Terrance Heath

The Morality of Health Care Reform, Pt. 2

Filed By Terrance Heath | September 24, 2009 5:30 PM | comments

Filed in: Living, Politics
Tags: health care reform

"We are determined to make every American citizen the subject of his country's interest and concern; and we will never regard any faithful law-abiding group within our borders as superfluous. The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little."

Franklin D. Roosevelt, Second Inaugural Address

"Sixty years after Roosevelt's Second Inaugural, that egalitarian test, I think, is still the best measure of our progress and humanity, and the core of The Triumph of Meanness is the contention that as a nation we are failing that test."

Nicolaus Mills, The Triumph of Meanness - America's War Against Its Better Self.

Home of the Mean

As with the election of Barack Obama last fall, the health care reform debate presents us with another opportunity to decide what kind of country we want to be. But that making that choice requires an unvarnished look at the country we have become.

In the seventy-plus years since Roosevelt's Second Inaugural, and the dozen years since Nicolaus Mills' offered his assessment that "as a nation we are failing" at "providing enough for those who have too little," we have actually become a country where a surprising number believe that those who have too little don't deserve to have any more than they do. It's a phenomenon at play in our reactions to any number of current crises, including health care reform.

When it comes to health care reform, it means many Americans now have a ready answer to the question from the previous post, originally posed by James Kwak.

"Given a poor person and a rich person who have the same potentially fatal disease, should both of them live, or only one?"

The answer comes back from yet another American voice from Anna Devear Smith's New York Times column.

Adam, a "patriot" from Grand Junction, Colo.

Our founding fathers went to war to throw out tyranny, to overthrow a tyrannical government without proper representation. We are about at that point now. We're here to say we want our country back. Health care ... is socialism. And socialism is not an American value. ... No, I do not have health insurance. I've never had insurance. [If I need medical care] I should pay for it. I've been to the doctor one time since I was 12 years old. I paid the full bill. ... If I truly needed, had a medical need, I have a catastrophic plan that I bought. But it just covers something that's truly catastrophic. Has a huge deductible. And if that came about I would pay that. You know, you don't look for a handout.

In other words, Adam's answer -- and that of a number of Americans like him -- is that only one of the people in Kwak's scenario should live. And not the one who cannot afford the treatment for the same potentially fatal disease.

Adam's self-identification and his reference to "our founding fathers" is not accidental, nor is the sentiment behind them recent in origin. They, rather, are like the surface of a callous. There is a callous on the American conscience, perhaps there since the first European settlers wrested the land away from Native Americans and began the push from one coast to the other -- exchanging the divine right of kings for a "manifest destiny" that instead made each man a "king" and enshrined the divine right of those with "might," not just in numbers, but in terms of weaponry and/or wealth.

George Lakoff offered perhaps the best distillation of this when he defined the conservative worldview, with particular attention to the connection between well-being and moral virtue.

Worldly success is an indicator of sufficient moral strength; lack of success suggests lack of sufficient discipline. Dependency is immoral. The undisciplined will be weak and poor, and deservedly so.

From there is it is a short trip to the belief that the better off are so because they are better people. The poor would be better off if they were better people, and alleviating the material symptoms of their moral failing might simply encourage more of the same.

It is the worldview that leads conservatives to look upon disasters like Katrina and not see people in need of help, but people who are getting what they deserve -- people who don't deserve help precisely because they need help. It is given voice by conservative pundits like Bill O'Reilly and George Will.

There was Bill O'Reilly, for whom disaster and human tragedy is also a "teachable moment."

American middle and high school students everywhere should be required to watch video tape of the poor people stranded by Hurricane Katrina. Teachers should point out that many U.S. citizens without the financial means to get out of New Orleans wound up floating face down in the water or, at the very least, were subject to gross indignities and suffering of all kinds.

The teachers should then tell the students that the local, state and federal government bureaucracies failed to protect those poor people, even though everybody knew the storm was coming days in advance. The lesson should then segue into how the most powerful nation in the world was powerless to stop 9/11, and scores of other natural and man made disasters throughout our history.

After presenting those undeniable facts, the teachers should then present two questions to the students: Do you want to be poor? And do you believe the U.S. government can protect you if you are poor?"

People for the American Way has the video, for broadband and dial-up, if you need the added effect. O'Reilly extends the metaphor a bit to reveal that conservatives live in a world where everyone -- everyone -- can at least attain middle class, and those who don't have no one to blame -- no one -- but themselves. Of course and what O'Reilly leaves out is that this point of view conveniently absolves the better off (the better people) from helping the less fortunate (the less worthy). In the picture O'Reilly paints there's no one who's obligated to help. In fact, if anything, the problem is that there's been too much help and there really ought to be less. So, we don't need to maintain the status quo, but we actually need to push it back.

