the resources given by God, healthcare ministry to heal and to care for the suffering. Broad and deep consensus on principles should support consensus on identity. Yet, rather than solidifying the case, constant repetition seems only to deepen the sense of something missing, a nagging sense that these principles and commitments are not enough, that there is some other element, some special "glue" that holds together the principles and the diverse activities of Catholic healthcare.

Moreover, there is a sense within Catholic institutions that commitment to principles and traditions becomes lost at the operating level. When it comes to daily activities, are Catholic organizations any different from other religious or from secular counterparts? Catholic identity makes it into the hospital's brochures; does it make it into the operating rooms?

Realize that the dilemmas described for healthcare pervade other parts of the Christian Church and civil society. Realize too that the paradoxes sketched are not simply internal to healthcare. First, social services and parish/congregational life exhibit similar paradoxes. Second, these institutional paradoxes affect other religious traditions equally profoundly. Take, for example, higher education. Protestant scholars (Marsden, Noll) and Catholic scholars (Burtchaell) have documented the failures of most religious colleges and universities to respond well to the challenges of modernity. Buying into the premises of Enlightenment academic methods, in the early to mid-20th Century they abandoned distinctive religious identities and weakened denominational ties. Now they wonder about their religious identity and mission. Take, as another example, the local congregation. The growth of new "mega-churches" (Willow Creek is the most frequently cited example) challenges denominational identification and the traditional congregation committed to teaching, worship, and pastoral ministry. In order to attract the unchurched (a noble goal), have the mega-churches bought into the worst excesses of American marketing and self-help mentality? What is the future of the 21st Century congregation?

Religion and Social Capital

The issues and examples just cited are well below the radar of most political scientists, but there is one topic directly related to institutional church life that has captured their fancy. Calvin College even sponsored a conference on the topic last Fall - religion and "social capital."

Political Scientist Robert Putnam's "Bowling Alone" brought "social capital" to the forefront of popular and scholarly attention. (Putnam 1995) In brief, the concept refers to reserves of interpersonal and social trust and loyalty that any society needs for social prosperity, analogous to the reserves of financial capital necessary for economic progress. Trust generates willingness to participate in community affairs, to pay taxes, and to support the social and political institutions that organize collective action and that hold the society together.

Putnam's argument, supported by some and challenged by others, is that American social capital has been in decline for some decades, a decline manifest in such phenomena as falling membership in traditional associations such as Elks and Rotary clubs, falling levels of trust in such basic social institutions as media, Congress, business, and labor, and falling rates of political participation. "Monicagate" drove the final nail into the coffin of political trust.

Some social scientists have studied the potential of churches and other religious institutions to respond to social crises, crises that include declining social capital, but extend to juvenile crime, drug addiction, family disintegration, and general social anomie. Political scientists and sociologists have attended particularly to community-building efforts in marginal or run-down neighborhoods, in which parishes, congregations, and other religious organizations often are the only viable institutions facilitating reconstruction. (Dionne 1998) The point here is not to affirm or deny the diagnosis of crisis, but to consider the implications of widespread calls for churches directly to help to repair or to recreate the institutions of civil society and indirectly to generate the social capital necessary for social advancement.

This development in the social sciences raises fascinating questions for the political theorist (me!) interested in religion generally and faith-based institutions specifically. Suppose it were true that religious institutions are essential for community-building and social reconstruction in marginal urban and rural neighborhoods. Suppose it were true both that social capital is declining in turn-of-the-millennium America and that religious institutions are central repositories of social capital.

What are the implications for theories of church and state? One alternative might be rejection of "bright-line" separationist stances as both unworkable and damaging to democracy. If getting drug addicts into a personal relationship with Jesus Christ will cure their addiction, the argument might go, then government and the public will benefit from funding programs that do just that. Worries about separation of church and state must take a back seat to attacking our drug problems. Another response to the social capital issue could well take the opposite position: commitment to maintaining separation of church and state and its unique value for American democracy and for American religion is of the highest value. Even if funding religious institutions would reduce crime and drug addiction or better educate children, reluctantly we must be willing to pay the price of religious and political freedom by forgoing these benefits.

But there are more fundamental principles at stake when we think about religious institutions and social capital. Why, for example, accept the legitimacy of a religious contribution to civil society? Is it the business of religion to prop up any political system, including the United States? What changes in religious institutions themselves might be required to make them more efficient generators of social capital? The danger is turning faith into civil religion, an idolatrous religion of the nation that marks faith as important only when useful for secular purposes. Why should religious support of civil society be viewed as salutary, rather than as betraying the essence of faith?

