Terrance Heath

The Morality of Health Care Reform: Competing Voices

Filed By Terrance Heath | September 14, 2009 5:00 PM | comments

Filed in: Living
Tags: health care industry, health care reform

During Take Back America 2008, I spent part of a day running around with a camera and a microphone asking people which issue was most important to them in the upcoming election. Just when I thought I was done, the camera turned to me and I was faced with the same question.

My answer came quickly and easily: health care reform. When I explained why, the argument that came out of my mouth was based more in morality than economics.

“In a country as wealthy as this one,” I said, “It’s criminal that a single child lacks coverage and does without health care.” I was thinking of my own two kids -- particularly Dylan, who was less than a year old, and had regular well-baby checkups. But I was also thinking about children like Deamonte Driver, whose death from complications due to lack of access to dental care and a resulting abscessed tooth made headlines a couple of years ago.

It wasn’t because the cost of providing coverage and care to children was less than the cost of not doing so. (Though an $80 tooth extraction would have spared Deamonte the need for brain surgery and $250,000 worth of medical care because of the spreading infection.) It was because of a core belief that, as a country, we have moral imperative to make sure everyone has access to quality health care.

I don't remember where I heard it, but it's something a core belief of mine: Freedom and liberty are meaningless concepts without two things--knowledge of them and the ability to act on them. To my mind, the former is basically education, and the latter means health care. I've come to believe that a country that can't provide those two basic things to its citizens can't have more than a tenuous grasp on the two concepts above.

Not long ago, I wrote that on election night Americans weren’t just choosing a president, but choosing the kind of country we want to be. Voting for Barack Obama, on the basis of his campaign platform after eight years of George W. Bush and a Republican Congress, signaled that we were approaching a crossroads as a country and were deciding which road to take.

If this past August is an indication, we’re still at that crossroads, shouting at each other over which road to take.

With her acuity for distilling and channeling diverse American voices in her work, Anna Deveare Smith in her recent New York Times piece captures voices on both sides of the health care reform debate, revealing perhaps one of the most difficult tasks that reforming health care will require of us: not only are we still deciding what kind of country we want to be, but continuing down the path of change we apparently chose in November will mean changing the story we tell ourselves about who we are and who is included in that “we.”

That choice is illustrated in two of the voices Deveare Smith. One, a nurse from the Western United States, illustrates part of the problem some Americans have with health care reform, and specifically with universal health care achieved through a government-funded public heal care plan.

When you come to the West, you have a different mentality. There’s an independence and an individuality here that you don’t get anyplace else, because when you’re in the city, you’re kind of like part of the hive. You know, people that take the light rail in to work and come back and live in these big apartment buildings and have restaurants and things and they’re fine with that.

Here, people are really, really proud, and they cherish their independence. And they cherish the fact that we are all individuals. And that’s what we’re afraid of, is that we’re going to lose our individuality and we’re just going to be part of the hive. If you’re just part of the hive, then what are you going to do? You’re going to cull out the weak links. You’re going to cull out the lady that’s on crutches and got diabetes, because she may be a good grandmother and she may be a good person, she lives by herself, and her house is paid for, but you know, her medicines cost a lot.

Another voice, that of a doctor from Montana, shows how much will have to change if we’re going guarantee quality , affordable health care for all.

American culture simply has never been based on caring about what happened to your neighbor. It’s been based on individual freedom and the spirit of, if I work hard I’ll get what I need and I don’t have to worry about [the] fellow that maybe can’t work hard. It’s a pretty cynical view of America.

But I honestly think that drives an awful lot of this debate — the notion that I’ve done my job, I’ve worked hard, I’ve gotten what I’m supposed to get. I have what I need and if the other people don’t, then that’s sort of their problem. And unfortunately the big picture — that our nation can’t thrive with such a disparity between the rich and the poor, the access people and the disenfranchised — that hasn’t seemed to really strike a chord with Americans.

So your average person actually has fairly good access. They’re happy with their physician and they’re really frightened that something’s going to happen to that, on behalf of people that maybe they don’t think it’s their job to take care of

Obama addressed much of this in his speech to Congress. Anyone who wasn’t busy heckling might have heard him frame whether or not we have the will to reform health care makes as a defining a test of American character.

That large-heartedness--that concern and regard for the plight of others--is not a partisan feeling. It's not a Republican or a Democratic feeling. It, too, is part of the American character--our ability to stand in other people's shoes; a recognition that we are all in this together, and when fortune turns against one of us, others are there to lend a helping hand; a belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgment that sometimes government has to step in to help deliver on that promise.

With so much discussion about what health care reform will or won’t cost, and the cost of not reforming health care, every suggested compromise in Congress seems designed to cost less up front while covering fewer people. James Kwak turned the discussion of costs and consumer choice around to one very basic question about health care reform.

