Terrance Heath

The Morality of Health Care Reform, Pt. 4

Filed By Terrance Heath | September 27, 2009 10:00 AM | comments

Filed in: Living, Media, Politics
Tags: health care reform

...[Q]uality care shouldn't depend on your financial resources, or the type of job you have, or the medical condition you face. Every American should be able to get the same treatment that U.S. senators are entitled to.

This is the cause of my life.

Sen. Ted Kennedy, 'The Cause of My Life'

As I noted in the previous post in this series, it can't honestly be said that the reason millions of American's go without health insurance is because we can't afford it. Nor is that the reason why more than 14,000 Americans lose their health insurance every day, or why:

None of this is because these people don't want health insurance, and certainly not because they don't need it. Nor is it that we cannot afford to guarantee quality, affordable health care to all citizens. A fraction of our military budget, or the amount sunk into the Iraq war, for example, could go a long way towards providing coverage for many. So it's not because we can't do it.

We can. So, perhaps we simply lack the will to do so; to make it so. Maybe we just don't want to. If so, the question remains: Why?

One answer may lie in the "mean streak" in the American mainstream, mentioned in the previous post in this series.

When we Europeans -- the British included -- contemplate the battles President Obama must fight to reform the US health system, our first response tends to be disbelief. How can it be that so obvious a social good as universal health insurance, so humane a solution to common vulnerability, is not sewn deep into the fabric of the United States? How can one of the biggest, richest and most advanced countries in the world tolerate a situation where, at any one time, one in six of the population has to pay for their treatment item by item, or resort to hospital casualty wards?

...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.

That "mean streak" that's taken root, has been watered by the eight years of the Bush/Cheney administration, fertilized by right wing media, and has sprouted into a culture of cruelty that is not in full bloom -- yet. But it's tendrils threaten to choke off the health care reform debate, precisely because of how it colors our view of those who have lost their health insurance, can't afford health insurance, and can't afford the medical care they need or insurance that would cover it.

Under the Bush administration, a seeping, sometimes galloping, authoritarianism began to reach into every vestige of the culture, giving free rein to those anti-democratic forces in which religious, market, military and political fundamentalism thrived, casting an ominous shadow over the fate of United States democracy. During the Bush-Cheney regime, power became an instrument of retribution and punishment was connected to and fueled by a repressive state. A bullying rhetoric of war, a ruthless consolidation of economic forces, and an all-embracing free-market apparatus and media driven pedagogy of fear supported and sustained a distinct culture of cruelty and inequality in the United States. In pointing to a culture of cruelty, I am not employing a form of left moralism that collapses matters of power and politics into the discourse of character. On the contrary, I think the notion of a culture of cruelty is useful in thinking through the convergence of everyday life and politics, of considering material relations of power - the disciplining of the body as an object of control - on the one hand, and the production of cultural meaning, especially the co-optation of popular culture to sanction official violence, on the other. The culture of cruelty is important for thinking through how life and death now converge in ways that fundamentally transform how we understand and imagine politics in the current historical moment - a moment when the most vital of safety nets, health care reform, is being undermined by right-wing ideologues. What is it about a culture of cruelty that provides the conditions for many Americans to believe that government is the enemy of health care reform and health care reform should be turned over to corporate and market-driven interests, further depriving millions of an essential right?

Increasingly, many individuals and groups now find themselves living in a society that measures the worth of human life in terms of cost-benefit analyzes. The central issue of life and politics is no longer about working to get ahead, but struggling simply to survive. And many groups, who are considered marginal because they are poor, unemployed, people of color, elderly or young, have not just been excluded from "the American dream," but have become utterly redundant and disposable, waste products of a society that not longer considers them of any value. How else to explain the zealousness in which social safety nets have been dismantled, the transition from welfare to workfare (offering little job training programs and no child care), and recent acrimony over health care reform's public option? What accounts for the passage of laws that criminalize the behavior of the 1.2 million homeless in the United States, often defining sleeping, sitting, soliciting, lying down or loitering in public places as a criminal offense rather than a behavior in need of compassionate good will and public assistance? Or, for that matter, the expulsions, suspensions, segregation, class discrimination and racism in the public schools as well as the more severe beatings, broken bones and damaged lives endured by young people in the juvenile justice system? Within these politics, largely fueled by market fundamentalism - one that substitutes the power of the social state with the power of the corporate state and only values wealth, money and consumers - there is a ruthless and hidden dimension of cruelty, one in which the powers of life and death are increasingly determined by punishing apparatuses, such as the criminal justice system for poor people of color and/or market forces that increasingly decide who may live and who may die.

