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PA Goals for the 21st Century: #3 Re-enforce the Secular Basis of the Administrative State (Part One: HealthCare)

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Erik Devereux
March 23, 2021

Secular (adj.): “Denoting attitudes, activities or other things that have no religious or spiritual basis.”

This is the third of a series of monthly columns I will write for the PA Times on the topic of setting public administration (PA) goals in the 21st century. (The first column on the need to make government data sacrosanct is online here and the second on restoring the place of administrative expertise in policy implementation decisions is here.) I am grateful to the PA Times for providing me this opportunity and I hope the readers find the goals I suggest worthy of discussion and action.

The 21st century inevitably will see two trends solidify in the United States regarding the place of religion in society and politics. As convincingly argued in their book, American Grace: How Religion Divides and Unites Us, Robert Putnam and David E. Campbell show that, across this century, a substantial majority of Americans will no longer identify as part of any faith tradition. I understand the recent prominence of evangelical Protestants in United States politics seems at the surface to contradict this trend, but the numbers are clear. Across the board, affiliation with organized religion is on the decline. One consequence is an ongoing conversation among tax policy experts as to whether churches should continue to qualify for tax-exempt status. Simultaneously, the presence of religious traditions other than Christianity and Judaism in the United States will grow as witnessed by the increasing numbers of mosques, Hindu temples, Buddhist temples and other such houses of worship in all parts of the country.

The bottom line here is that in this century most persons in the United States will not be affiliated with a religion and those that do affiliate are likely to do so outside of Christianity or Judaism. For me, this reinforces the need to ensure that public sector services across the board adhere to a completely secular standard that contains two elements:

  1. The administrative state will not discriminate based on religious beliefs.
  2. Public services will not be shaped by any religious beliefs but by science and evidence.

The first component includes that the administrative state will not enforce the doctrines of one faith tradition on the adherents of another. This is easiest to achieve if the administrative state is insulated from religion all together.

There are two domains of public services for which these standards merit continuous and intense attention at all levels of government: healthcare and education. The remainder of this column focuses on healthcare and part two of this column, to be published next month in PA Times, will turn to education.

Where I reside in the Maryland suburbs of Washington, DC, most of the dominant healthcare systems all are affiliated and owned by Christian organizations. Nationwide, many such healthcare systems are affiliated with one Christian denomination—the Catholic Church—which doctrinally opposed birth control and abortion and overall does not have a good track record on respecting women as equals to men. As has been the subject of much discussion and reporting in the past decade, one direct consequence of this affiliation between healthcare and religion is a pervasive disregard for the healthcare rights of women. Women are far likelier than men to die from experiencing such healthcare crises as a heart attack or stroke. Research specifically on cancer treatments for women has lagged behind research on men. Women frequently struggle to achieve access to legal reproductive health services, including birth control and abortion, because the dominant sources of healthcare in their locations oppose those services on religious grounds. These disparities are even wider for Black and Hispanic women.

In the 21st century, it must be the obligation of the PA field to strive to end the near monopoly of religious-based healthcare systems in the United States and replace them with entirely secular systems. Women of all races and ethnicities deserve equal rights when it comes to healthcare, especially when in this century a substantial majority of women will not be affiliated with any religion. Healthcare is about medical science; let PA work to make such science drive healthcare services. Whenever I hear a doctor indicate religious opposition to providing a legal health service to a woman, my vote is that the doctor should choose a different profession.

As noted above, this does not mean forcing persons to have medical procedures to which they disagree on personal religious grounds. There are a few circumstances where the state has the obligation to override religious beliefs—prevention of communicable diseases and child endangerment are two such cases—but, overall, we can respect religious freedom without putting religion in the “driver’s seat” for healthcare. If we fail do this, the current situation in which women are suffering and dying because of doctrines instead of science is reminiscent of how things work in a theocracy like Iran, not a representative democracy like the United States. We can do better and we will.


Author: Erik Devereux is a consultant to nonprofits and higher education and teaches at Georgetown University. He has a B.S. from the Massachusetts Institute of Technology (Political Science, 1985) and a Ph.D. from the University of Texas at Austin (Government, 1993). He is the author of Methods of Policy Analysis: Creating, Deploying, and Assessing Theories of Change (Amazon Kindle Direct). Email: [email protected] Twitter: @eadevereux.

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