Then there's George Will, who thinks that Barak Obama -- who described Bush adminsitration officials as unable concieve of people who couldn't (as O'Reilly says a professor pal of his did) hop in the SUV and head for higher ground -- missed the point.

America's always fast-flowing river of race-obsessing has overflowed its banks, and last Sunday on ABC's "This Week," Sen. Barack Obama, Illinois's freshman Democrat, applied to the expression of old banalities a fluency that would be beguiling were it without content. Unfortunately, it included the requisite lament about the president's inadequate "empathy" and an amazing criticism of the government's "historic indifference" and its "passive indifference" that "is as bad as active malice." The senator, 44, is just 30 months older than the "war on poverty" that President Johnson declared in January 1964. Since then the indifference that is as bad as active malice has been expressed in more than $6.6 trillion of anti-poverty spending, strictly defined.

The senator is called a "new kind of Democrat," which often means one with new ways of ignoring evidence discordant with old liberal orthodoxies about using cash -- much of it spent through liberalism's "caring professions" -- to cope with cultural collapse. He might, however, care to note three not-at-all recondite rules for avoiding poverty: Graduate from high school, don't have a baby until you are married, don't marry while you are a teenager. Among people who obey those rules, poverty is minimal."

You don't need glasses to see the frame. In fact, you see the frame before you get the picture. Again, the people standing on rooftops in New Orleans (or floating face down in its flood waters) are right where they deserve to be. In fact, you can infer from his use of quotation marks that leaving them there for a while might just have been be the best thing for them; certainly better than wasting time in "caring professions" and taking money from the better off (better people) to help the less fortunate (less worthy).

Why? Because having the "wrong values" put them where they are, and removing or alleviating the consequences of those bad values merely reinforces them. Seen through that frame, the government's failure to evacuate the poor or to send them relief after the hurricane becomes a kind of "tough love." Maybe that's the compassion in "compassionate conservatism."

From there it's just a tiny step further, beyond the stated conservative article of faith that government can't help people to the foundational belief that the government shouldn't help people who are unable to help themselves.

This is still the conservative take on Katrina. But where O'Reilly and Will merely suggested that the government can't help those who are unable to help themselves when disaster strikes, Neal Boortz is much more blunt in his latest rant against Katrina victims.

BOORTZ: I like this: "Edwards' campaign will end the way it began 13 months ago, with the candidate pitching in to rebuild lives in a city still ravaged by Hurricane Katrina. Edwards embraced New Orleans as a glaring symbol of what he described as a Washington that didn't hear the cries of the downtrodden." Cries of the downtrodden, my left butt cheek. That wasn't the cries of the downtrodden; that's the cries of the useless, the worthless. New Orleans was a welfare city, a city of parasites, a city of people who could not and had no desire to fend for themselves. You have a hurricane descending on them and they sit on their fat asses and wait for somebody else to come rescue them. "It's somebody else's job to get me out of here. It's somebody else's job to save my life. Not mine. Send me a bus, send me a limo, send me a boat, send me a helicopter, send me a taxi, send me something. But you certainly don't expect me to actually work to get myself out of this situation, do you? Haven't you been watching me for generations? I've never done anything to improve my own lot in life. I've never done anything to rescue myself. Why do you expect me to do that now, just because a levee broke?"

And then Edwards said, yeah, it was Washington's problem, it was all Washington's problem, it was all George Bush's fault. You had a city of parasites and leeches, and that's George Bush's fault? So, boy, I need to slow down. I'm saying too many of the things I actually believe today.

What Will and O'Reilly merely implies, Boortz all but says outright: it's not that the government can't help people, especially the poor, who can't get themselves or their families out of harms way; it's that the government shouldn't help them. Their poverty itself marks them as undeserving of help.

And it's not just the government that must not offer help. Boortz's rant, and the philosophy behind it, excuses him or any individual from offering help to the poor and suffering. "Not my job," says Boortz, or anyone else's. Where Al Gore quietly flew people out of New Orleans, on his own dime and his own time, Boortz rants self-righteously from a radio studio. According to conservative philosophy, it's Boortz who actually did the right thing. After all, the aftermath of Katrina, given who was left behind, was simply the way things ought to be. The poor are so solely because of their own moral failings. If they were better people they'd be better off.

Anyone who helps them is actually helping the wrong people. That's why it's not just neglect but "devout neglect," as Stahl refers to it. It may be neglect, but in the world Boortz and conservatives like him would have the rest of us live in, it is not just "devout neglect." It is righteous neglect. If survival is "a matter of privilege," then some people shouldn't survive. Their poverty identifies them as such, and thus helping them survive is actually immoral.

Taken to its logical extreme, it means that those who are in need of help are undeserving of help because of their need. If they were the kind of people they should be, after all, they wouldn't need help.