The social capital debate, taken seriously then, forces us as political scientists to think afresh about classic issues of church and state, or religion and political life. Taking institutions seriously as Christians, forces us to think anew about the relationship between church and world, that ancient Christian puzzle.

Healthcare and Social Services

Now the focus of my own research has been Catholic healthcare and social service institutions. The United States provides health care and assistance with basic needs in a wide variety of ways, including direct government provision and indirect use of private, not-for-profit religious institutions. Familiar examples are church-related hospitals and nursing homes and faith-based providers of adoption, food distribution, homeless shelter, counseling, and child welfare/child care services. Catholic hospitals and Catholic Charities affiliates are key participants, but other religious traditions operate numerous institutions as part of this resource network.

{I did brief research on the Grand Rapids web site and on the Christian Reformed Church's site. The limits of the web mean that I could well have missed something important. The CRC clearly is invested in a wide variety of ministries, but does not as far as I can tell directly operate healthcare facilities. (There is Pine Rest Mental Hospital, which originated in the CRC, I'm told, by is not officially CRC, which is, according to Tom McWherter, "the CRC way.") (Note the institutional implications!) There may be analogous issues in CRC ministries for those of you who are members of that church. There is a Catholic hospital (St. Mary's Health Services) in town, with a variety of outreach clinics. The other private, not-for-profit hospital seems to have had some religious origin, but no current religious affiliation. There are a wide variety of social service organizations sponsored by or affiliated with churches.}

Religious healthcare and welfare institutions face fundamental internal and external challenges. Internally, they can no longer depend primarily upon their affiliation with particular denominations for mission and identity. The nature of these linkages and the nature of clients has changed. Until the last few decades, one could reasonably expect that (for example) a Catholic Charities agency would serve almost exclusively a Catholic clientele; that it would be staffed by Catholics, including priests, sisters, and brothers; and that its principal sources of financial support would be Catholic. None of these can any longer be assumed. Persons are served regardless of creed, and most will not be Catholic. People wearing clerical garb or habits have virtually disappeared from the scene, and the principal staff persons in many agencies are not Catholic. Government contracts have replaced religious sources of funding.

External challenges stem from basic changes taking place in family and community and in the ensemble of federal and state public assistance programs with which faith-based organizations contract. The 1996 federal welfare reform legislation and its state-based counterparts radically restructured the programmatic assumptions that characterized government-religious provider relations. Old programs disappeared; new ones with new regulations appeared. Vouchers rather than direct service contracts now fund many programs. Governments contract with secular, for-profit social service providers in addition to religious non-profits. The "Charitable Choice" provisions of the 1996 welfare reform legislation open such programs more widely to faith-based institutions, and political scientists affiliated with Calvin and with the Center for Public Justice and other Christian organizations are studying the ways in which churches are responding (or failing to respond) to this law.

Analogous changes characterize the healthcare system. Religious institutions operate approximately 15 percent of the community hospitals and perhaps 20 percent of the hospital beds in the United States. They run thousands of nursing homes, clinics, home health, and hospice services. Government and market forces, however, are fundamentally transforming the healthcare sector. Once-familiar physician offices, pharmacies, and hospitals no longer look the same or carry the same names. Mergers and acquisitions, closure or sale of hospitals, ecumenical ventures, and new financial pressures make both viability and faithfulness to religious mission questionable.

These changes spurred religious healthcare institutions to embark on quests to define their "missions," "values," and "identity." How are we, such institutions ask, different from our secular counterparts, often committed to precisely the same medical principles and codes of ethics, pursuing the same healing mission, subject to the same market pressures, and answerable to identical government regulations? Do Baptist or Methodist or Jewish hospitals respond differently from for-profit systems to managed care or to Medicare and Medicaid? If not, what is their reason for existence? If so, then precisely how, and what implications do the differences have for social service delivery and for public life?

To sum up the first half of this argument. At the very same time that many politicians and scholars look to religious institutions to address basic social concerns, those institutions experience both profound challenges and changes and undergo substantial soul-searching about their own identities. Are religious institutions distinctive? Should they be? If so, then what is the mission of such institutions in the health care and social service realm? What is their mission to the world of politics? Does that mission include, for example, direct or indirect generation of social capital for the repair of political life and community institutions? I cannot address here all of the ramifications of these questions. The book I hope to write over the next year or so will, I hope, consider most of them.

