Over the past few weeks as the debate over a national health care option has moved from the halls of Congress to the water cooler I have found myself engaging in several discussions with those opposed to a national health care option. There are several problems with how this debate is going. First, in typical republican style, those who oppose national health care have attempted to boil the debate down to simple talking points and rhetoric. Any attempt to point out that such a complex topic as this is inherently nuanced and requires complex analysis is dismissed outright since in my opinion many Americans don’t seem to have the attention span to fully understand the topic. This is exemplified in a recent interview of Republican Party Chairman Michael Steele by Steve Inskeep on NPR[i]. Inskeep’s assertion that Steele’s position is nuanced is forcefully rejected. If we can get beyond the talking points and rhetoric and treat this debate with the careful thought it deserves, I believe that the weak foundation of those opposed to national health care will crumble. This essay attempts to provide a logical foundation and reason for my support of a national health care option. The first portion of the essay will define four key philosophies that help provide a context for the debate. I will then describe how I think this debate should be reframed. Finally, I will provide direct rebuttals to some of the more common criticisms of the health care option.
A Foundation for Debate
There are four opposing philosophies that are at play in this debate: individualism, collectivism, capitalism, and democracy. Understandings of these opposing forces provide valuable insight into the differing points-of-view on this debate.
Individualism and Collectivism
Individualism is a philosophical or moral stance whereby independence and self-reliance are emphasized. Collectivism on the other hand is the philosophical or moral stance that emphasizes human interdependence and the importance of a collective. In most international studies that look at the individualism/collectivism spectrum, the United States nearly always ranks as the most individualistic nation, and usually by substantial margins. Though the Constitution provides a foundation for both philosophies (e.g. “We the people” supports collectivism; the Bill of Rights supports individualism), clearly over the last decade value of the individual has taken precedence. This extreme tendency towards individualism is perplexing as in many instances moving toward a more balanced society would benefit more individuals. Take Joe the Plumber’s view from the last election. He opposed Obama’s economic views because he felt it would infringe on his individual rights, and assuming his business would put him in the top 2% of the wealthiest Americans, he is correct. However, in reality Obama’s proposed economic policies would benefit him more than McCain’s would have. This is now the case with health care. Unless you are one of the lucky one to two percent of Americans, public health care will most likely benefit you. This is exemplified by the fact that nearly 60% of bankruptcies (75% of which had insurance) filed in the United States are the result of medical bills[ii]. So even if you are fortunate enough not to be one of the nearly 42 million uninsured Americans, consider that you are one medical emergency away from bankruptcy.
It is also important to point out the hypocrisy of religious leaders, particularly Christians, who argue for a moral government but ignore the preaching of Jesus of whom they hold as a model. Based on my understanding of his life, I believe Jesus would be in favor of national health care. His charity at the individual level does not imply individualism. In fact, most of his decisions were done with intent of helping the collective, that is, wasn’t he sent to Earth to save humanity?
There are countless examples of how the collective will often benefit the individual. Malcolm Gladwell argues that the success of individuals can largely be attributed to their environment or community. That is, raw talent, whether genetic or not, is not enough to be successful. It is raw talent along with opportunities provided by the community that allow one to be truly successful. However, it is Howard Zinn who provides a very damning critique of individualism:
It is an irony that these rugged individuals so loved individualism that they ganged up together to enslave black people, steal land from Mexico, and carry out an ethnic cleansing of the continent. At other times they ganged up to abuse and mistreat, among others within their borders, Chinese people and Japanese people and Jews and Catholics, before ganging up to abuse peoples of Central and South America and so on around the world. A nation of individuals saying, “I am an individual. Don’t blame me for the collective crimes of this country.”[iii]
Capitalism and Democracy
For nearly two centuries, capitalism and democracy have coexisted with minimal issues. However, the delicate balance between capitalism and democracy has been tipped in favor of capitalism, especially since corporations have been granted the rights of personhood. The Supreme Court will hear soon hear additional arguments in Citizens United v. The Federal Election Commission that brings into question the constitutionality of the McCain-Feingold bill. At the heart of the matter is the question of whether corporations have the same unfettered First Amendment right to free speech. The McCain-Feingold bill attempts to limit corporate speech during times of elections since corporations have an unfair advantage given their tremendous financial resources. This is merely the most recent example of how corporations are increasing their dominance over our democratic system. The systematic deregulation of the economic system over the last half-century has brought into question the viability of coexistence of capitalism and democracy.
It is my opinion that capitalism must be suspended for fundamental services/rights of society, two of which are health care and education. In these areas we must acknowledge that the collectivist approach will lead to a more harmonious society where all individuals benefit. We value our education system as providing a means for social mobility. However, as decades of educational research reveal, social economic status is still the biggest predictor of academic success. This is exacerbated by our system of funding schools by property taxes thereby creating a natural inequitable system. When profit motives come in play as they currently are with an increase of for-profit charter schools, the problem is only worsened as exemplified by the failure of charter schools in post-Katrina New Orleans[iv].