It is the root of what's been called a "mean streak" in the American mainstream, that has manifested itself in citizen anger on a number of issues, the most recent of which is heath care reform.

The reason why Obama is finding health reform such a struggle - even though it was central to his election platform - is not because an extreme wing of the Republican Party, mobilised by media shock-jocks, is foaming at the mouth, or because Republicans have more money than Democrats to buy lobbying and advertising power. Nor is it only because so many influential groups, from insurance companies through doctors, have lucrative interests to defend - although this is a big part of it.

...The unpalatable fact for Europeans who incline to think that Americans are just like us is that Democrats are not solidly behind Obama on this issue. Even many in the party's mainstream must be wooed, cajoled and even - yes - frightened, if they are ever going to agree to change the status quo. Universal healthcare is an article of faith in the US only at what mainstream America would regard as the bleeding- heart liberal end of the spectrum.

...The point is that, when on "normal", the needle of the US barometer is not only quite a way to the political right of where it would be in Europe, but showing a very different atmospheric level, too. For there is a mean and merciless streak in mainstream US attitudes, which tolerates much more in the way of inequality, deprivation and suffering than is acceptable here, while incorporating a large and often sanctimonious quotient of blame.

It will be a big change, but health care reform -- real reform, that is -- will require a change in our tolerance for inequality. That change faces its biggest challenge in the form of current economic realities, because change will require action that runs counter to the nature of our response the economic downturn and its attendant consequences thus far.

In The Triumph of Meanness - America's War Against Its Better Self, Nicolaus Mills looks forward from the vantage point of the late 1990s and writes that if we are to change course, to become a more generous and cohesive society, "We shall have to believe that because there is less to go around, we need to be all the more committed to sharing what we have."

Little more than a decade later, that callous on the American conscience has grown to reach from "sea to shining sea," toughened in response to even greater economic inequality, and deepened to become a callous "culture of cruelty." It is a culture that sees nothing with health insurance CEOs pulling down multi-million dollar salaries, even as 25 million underinsured Americans spend more for care because their insurance covers so little, or that medical bills account for 60 percent of bankruptcy filings, and that some 46.3 million Americas are uninsured.

It is a culture that not only threatens progress health care reform as it has recently on a number of issues, but seeks to define the kind of country we will become.


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America has become every bit the tyranny that it attempted to escape by becoming a republic. A tyranny based on wealth and privilege.

You still have an aristocracy of wealth and a culture that equates wealth with virtue. Wealth does not make a person 'better' just luckier.

The American people are ill served by the indirect democracy they suffer at a national level. There are too few senators, thus their power is disproportionate and the electoral system is so expensive that they are in thrall to those who finance their campaigns.

However saying that America has some structural problems bought about by a system of government that is slow to adapt because of a written constitution. The AMerican people have some virtues to be proud off. A passionate sense of patriotism and a rock solid work ethic. But the OP is write there is an essential lack of community spirit ( a sod you I am alright jack mentality) that holds America back from being the truly great country it could become.

For a religious country with a strong christian faith it as a society exhibits little of the values of the 'New testament' from a European perspective it is perplexing why huge numbers of homeless are tolerated (It is shaming to allow homelessness in such vast numbers) and reserves healthcare to those with money. These attitudes belong to the middle ages. Perhaps if the USA had suffered the very larger casualty rates that Europeans did in the great wars of the 20th century they may have developed a 'socialist' consciousness. Who knows.

As it is the American population has bought into the great lie that is the American Dream - America is not a nation to look up to and admire and emulate any longer it is a nation that has enshrined a new Feudal Tyranny - without the sense of obligation inherent in such a system. America has lost its way because the American government and elite have forgotten the fundamental point of the Revolution as enshrined in your constitution; that is...
"We the people ...." Not I an individual.

From the very outset of the establishment of the USA was the concept of socialism, of equality and fairness and that has been lost through the pursuit of happiness as defined as the pursuit of money at all costs.

|Damn sorry for the grammatical and typographical errors in the above post - I should have previewed it. Oh for an edit button.

But to clarify my point America can yet become a great modern country if it can remember that it was a country built upon the principles of equality.

That all persons are equal in the eyes of God and some fundamentals are a human right and not a privilege that should be reserved for the rich.

Money does not a better person make - it is not a reward for virtue but a test.

Societies work because they look after the interests of the people and they fail when those interests are not being met. At the moment America is failing. It has not failed yet but if it persists in selfish and self centred behaviour it surely will fail.

I love what Margaret and Helen had to say about this:

What does it say about our country if the biggest debate of the decade is no longer about the two wars we are fighting but rather about preventing children and families from having access to affordable healthcare? I’ll tell you what it says to me. It says the Christian Right never really was and Value Voters aren’t very valuable.