This just illustrates that a core function of any health insurance scheme is redistribution. People start out in different economic circumstances, and they suffer different fates in their lives. Without redistribution in some form, the ones who are poor and get sick will simply not be able to afford health care. Cashing out their employer health benefits and giving them “choice” won’t change that — especially if they don’t have employer health benefits to begin with. Yes, insurance can play a redistributive role on its own, but it only works if poor people can afford to buy insurance that will cover them against serious illness. And once they have that insurance, then the price signals so beloved of conservatives won’t function anymore. The problem is really very simple: for price signals to work, you have to be willing to let consumers run out of money, since no one can predict his future health care needs. And then they die.

So what really frustrates me about this whole “consumer choice” fraud is the premise it begins with. It starts out by framing health care as a problem of consumer incentives — health care is too cheap. This is a factually accurate framing that leads you to a dead end (unless you think people who underestimate their future sickness should die). I think the right way to frame this issue is with this question: Given a poor person and a rich person who have the same potentially fatal disease, should both of them live, or only one?

Put another way, it becomes a personal question: If you and a rich person (or someone much wealthier than you) have the same potentially fatal disease, should both of you live, or only one? That our current system often determines that whoever has the most “wins,” or that the person with the most money lives, makes it a moral question.

How we answer that question will not only determine if or how we will reform health care, but also what kind of country we become — because ultimately whether everyone should have access to quality, affordable health care, and whether the government should provide that access, is a moral question.

In writing about the moral case for health care reform (and the absence of such an argument in our current debate about health care reform), Ezra Klein quoted T.R. Reid’s The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care about successful efforts to reform their health care sector into a national system — by making a moral case for reform.

Both countries decided that society has an ethical obligation — as a matter of justice, of fairness, of solidarity — to assure everybody has access to medical care when it’s needed. The advocates of reform in both countries clarified and emphasized that moral issue much more than the nuts and bolts of the proposed reform plans. As a result, the national debate was waged around ideals like “equal treatment for everybody,” “we’re all in this together,” and “fundamental rights” rather than on the commercial implications for the health care industry.

Over the next week, I plan to write about health care reform as a moral issue, in hopes of staring a discussion about why health care reform that provides quality, affordable health care to all Americans is simply the right thing to do.


Recent Entries Filed under Living:

Leave a comment

We want to know your opinion on this issue! While arguing about an opinion or idea is encouraged, personal attacks will not be tolerated. Please be respectful of others.

The editorial team will delete a comment that is off-topic, abusive, exceptionally incoherent, includes a slur or is soliciting and/or advertising. Repeated violations of the policy will result in revocation of your user account. Please keep in mind that this is our online home; ill-mannered house guests will be shown the door.


LAWYERS FOR POOR AMERICANS | September 14, 2009 11:49 PM

~ AMERICAN RELIGIOUS LEADERS HAVE BEEN SILENCED ~


OUR U.S. RELIGIOUS LEADERS SILENCE IS MORE FRIGHTENING THEN DENIAL OF HEALTH~CARE FOR ALL OUR POOR AMERICANS ....

* THE LOUD RANT OF SATAN WAS HEARD IN THE PEOPLES HALLS OF U.S. CONGRESS AND AMERICAN RELIGIOUS LEADERS HAVE TURNED THEIR HEADS,CLOSED THEIR EYES AND SHUT THEIR EARS IN FEAR ~

THIS OLD WORLD ORDER OF ABUSE AND NEGLECT OF OUR POORER AMERICANS NEEDS ENLIGHTENED POLITICAL MINDS AND HEARTS TO VIEW GOD DIFFERENTLY THEN $$$.... NO MATTER WHAT THEIR POLITICAL PARTY AFFILIATION ???

WHEN WILL OUR WEALTHY ELITE AMERICANS ABATE THEIR ASSAULT ON POORER AMERICANS WITH THEIR MONETARY CONTROL OF OUR IVORY TOWER U.S. CONGRESSIONAL LEADERS OF THE NEW WORLD ORDER ???

THERE ARE NOT MANY MORE DISTRACTIONS LEFT WHICH ARE AVAILABLE FOR OUR WEALTHY ELITE AMERICANS TO HIDE BEHIND IN NOT TAKING PROPER CARE OF ALL OUR AMERICANS IN A HUMANE FASHION !!!

RALPH NADER ATTEMPTED TO EDUCATE AMERICAN VOTERS ABOUT U.S. CORPORATE POWER IN AMERICA AND HOW THEY CONTROL OUR CONGRESSIONAL PEOPLE THROUGH THEIR POCKET BOOK (POLITICAL DONATIONS).* WITHOUT THE DOUGH $$$ THESE U.S. CONGRESSIONAL LEADERS OF THE FREE WORLD DO NOT GET RE~ELECTED TO CONGRESS.TO STAY IN POLITICAL OFFICE IN AMERICA,ONE HAS TO BARTER YOUR VOTES IN CONGRESS AND REPRESENT POWER INTERESTS IN RETURN FOR THE BUCK$.