One of the problems is the disparate value placed on goods by consumers and share holders. Take Apple for example. It is in Apple’s best interest to create and increase the value of their products as to increase consumer demand. Therefore working to better their consumer’s experience not only benefits consumers, it benefits their shareholders as well. However, the correlation between consumer and shareholder interest falls apart for health care and education because the consumers of the service are not necessarily or usually the payers of these services. For education, it is tax money in the form of property taxes that are redirected to the for-profit companies. The same holds true for health care, except it is generally directed through the employer. Employers often have a choice of health care providers, but rarely do the individuals. Understand it is the service providers’ legal obligation to act in the best interest of their shareholders. In these cases where the consumer is not the payer, it is not the case that the consumer and shareholder interest coincide. This results in a system where the most efficient way for an insurance company to increase shareholder value is to simply reduce the number claims they pay. Or eliminate those individuals who are too costly.
Reframing the Debate
Though I argue that national health care is ultimately a nuanced argument, where proponents of national health care have failed is in articulating their entry point to discussion. That is, the question of health care for all is a moral decision. More specifically, the question must be asked: Is it moral for anyone to make money on someone else’s care? By no means am I arguing that doctors and health care professionals not make any money. I agree that having high paid doctors attracts the most qualified individuals to such an important profession. However, the profit I am opposed to is the money that is directed to Wall Street and investors. In effect, these people are valuing profit over a person’s health. Bill Moyers put it best: “we should be treating health as a condition, not a commodity”[v].
Direct Rebuttals to Opposing Arguments
I have provided the basic framework from where I decided that national health care is a fundamental right of all individuals. In this section I will provide direct answers to some of the more common arguments I have encountered against national health care.
I don’t want the government deciding what care I can get.
In no way has the proposed health care bill suggested that the government will control the health care individuals receive. In fact, under the government plan control of one’s healthcare will be better controlled by the individual and their doctor. Reuters has recently reported that on average, 21% of claims filed in California were denied[vi]. As explained above, insurance companies are motivated to reduce costs to increase profitability, including denying claims whenever possible.
With respect to “death panels,” this idea coined by Sarah Palin but initiated by Betsy McCaughey has been duly debunked. It stems from language in the proposed bill that indicate that doctors could partially be rated based upon their creating an end-of-life plan with patients and the extent to which they followed those plans. For example, if a patient indicates that they want every possible attempt to be made to be kept alive, a doctor who does not follow this end-of-life plan could potentially be rated poorly. Conversely, doctors who do not honor a patient’s do-not-resuscitate will also be negatively rated. These provisions are an attempt to ensure individuals and their families are prepared for end-of-life treatment and to hold doctors accountable for honoring their patient’s wishes. Might I suggest watching John Stewart rather entertaining debate with Betsy McCaughey[vii]?
The Social Security program is going bankrupt, how can the government do better with health care?
At the time the Social Security Act was signed in 1935, the life expectancy was 60, but for a child born in 2005 they can expect to live to 78[viii]. Moreover, the retirement age has only increased 2 years from 65 to 67 resulting in an increase of number of Americans over 65 from 6.7 million to 34.9 million[ix]. Clearly the Social Security Act needs to be amended to account for a changing society, it the program itself and of itself not a failure.
We already have the best health care in the world.
This is simply a fallacy. Spend a few minutes at the World Health Organization (WHO)[x] and you will quickly see that the United States ranks fairly poorly on many quality of life metrics. The WHO last provided an overall ranking of health systems in 2000 where the United States ranked 37th; the US ranks 42 in life expectancy; and 29th in infant mortality. And to make matters worse, we spend more per capita than any other nation on health care.
The Government is already too big.
This is a particularly comical argument coming from the party that gave us The Patriot Act and the largest deficit in history. The former arguably stripped more civil liberties than any other law passed. The starting of two wars, irresponsible tax cuts during a time of war, among other arcane policies despite evidence to the contrary undermine this argument (e.g. abstinence only sex-education programs despite evidence of their lack of effectiveness). The republican’s idea of small government includes corporations ability to create unlimited access to profit while at the same time dictating what is moral, despite the irony that those most strongly preaching for a “moral” America are those caught engaging in immoral acts themselves.
[i]
http://www.npr.org/templates/story/story.php?storyId=112281170
[ii]
http://www.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bills/
[iii]Zinn, Howard (2005).
A People’s History of the United States: 1492-present. Harper Perennial Modern Classics.
[iv]There are many resources available on this topic, but
The Shock Doctrine (2007) by Naomi Klein provides an excellent analysis of the impact of pure Milton Freidman economics.
[v]
http://www.pbs.org/moyers/journal/09042009/watch3.html
[vi]
http://www.reuters.com/article/pressRelease/idUS202570+02-Sep-2009+PRN20090902
[vii]
http://www.thedailyshow.com/full-episodes/246932/thu-august-20-2009-betsy-mccaughey
[viii]
http://www.sciencedaily.com/releases/2007/09/070912141110.htm
[ix]
http://www.ssa.gov/history/lifeexpect.html
[x]
http://www.who.int/whosis/en/