Health Reform: Is "What’s In It For Me" All That Matters?
July 31st, 2009
As President Barack Obama and Congress wrestle with the difficult details of health care reform, various politicians and pundits warn that no legislation will pass unless voters first can understand “What’s In It for Me?” The “me,” of course, is the majority of Americans who already have some form of insurance and are generally satisfied with their care. It is not the 47 million uninsured, who evidently do not have enough electoral clout to matter. But I wonder–are we Americans really so cold-hearted that self-interest is all that matters when it comes to national policy?
As parents, most of us teach our children from their earliest years about empathy, about considering the feelings and needs of others. We urge them to donate at church, volunteer in the community, raise money for their school, join sports team where the whole is more important than the individual. Once they become voters, are they supposed to forget all that?
As Washington Post colmunist Ezra Klein asks, What Happened To The Moral Case For Health Care? The same could be asked about the moral case for climate change regulation, immigration reform, tax policy, education financing and any number of other public issues.
I’d like to believe the talking heads on TV, the pollsters and the politicians, are underestimating the American spirit. After all, the moral case certainly carries weight in every other nation; Why not here? At the moment I’m reading The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care, by T.R. Reid, an excellent book that I will soon review for BusinessWeek. Reid, a former Washington Post reporter, investigates health care systems around the world in an effort to understand why other nations have better medical outcomes for half the cost of the U.S. All the advanced countries he visits have universal health care in some form or another–that is, every resident is guaranteed access to affordable, high quality medical treatment. The one exception, of course, is the U.S.
One common denominator he found in all the countries he visited is that there is a sense of shared responsibility. Here’s a French professor on the subject:
“The solidarity principle,” explains Professor Rodwin, “requires mutual aid and cooperation among the sick and the well, the inactive and the active, the poor and the wealthy, and insists on financing health insurance on the basis of ability to pay, not actuarial risk.”
Or listen to Reid’s conclusions about Taiwan and Switzerland, two countries that only in the last 20 years instituted universal health care (proving that systems can change even in the me-decades of the late 20th century):
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.
For a window into the American approach, Reid includes a case study of Nikki White, a U.S. taxpayer who was diagnosed with lupus shortly after she graduated from college. Though a serious chronic disorder of the immune system, lupus can be managed with drugs, but they are costly. But once she was diagnosed she lost the health insurance she had gotten through her new job, and Nikki wasn’t poor enough to qualify for Medicaid. She could not afford all the drugs, tests and doctor appointments she needed and as a result suffered a seizure due to kidney failure. The emergency room had to treat her under federal law, and over the next 10 weeks she underwent 25 operations in an attempt to undo the damage of delayed medical care. It was too late, and she died in 2006 at age 32. “Nikki didn’t die from lupus,” her doctor told Reid. “Nikki died from complications of the failing American health care system.”
A French primary care doctor said of her country’s health care system, “Everybody must have equal right to the best medical treatment we can provide…Surely that is the basic rule of health care in every country.” Surely, but why not here?
Harold Pollack, a University of Chicago professor, wonders if the debate should be reframed, in The New Republic blog The Treatment:
In conceding ground to a dry policy discourse that downplays the moral urgency of collective obligation, we unilaterally surrender some of the best moral and political arguments for health reform. It’s a genuine dilemma. We must legislate in the society we actually have, not in the society as we wish it to be. So we present a rather cold-hearted calculus to sell humane policies. This isn’t a stupid calculation, but I’m starting to think it is the wrong approach.
What do you think? Do we really only care about what’s in it for me? Do the lessons we teach our children somehow disappear as we grow up?
And if not, how do we chnage the debate to one of shared responsibility?
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