The growing dominance of a right-wing media forged in a pedagogy of hate has become a crucial element providing numerous platforms for a culture of cruelty and is fundamental to how we understand the role of education in a range of sites outside of traditional forms of schooling. This educational apparatus and mode of public pedagogy is central to analyzing not just how power is exercised, rewarded and contested in a growing culture of cruelty, but also how particular identities, desires and needs are mobilized in support of an overt racism, hostility towards immigrants and utter disdain, coupled with the threat of mob violence toward any political figure supportive of the social contract and the welfare state. Citizens are increasingly constructed through a language of contempt for all noncommercial public spheres and a chilling indifference to the plight of others that is increasingly expressed in vicious tirades against big government and health care reform. There is a growing element of scorn on the part of the American public for those human beings caught in the web of misfortune, human suffering, dependency and deprivation. As Barbara Ehrenreich observes, "The pattern is to curtail financing for services that might help the poor while ramping up law enforcement: starve school and public transportation budgets, then make truancy illegal. Shut down public housing, then make it a crime to be homeless. Be sure to harass street vendors when there are few other opportunities for employment. The experience of the poor, and especially poor minorities, comes to resemble that of a rat in a cage scrambling to avoid erratically administered electric shocks." [1]

Recall the self-described "patriot" from the Anna Deveare Smith piece, quoted in a previous post.

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.

It serves as the answer, as far as health reform opponents are concerned, to the question James Kwack asked, that also launched this series.

"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 from the "culture of cruelty" -- metastasized from its "contempt for all noncommercial public spheres" and "chilling indifference to the plight of others" is obvious: only one should live. The person who can pay for the care he needs should get it. The person who cannot pay for the care he needs should not. The rich person should live, because he's rich. The poor person should die because he's poor. One is worthy of receiving medical care, and the other is not. Moreover, expecting the former to contribute to coverage for the latter is not just immoral, but criminal, and tantamount to subverting some sort of natural order by asking the "strong" support the "weak."

It's a perversion of a familiar moral aphorism, but the "culture of cruelty" says it should be easier for a rich person to get through the hospital doors than for a poor person -- or merely less-than-rich -- to get so much as an aspirin. In fact, it would be wrong to help someone who otherwise can't afford to be a consumer. Lakoff's earlier take on the conservative worldview starts with this premise, but extends it to the role of government as well.

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.

...The role of government is to:

  • Protect the country and its interests in a dangerous world by maximizing military and political strength;
  • Promote unimpeded competitive economic activity so that both the disciplined moral people and the undisciplined immoral ones are able to receive what they each deserve, based on their own choices;
  • Maintain order and discipline, through severe enforcement of the rules if necessary.

In other words, protecting property and persons is the extent of governments role. The helping the poor man through the door of the doctor's office or even local clinic is not only outside of that role, but upsets the moral order -- which assumes that everyone who needs and deserves medical care can afford care or insurance, and thus already has access. Anyone who can't afford either on their own doesn't deserve it. And they have no one to blame but themselves.

Again, it goes back to the conservative worldview as defined by Lakoff, recently put in a more straightforward manner by Mike Papatonio.

There is a term that sociologists developed to describe an incredibly ugly quality of human nature. The term they use is "victim blame." Here's how it works: Americans are fearful people. That's why drug companies are able to sell more pharmaceuticals per capita in America than any other place in the world. It is also the reason that gun manufacturers love Americans. On the outside , most Americans want to project a Rambo quality of "gutsy" but "fearfulness" lies below that veneer. It is that fearful nature, according to sociologists and shrinks that compels us to blame victims for their misfortune. It makes us feel better when we convince ourselves that bad things only happen to other people.

...It is a mechanism that promotes false bravado as a way to help us believe that bad things will never happen to us. After all, "we," unlike those other victims, are smarter, stronger, and more righteous.

Conservative political policies have been built around the manipulation of that ugly quality called victim blame. If an American is homeless or jobless, if they cannot afford healthcare, ... If they lost their home in foreclosure, then surely they have done "something" to deserve that fate. Conservatives are brilliant in that they have freed us from the responsibility of being our brother's keeper. It's much easier to conclude that our brother is always stupid, irresponsible, immoral, and obviously not as smart, responsible and virtuous as "us." If they had "our" superior qualities, their lives would flourish.

It's a view that ultimately increases suffering, and then turns away from the sight -- turning on its head not just the aphorism above, but the philosophy supposedly motivating so many "Values Voters."

The overhead for the U.S. government to run Medicare is 3 percent. Major insurance companies that provide health care insurance average 30 percent overhead.

American pharmaceutical companies regularly sell medicines outside of the United States for lower prices than they charge inside the United States.

Yet both industries are spending billions of dollars warning Americans about government involvement in medical care.

As a follower of Jesus from Nazareth, I ask all who have taken the name Christian to remember that 1) Jesus was committed to giving people healthy bodies, 2) that Jesus had a priority commitment to the poorest of the poor, and 3) that his warnings to the wealthy and the selfish were relentless.

This is called Bible 101.

Meanwhile fundamentalists of a religious stripe are united in a bizarre coalition with free-market fundamentalists in service of a politics that serves the "strong" and ignores -- or even antagonizes -- the "weak."