POORER AMERICANS HAVE NEVER HAD THE $$$ LOBBY TO INFLUENCE THIS CORRUPT POLITICAL CONCEPT (of horse trading political votes for political contributions) TO ACHIEVE PROPER HEALTH ~CARE OR LEGAL REPRESENTATION FOR ALL OUR MIDDLE ~ CLASS AND WORKING POOR AMERICANS.

AMERICAN IVORY TOWER U.S.CONGRESSIONAL LEADERS OF THE FREE WORLD HAVE PASSED FEDERAL LEGISLATION IN WASHINGTON DC TO SPEND 50 BILLION AMERICAN TAX $$$ ON THE INTERNATIONAL FIGHT AGAINST AIDS OVER THE NEXT FIVE YEARS WHILE THEIR OWN AMERICAN CITIZENS ARE BEING TOLD BY THIS SAME U.S.CONGRESS THAT NATIONAL HEALTH CARE AND PROPER LEGAL REPRESENTATION FOR MIDDLE CLASS AND WORKING POOR CITIZENS IS UNAFFORDABLE.

WEALTHY ELITE AMERICANS (WHO ARE ONLY 1% OF OUR USA POPULATION) SADLY ALSO CONTROL HOW OUR U.S.CONGRESS SPENDS THEIR BUDGET TRILLION$ AND HAVE OBVIOUSLY FOUND MORE WORTHY INTERNATIONAL CITIZENS THEN OUR OWN DESPERATE AND NEEDY POOR TO ASSIST !!!

~Poorer Americans Nationwide only get 400 million $$$ per year for legal representation allocated them by CONGRESS~

Middle Class and Working Poor Americans are unable to afford proper legal representation in their Civil, Criminal and Family Courts of law all across America causing tremendous hardships nationwide,but these great minds and callous hearts in our American Congress have found others Worldwide more needy then their own citizens who are being falsely incarcerated,wrongfuly executed,losing their homes or apartments,losing child custody or visitation with their children etc...

*Not being afforded proper legal representation by our U.S. Congress has created a total breakdown of the American judicial system for our poorer Americans because the our U.S. Courts punish all of us little people if we are not assisted with proprer legal counsel.

It is a known fact that our average Middle Class and Working Poor Americans without proper legal representation in all of our American Courts of law lose their legal cases to the better financed who are able to afford lawyers.

Lawyers For Poor Americans is now actively in the hunt for International Countries and Leaders Worldwide to help raise 5 Billion Dollar$ for our slighted poorer Americans who have had their own American Congress turn their backs on their desperate needs in not affording them proper legal representation.

Troy Davis and Mumia Abu ~ Jamal are 2 perfect examples of American citizens who never had proper legal representation or defense investigations afforded them by our U.S. Congressional Leaders Of The Free World in their initial criminal trials in (Georgia and Pennsylvania) who might very well have to pay the ultimate price of possibly being completely innocent and falsely executed in the near future.

These two poorer Americans are among tens of thousands of legal cases nationwide that never were afforded proper legal representation or proper defense investigations at their initial trials??We the public really have no idea if these men are innocent or guilty until they both are given fair legal representation at their new future trials.

Improper murder trials and needless deaths due to the lack of healthcare take place in Third World Countries all the time. ** Why should average Middle~Class and Working Poor Americans in the Wealthiest Country Of The World be treated as if they are living a Third World Life Style ??

This is the first of many www International pleas by Lawyers For Poor Americans for other leaders and countries to help raise the needed monie$ to correct these blatant injustices that have been inflicted on poorer Americans for the last few decades. Lawyers For Poor Americans has many other written articles that can be viewed with any www search engine by our name or our telephone number.

Lawyers For Poor Americans is a www lobby group of volunteers that sing out about the decades old neglect,abuse and injustices being inflicted on our poorer Americans that have become Crimes Against Humanity issues for the International World Court to investigate.

lawyersforpooreramericans@yahoo.com
(424-247-2013)



Thanks for that. If the rant wasn't in all caps for half of it and incredibly long and rambling, I might have read it.

Bottom Line--I don't want my health in the hands of folks whose first priority is profit. From 1978 to the present I've had a first-hand view of the health care system: 1)with a spouse who died in 1991 after a battle with diabetes, 2)myself battling the same disease.
--in 1978 health care decisions were primarily made by doctors and their patients
--the advent of managed health care has changed that focus from first-hand decisions to serious illnesses in which a third party who is rewarded for lowering cost--one who never examines the patient in question.
My observation is that health care costs began their escalation with the advent of the mid-level bureaucracy of an industry that was invented to lower costs.
Another observation--this mid-level depends on putting so many barriers in front an ill person that that person gives us. As a side note Social Security Disability works on much the same premise: most claims are rejected the first time.
For my own well being I'd like to turn back the clock to a time when the doctor who cares about my well being is the first-line of making health care decisions.

You've done an excellent job of covering the health care debate, Terrance. I always learn a lot from your posts and find myself agreeing with you completely on 99.9% of it.