“A common incantation during
debates on health reform… is ‘that we all want the same thing; we merely
disagree on how best to get there.’ That is rubbish.” – Uwe Reinhardt
In a 2011 Republican Presidential debate,
candidate Ron Paul was asked a pointed question about what to do with someone
who needed expensive healthcare but did not have insurance: “Are you saying
that society should just let him die?” Some in the crowd jeered
“Yeah!” Paul indicated that as a physician, he did not find it
acceptable to do so and offered charitable care from “churches” based on his
experience of practicing medicine in the in the early 1960s, before Medicare and
Medicaid, eliciting applause from the crowd.
Last year, I attended the Keystone
Progress Conference in Pittsburgh, PA for a few hours. I attended a panel
discussion of progressive candidates who lost their elections in deep red
districts. One of the things I heard was straight out of this Ron Paul
universe – all four of these candidates said they were surprised that so many
of the conservative voters were afraid, of having others “get over on them.”
That these others would get free healthcare and they were going to have to
pay for it, for “those people” to be freeloaders that they would have to
subsidize, etc.
In 2013, Dan Munro, writing for Forbes magazine,
on the anniversary of Martin Luther King, Jr.'s “I have a Dream” speech,
pointed to several myths so common to conservative thought about America, in
particular our backwards interpretation
of the “bootstraps” fable:
“the myth that literally anyone – through
hard work and determination – can rise out of any poverty and become rich and
prosperous. We salute, praise and deify everyone who does. But there’s a dark
side to this myth. Anyone who doesn’t isn’t working hard enough – or doesn’t
have enough determination. In effect, they’re a loser – and nobody wants to pay
for the healthcare of those losers.”
Veronica Combs paraphrased it as
”There is a real meanness in the conversation about who should have healthcare,
an implication that people who need help somehow don’t deserve it, or that they
are taking advantage of ‘the rest of us.’”
All of this, of course, is not really
news. Making a moral case for universal health care in any form is denounced as
socialism or “not the job of government,” or as Ron Paul said, that we must
“assume responsibility for ourselves.” The American Medical Association has
famously opposed movement towards universal healthcare, from the Truman
Administration to the passage of Medicare and Medicaid and through opposition
to major parts of the Affordable Care Act.
Martin Luther King, Jr., noted that “Of
all the forms of inequality, injustice in healthcare is the most shocking and
inhumane.” Many have railed about the inhumanity of Americans towards each
other regarding healthcare, and the late Professor Uwe Reinhardt has asked for decades, “To
what extent should the better off members of society be made to be their poorer
and sick brothers’ and sisters’ keepers in healthcare?” Americans, capable of
unbridled generosity in helping individuals pay for a
transplant or some other services when the individual in question is deserving, are
ruthlessly coldhearted when compassion is requested for those they deem
undeserving, as the Tea Party crowd showed us in 2011.
Reinhardt was clearly stung by the idea
that his adopted countrymen (he was German born US citizen) rejected this
solidarity, in contrast to every other nation’s resounding “yes” to the
question. He also pointed out that the way Americans avoid the moral question
that faces us is to play the game framed by the introductory quote: we pretend
that the problem is that we disagree on policy, writ small and large, and find
ourselves down rabbit holes about the reimbursement for an anesthesiologist for
a fifteen minute unit of time with or without a nurse anesthetist!
Every other nation has started with the
moral and ethical question over their values as a society and worked towards a
solution to provide healthcare to all their people, “deserving” or not. As
another professor noted:
"The last time I taught in the Semester
at Sea program, I found it necessary to interpret for our students the rich
“social capital” that runs through the Northern European societies we were
visiting. What they knew and had read in their guide books was that not many
people are in church on Sunday morning, especially compared to the florid
religiosity of the United States. So their working assumption was that
Americans take religion seriously and Europeans don’t. The new thought that
amazed them was that the unchurched Europeans live in social democracies deeply
saturated with historic Christian values, while the much-churched Americans
celebrate a society characterized by a ruthless social Darwinism that the God
of the Bible, Old and New Testament alike, denounces."
What is preventing us from having the
basic moral argument about our values regarding health care? The answer is
three-fold. The first is a strong puritanical streak in American culture that
prompts many of us to divide our fellow citizens into camps of deserving and
undeserving people. The second is a now unfathomably large industry that has
much to lose should efficiency and order find their way into the American
Healthcare system. The third is our human cognitive biases that lead us to
sloppily assume political and moral positions that cold be overcome with
rigorous analysis and vigorous debate.
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More to come? Thoughts?
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