What Commitments are at Stake for Christians?

Why should we care about institutions? What Christian commitments are at stake in faith-based hospitals, nursing homes, addiction treatment centers, and family intervention programs? My contention: Social ministry and healing are constitutive of Gospel, and they require institutional expression. Certain foundational principles lead me to this conclusion.

Foundational Principles

Ministry to the poor, the suffering, the outcast is inseparable from our salvation. The most clear text is Matthew's Gospel, chapter 25, verses 31-46. You know the passage: "For when I was hungry, thirsty, a stranger, naked, sick, and in prison. . . ." Here is a "simple truth" of our faith: Our entrance into eternal life with God acutely depends upon our service to the sick, the suffering, the hungry, the outcast, and the imprisoned.

Truth is so challenging in its simplicity that we go to any lengths, fill our heads with noise, build up systems of morality and doctrine, and fight battles over the right way to worship C all to avoid coming face to face with the truth that God has a most special care for the poor, cherishes peace, and loves justice. Therefore, the truth is that we as individuals and as Church will be judged by the degree to which our care for the poor and our love of justice matches the standard set by God in His Word in Scripture and in His Word made flesh, Jesus Christ.

I sometimes imagine a grand procession into heaven. Thousands upon thousands of men and women of all ages, races, and shapes dancing into heaven at the final judgment. But since time is human, not divine, the procession really takes place in God's eternal NOW. The procession into the Kingdom is happening right now, right here, moving through all the places (like this one) where God's people assemble.

Imagine it with me. We sit in amazement as this rag-tag line dances through our midst. Jesus, of course, is at the head, as St. Paul (1 Cor 15:20ff) says, "the first fruits of those who have fallen asleep." Then the rest come through, "each one in proper order."

Now, I know only a little bit about the "proper order." I know that the first one after Christ is a thief, because it was a thief that Jesus first promised heaven. "This day you will be with me in paradise," he said to one hanging next to him.

Who comes next? The people of Matthew 25: the hungry, the thirsty, the immigrants, those so poor that they are naked, the sick, and men and women from our prisons and jails. We ache to be in that procession into paradise, but there is only one way. Someone already in the procession must recognize us and pull us in! We cannot rise and join until we are beckoned.

We watch the procession, and we hear someone shout to Jesus. "Hey, there's Virginia Alamanza. I remember when she gave my family the food it needed to make it through the week."

"Wait a minute," another hollers, "There's Joe Newmann. He helped me get my GED and find a job when I was down on my luck."

"Hey! Jesus! I recognize that man. That's Pastor Lambert. He counseled me in the state prison and walked with me to my execution."

One by one faces are recognized and names called. The poor and the forsaken will remember us, or not. They will say our names, or not. Some of us will stand up and dance into the parade. Some will not.

Left to our own devices, we don't have a clue about our salvation. According to the Gospel, we won't even recognize that we are among the elect, until we hear our name called, and even then we won't be sure how we got there! "Lord, when did we see you naked, or sick, or ....."

Now here is the point about institutions. Church agencies like Catholic Charities or Lutheran Social Services are primary entry-points into that great procession passing through our midst. Your lives and mine seldom come naturally into contact with the hungry, the naked, the stranger, the imprisoned. Our institutions of social service bring us into contact with them and give us the chance of salvation, if only we reach out our hands to their needs.

Our faith is a faith of simple truths. We do not save the poor; the poor save us and bring us into the Kingdom of God. Without Catholic Charities or the Salvation Army or Habitat for Humanity the Church would not be the Church. Your salvation and mine would be deeply in jeopardy.

This is even more true with regard to healing. Healing is a special manifestation of Jesus' own action. "Health care is holy ground," in the words of Sr. Julianna Casey. (Casey 1991, 16) Jesus healed persons with a variety of physical and (some might say today) emotional maladies: leprosy (Mt 8:1-4; Mk 1:40-42), blindness (Mt 20:29-34; Mk 10:46-52), muteness (Lk 11:14); hemorrhage (Mt 9:20-22; Mk 5:25-34); and demonic possession (Lk 9:37-43). He restored the dead to life (e.g., Mk 5:35-42). Jesus' cures were never simply for the personal, physical benefit of the one healed. They were signs of a deeper healing of soul in response to faith. The cures were also signs of the reign of God breaking into history.