Jesus has left us at least five mandates.

First, all men and women without regard to race, age, cultural roots, or sexual orientation, are to have full human rights....civil, political, economic, religious.

...Second, priority attention is to be given to the people who are most vulnerable. The poor, the hungry, the sick, the naked, the widow, the orphan.

In a modern world universal health care, expansion of the food stamp program, social security for older persons, tax and budget policies that diminish the gap between the rich and the poor, quality education for everyone, and affordable housing, cannot be set aside.

The resulting morality is that of a "culture of cruelty" that looks upon "weakness" -- in the economic sense here, exemplified by the inability to afford health care or health insurance -- as a mark of unworthiness, and gives "priority attention" to the least vulnerable. The fear, augmented by a financial crisis that still threatens those of us who aren't in the "top 1%" economically, is morally transformed a kind of sanctified selfishness.

Its adherents, as a result, not only stand against health care reform, but have no solution for Americans who are among the uninsured or underinsured. They have no solution because none is needed.

So, sure, 47.5 million are uninsured, about 25 million are underinsured, 86 million have been uninsured at some point in the past year, 14,000 lose their health insurance every day, and 45,000 a year die because they lack health insurance. In the culture of cruelty, those numbers don't mean there's a crisis.

In fact, those numbers actually show that things are as they should be. It's the reverse of what Sen. Ted Kennedy, for whom health care reform was a lifelong cause, expressed in his last days.

In 1964, I was flying with several companions to the Massachusetts Democratic Convention when our small plane crashed and burned short of the runway. My friend and colleague in the Senate, Birch Bayh, risked his life to pull me from the wreckage. Our pilot, Edwin Zimny, and my administrative assistant, Ed Moss, didn't survive. With crushed vertebrae, broken ribs, and a collapsed lung, I spent months in New England Baptist Hospital in Boston. To prevent paralysis, I was strapped into a special bed that immobilizes a patient between two canvas slings. Nurses would regularly turn me over so my lungs didn't fill with fluid. I knew the care was expensive, but I didn't have to worry about that. I needed the care and I got it.

Now I face another medical challenge. Last year, I was diagnosed with a malignant brain tumor. Surgeons at Duke University Medical Center removed part of the tumor, and I had proton-beam radiation at Massachusetts General Hospital. I've undergone many rounds of chemotherapy and continue to receive treatment. Again, I have enjoyed the best medical care money (and a good insurance policy) can buy.

But quality care shouldn't depend on your financial resources, or the type of job you have, or the medical condition you face. Every American should be able to get the same treatment that U.S. senators are entitled to.

This is the cause of my life...

Sen. Ted Kennedy, 'The Cause of My Life'

§§§

I want you to know, Your Holiness, that in my nearly 50 years of elective office, I have done my best to champion the rights of the poor and open doors of economic opportunity. I've worked to welcome the immigrant, fight discrimination and expand access to health care and education. I have opposed the death penalty and fought to end war. Those are the issues that have motivated me and been the focus of my work as a United States Senator.

I also want you to know that even though I am ill, I am committed to do everything I can to achieve access to health care for everyone in my country. This has been the political cause of my life. I believe in a conscience protection for Catholics in the health care field and will continue to advocate for it as my colleagues in the Senate and I work to develop an overall national health policy that guarantees health care for everyone.

Sen. Ted Kennedy, in a letter to Pope Benedict

§§§

When I thought of all the years, all the battles, and all the memories of my long public life, I felt confident in these closing days that while I will not be there when it happens, you will be the President who at long last signs into law the health care reform that is the great unfinished business of our society. For me, this cause stretched across decades; it has been disappointed, but never finally defeated. It was the cause of my life. And in the past year, the prospect of victory sustained me-and the work of achieving it summoned my energy and determination.

There will be struggles - there always have been - and they are already underway again. But as we moved forward in these months, I learned that you will not yield to calls to retreat - that you will stay with the cause until it is won. I saw your conviction that the time is now and witnessed your unwavering commitment and understanding that health care is a decisive issue for our future prosperity. But you have also reminded all of us that it concerns more than material things; that what we face is above all a moral issue; that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.

And so because of your vision and resolve, I came to believe that soon, very soon, affordable health coverage will be available to all, in an America where the state of a family's health will never again depend on the amount of a family's wealth. And while I will not see the victory, I was able to look forward and know that we will - yes, we will - fulfill the promise of health care in America as a right and not a privilege.

Sen. Ted Kennedy, in a final letter to President Barack Obama.

Quality care should depend on your financial resources. The state of a family's health, to upturn a phrase from Ted Kennedy's letter to Obama, should depend on the state of a family's wealth. Health care shouldn't be guaranteed to everyone.

There is nothing to be done because, in fact, nothing is wrong.


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I've never heard this better expressed when talking about America and health reform:

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.