Even more profoundly, Jesus does not simply heal the sick; he identifies himself with the sick. "I was sick and you visited me" (Mat 25:36). "He took our infirmities and bore our diseases" (Mt 8:17; Is 53:4). On the cross Jesus takes on the whole weight of physical and moral evil, especially suffering and death. Therefore, Christians have always imitated Jesus' healing action: from Peter in Acts to the healing ministry of monasteries to modern hospitals and clinics. Remembrance of his words and deeds becomes the holy ground of Christian healthcare ministry and public advocacy. It's no great stretch from this point to institutions, for 20th and 21st century healing needs lots of money, medical professionals organized into health care systems, and large buildings.

So Christians not only enter individually into healing ministries, they are also deeply and necessarily embedded in the healthcare system itself. This location is institutional, not simply personal or professional. Recall the thousands of Christian hospitals, clinics, nursing homes, hospices, home health care services, and other institutions large and small. Christian concern extends simultaneously to public advocacy for policies that reflect their faith and to direct service according to that same faith. Personal advocacy and personal care for the sick are not and never have been sufficient for Christian ministry. The Church has organized itself to do these things. It has developed these ministries within its own organizational structures (parish nurses, for example), or it has spun off affiliated or subsidiary institutions (hospitals and nursing homes, for example).

These institutions are testimonials to Christ's presence in the world, especially his presence to the vulnerable. The Christian community witnesses that another way of life from the life of the world, a different way of health care, is indeed possible and salvific. Faith witnesses the reality of hope in the face of pain and loss, life in the midst of suffering and death.

A Juggling Lesson

As we move toward the conclusion, here's the challenge to creative political science and creative Christianity. If you have been listening closely, you will have noticed that I have been trying (metaphorically of course) to keep five balls in the air. All political theory is a kind of juggling act. The better the theory, the more dimensions of our complex lives it can keep in the air. In case you've lost track, here they are:

1. (blue) - Christians are committed to individual service of the poor.

2. (green) - Individual service is not enough. Christians are committed to institutional ministry, precisely because such ministry witnesses Christ's saving action and connects us to the poor.

3. (purple) - Institutions become too comfortable; they lose hold of their distinctiveness. The identity of Christian institutions is always problematic. Christian institutions break the heart of Christians and give scandal to the world. They fail, but we are committed to them.

4. (bright yellow) - Government and market forces are intertwined with and challenge Christian institutions. Advocacy for public policy change is part of the mission of Christian institutions. Their location in the world of service delivery gives legitimacy to their advocacy; yet their dependence upon government monies blunts the point of their advocacy.

5. (red) - Political scientists have become interested in the potential of local religious institutions to generate social capital and restore civil society. But training Christians to be good citizens is problematic, because they may become such good citizens that they forget how to be good Christians.

How can we learn to juggle these five objects? Is there a school for Christian political jugglers? A theory of Christian juggling?

Relevance of Catholic Social Theory

Catholic social theory is remarkably pertinent to the institutional problems just described because the Catholic church combines both a long institutional history in the intersections of these problems with a long tradition of theological and political thinking about the church in the world and the purpose of politics. The institutional presence of the Catholic church in neighborhoods through parishes, in social service and welfare through Catholic Charities, and in healthcare through hundreds of institutions gives it a unique institutional perspective. The Catholic church is possibly the most institutionally focused of the Christian churches. (Cochran 1998) It has an extraordinary depth and breadth of health, social service, educational, and community organizations, including parishes, soup kitchens, parochial schools, St. Vincent de Paul Societies, AIDS ministries, hospitals, nursing homes, and family counseling centers. At the same time, lively debates within these institutions bring questions of religious identity and mission to the forefront. Controversies among Catholic social theorists furnish rich material for theoretical reflection. {I am not saying that other religious traditions don't juggle well. You'll have to judge that!}

Catholic theory is thus relevant for addressing the crises of institutions, but its own dynamics make it problematic. Catholics are embedded in the institutional world; this gives them warrant to address its challenges. But that very embeddedness generates an inertia that stymies new institutions for social service. Catholic policy advocacy too faces tensions because of the ways in which its institutions are embedded in the public world. How can Catholic institutions or leaders advocate for policy changes, perhaps sharply criticizing politicians or program administrators, without biting the hands that feed their institutions? (Alternatively, how can they bite these hands and get away with it?)

The task, then, is to establish (1) that there is indeed something in both the Catholic intellectual heritage and in Catholic institutional practice that distinctively illumines the interaction between religion and politics; and (2) that these distinctive marks suggest alternative or model practices in healthcare, social welfare, and civic life.

One aspect of the uniqueness of the Catholic tradition is that in theory and in aspiration it accommodates the tensions (intellectual and institutional) characteristic of life on the border between religion and politics. It knows how to juggle. One simple way of putting this quality of Catholicism is that it is a religion, at least with regard to institutional life, of "both/and." (McBrien 1994, p. 1190) For example, God is transcendent and immanent; faith this-worldly and other-worldly; believers are deeply realistic about human possibility and committed to saintly virtue. The Catholic church is both universal and deeply particular in culture and history, both world-wide and parish-centered. Catholics are intensely devoted to rationality and order, but also deeply respectful of history, tradition,and contingency.

Therefore, in the discussion of whether the Church is to accommodate the world as it goes about its missions of healthcare and welfare, or whether it must be a model of a new polity with practices and standards at odds with the world, the Catholic option is to affirm both horns of the dilemma. So, to illustrate, Catholics operate large social service agencies profoundly dependent upon government grants and contracts, employing persons of many and no faiths, and committed to the standards of the social work profession. Other Catholics operate Catholic Worker houses, deeply invested in opposition to the world of politics, refusing government monies and standards, and embodying a non- or even anti-professional ethos of radical solidarity with the poor. The two sides of this "both/and" approach are not, strictly speaking, contradictory, but they are in tension, particularly when changes in the institutional and political context demand institutional adaptation.

Church Institutions as Witnesses

These ecclesial implications can be suggestive only, but perhaps sufficient to engender new insights into the place of Catholic and other Christian organizations in the institutional paradoxes of modern healthcare. Catholics speak sacramental language. I cannot develop such language here, but can translate it into the more familiar vocabulary of witness.

Dutch Catholic theologian Edward Schillebeeckx famously described the church as the "earthly representation of the sign of salvation in heaven. . . ." (Schillebeeckx 1963, 51) Whatever the demands of the institutional challenges of modern healthcare, no Catholic institution is justified unless it represents or reflects the Kingdom of God; that is, institutions are to be "icons" of Christ. (Zizioulas 1985, 138ff) The political-policy-institutional task of the Church is to represent a different vision of the way the world truly is and, in aspiration, can be, a vision through the lens of the crucified and resurrected Lord. Appeals to justice or common good or human dignity are not Catholic (or Christian) unless they draw strength from and point to this Kingdom, represented in this person, Jesus Christ, now sacramentalized in this Church. The Church as sacrament of Christ (witness to Christ) persists through (changing) institutions, a sign of God's actual presence with humanity. (Rahner 1963)

In this sense the Church may be defined as the "community of competence to recognize Jesus as Risen Lord." (Sawicki 1994, 1) The recognition is two-way. The church community recognizes Jesus in the faces encountered in health care settings (for example), but church institutions also represent Jesus to the world, so that the ill and injured experience the love of Christ in those who heal.

The role of the Church is always to witness the truth of Christ; that is, to represent Christ. But not Christ outside the tensions of the world, not the Christ from above, but the Christ within, immersed in the fragments and divisions of life. (Von Balthasar 1993, esp. 85ff) It is like salt or leaven, metaphors from the Gospel that point to the Church as an "active ingredient" in the here and now. (Sawicki 1999); also (Von Balthasar 1993, 89-100) Salt and leaven flavor and energize from within. A Church of salt and leaven does not take itself or those it serves out of the world, nor tidy up the world, but rather witnesses to (represents) Christ precisely in the untidiness and the injustices of the world.

In this regard abstractions won't do. The Church cannot point to justice without being just. Hospitals cannot point to compassion without being compassionate. Christian healthcare or social service cannot point to principles without embodying the Christ who animates all principles. So there must be real people (and real institutions, structures through which real people witness in the world) ministering to other real people, mutually encountering Christ. Therefore, Christian healthcare institutions really must be different and distinctive. If Baptist hospitals look like any other hospitals, they represent not Christ, but the medical system. If Catholic hospitals are different only in their refusal to perform certain procedures, they represent only one face of Christ. We know that our institutions will fail fully to represent, fully to witness to Christ, but we are committed to them nonetheless.

Christian healthcare must be distinctive in political advocacy as well. Advocacy works to teach the whole society to see each other in a solidaristic way, to see each other as parts of the same community, with obligations of care and of justice to one another. Examples in healthcare would be lobbying for guaranteed universal health insurance, substantial funding for healthcare for the working poor, and preservation of solidaristic features of Medicare.

What's at Stake for Political Science?

One final, concluding point. I have been addressing why Christians should care about institutions. Well, political science and other social sciences too can profit from attention to religious institutions. I'll make a only a few suggestions.

The dominant topics in the study of religion and politics in America are voting patterns of religious traditions, believers' and religious elites' attitudes toward politics and policy, and the effect of the New Religious Right during the last two decades. Calvin political scientists have made vital contributions to this research. Interest group activity, especially in Washington, has received significant attention. But there has been little attention to the ways in which religious institutions think of themselves as institutions.

Political scientists interested in the role of churches and other religious organizations might well consider the ways in which such entities conceive their reasons for existence. The differences may partly explain variations in their approaches to policy arenas. That is, in addition to the theological and philosophical dimensions of the way in which different churches approach (for example) medicine, the ways in which lay persons, clergy, and social activists view (and operate) church itself can influence health care policy behavior.

There are clear differences in ecclesiology between Catholics, Mainline Protestants, Evangelicals, Jews, and so forth. These differences say quite a bit about how they behave politically. At the same time, dimensions of different policy arenas might make certain ways of doing church more or less likely to have an impact on policy. "Public church" traditions, such as the Catholic, will produce a politics different from those of more inwardly focused ecclesiastical traditions. To illustrate: a voluntaristic conception of church polity might incline evangelical Christians to establish medical missions in urban neighborhoods, but a sacramental and hierarchical conception among Catholics might produce hospitals. The kinds of institutions that evolve from contrasting church polities then place the two church types in separate spheres of interest when it comes to health care policy reform. Why do Roman Catholics and Seventh Day Adventists (proportionate to their demographics) build so many hospitals? Why does Christian Reformed Church (apparently) build none? How these differences play out in the public activity of these church bodies and their members?

What's at stake for political scientists as they attend to the intersection of faith-based institutional life with politics and public policy is the opportunity for a better empirical sense of the messy religion and politics border. Normatively, what is at stake is more complex justifications of church-state relations: neither "bright line" separationist ideology, nor a "fuzzy" accommodationism dangerous to both faith itself and to democratic politics. Religious institutions are a vital topic for social science research. This true not only for institutions that may contribute to social capital (currently fashionable), but also for institutions that challenge modern medicine or modern education or, even more radically, smuggle illegal aliens across the Mexican border or boycott college apparel sweatshops.

We have our work cut out for us as Christians and as social scientists if we take institutions seriously.

References

Casey, Julianna, IHM. 1991. Food for the Journey: Theological Foundations of the Catholic Healthcare Ministry. St. Louis: Catholic Health Association.

Cochran, Clarke E. 1998. "Taking Ecclesiology Seriously: Religious Institutions and Healthcare Policy." in Annual Meeting of the American Political Science Association. Boston.

Dionne, E.J., Jr. (Ed.). 1998. Community Works: The Revival of Civil Society in America. Washington, DC: Brookings Institution Press.

McBrien, Richard P. 1994. Catholicism. San Francisco: HarperCollins.

Putnam, Robert D. 1995. "Bowling Alone: America's Declining Social Capital." Journal of Democracy 6:65-78.

Rahner, Karl. 1963. The Church and the Sacraments. London: Burns and Oates.

Sawicki, Marianne. 1994. Seeing the Lord: Resurrection and Early Christian Practices. Minneapolis: Fortress.

Sawicki, Marianne. 1999. "Salt and Leaven: Resistance to Empire in the Street-Smart Paleochurch." in Paths the Lead to Life: The Church as Counterculture, edited by Michael L. Budde and Robert Brimlow. Albany, NY: State University of New York Press.

Schillebeeckx, E., O.P. 1963. Christ the Sacrament of the Encounter with God. New York: Sheed & Ward.

Von Balthasar, Hans Urs. 1993. Razing the Bastions: On the Church in this Age. San Francisco: Ignatius Press.

Zizioulas, John D. 1985. Being as Communion: Studies in Personhood and the Church. Crestwood, NY: St. Vladimir's Seminary Press.