Health Care Basics

So, the health care debate.

But first, a really long tangent. Feel free to skip this part, but it does kind of relate.

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One day when I was a boy, I was reading some old Jewish folktale that took place in a shtetl. There were some robbers, and they were stealing from a family’s home. My dad was shaving in the bathroom, and I went in and asked him, “Is there such thing as robbers?”

It seemed so weird to me that there could be a group of people who snuck into someone’s house and stole their stuff. It… just didn’t make sense. It was too scary and unsettling. It was… wrong. Why would people do something that was wrong?

I tend to be idealistic about humanity — or naïve, depending on how you look at it. I like to throw away the assumptions and ask the questions a child would ask. Why do dogs have four legs? Why is the sky blue? Why are people mean? Why can’t they just not be mean? Grow the hell up, someone might say. People are just mean. What? Come on! I can’t even ask why?

I believe, or I want to believe, that every human being wants to be good, that human beings care about their fellow human beings, and that if you just try to communicate with someone who is ill-informed — if you calmly lay out your reasoning, clearly and logically — the other person can’t help but come around; perhaps not right away, but eventually. Even if the person protests, I believe (or, again, I want to believe) that your words will seep into the person’s subconscious, take root, and flower when the time is right.

I believe deeply, almost religiously, in the power of logical argument. That doesn’t mean an argument divorced from emotion or morality; ultimately, arguments for the preservation of humanity or for the idea that we should treat each other well are moral ones, not logical ones. But the process by which you get from a moral premise to a moral conclusion, that involves logic.

As for the substantive part, the moral part: I do think everyone wants to do good. We can be selfish, fearful creatures, but we are also capable of great empathy and generosity. That empathy and generosity just needs to be teased out sometimes, and it has to be done in the right way. I don’t always know what that way is, but I believe it’s possible. I just refuse to believe that there isn’t a person who can’t ultimately be convinced.

Again, call me idealistic or naïve. I don’t care.

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Okay, that’s the end of the tangent. You really should have read it.

But back to the health care debate.

All the craziness is making people forget what this is all about:

Either you care about what happens to strangers, or you don’t.

Either (1) you believe your fellow citizens deserve health insurance, or (2) you don’t believe your fellow citizens deserve health insurance.

Either (1) you see other human beings — most of whom you will never meet and who may have life circumstances or cultures that are completely different from your own — as actual, living, breathing people, or (2) you see your fellow human beings as subhuman.

Why do I say subhuman? Because if you don’t ascribe to other people the same three-dimensionality that you ascribe to yourself and your own family members, if you don’t think their lives matter as much, then you’re not treating them as human beings. You’re treating them as less than human. As subhuman. (This is why good fiction writers are probably better people than the rest of us: because they take the time to imagine fully real, fleshed-out characters. Because they appreciate that every human being has value.)

It’s weird. For most of 2008, and most of the years before that, I thought that the health care debate was about the fact that millions of Americans don’t have health insurance. Either they can’t afford it or they’re denied coverage, but for whatever reason, they don’t have health insurance. So they get sick and die because they can’t afford to see a doctor for minor issues that become major issues or even for preventive care. Or they have an accident or develop a catastrophic illness and then they go into bankruptcy because they have to pay for everything themselves.

So health care reform is about insuring all of our citizens, like every other modern nation tries to do.

But then suddenly it’s 2009, and people are saying, “Health care reform, as we’ve long said, is primarily about reducing costs.” What? When did this happen? I thought health care reform was about insuring all of our citizens. When did it become about cost? Cost is an issue, but it is a secondary issue. The primary issue is that there are millions of Americans who lack health insurance.

The cost isn’t really a big deal. Why are people so selfish that they’re not willing to pay higher taxes to help out millions of other people? Our taxes are already so low compared to other countries. Back in the ’50s and ’60s, taxes were way higher than they are now — the top rate was 91 percent — and the economy thrived.

The response is, “Are you kidding? I’m struggling as it is.” Well, guess what? There are millions of Americans who are much worse off than you.

“But this is my money. I should be rewarded for my hard work.” Yes, but you have a moral obligation to the rest of human society.

“But if these other people just worked harder, they’d be doing as well as me.” Tell that to the woman working two minimum-wage jobs to feed her family.

“It’s not my fault she’s worse off than I am.” No. But again, you are part of human society, and therefore you should care about her.

You should care about her.

“Why can’t we all just give to charity?” If that worked, we wouldn’t be in the mess we were in. Besides, mandatory payment — taxes — takes the social pressure off you. We care about how we’re doing in relation to other people, and if you know that everyone else has to give money for the common good, you won’t feel like a chump for being the only one doing it.

I don’t understand why more preachers and pastors and other religious leaders aren’t pleading with their congregants to support universal health care and the higher taxes that are necessary to achieve it.

I can be selfish and irritable and scared and suspicious just like anyone else can. But that’s why I need to be made to contribute, just like everyone else. We can’t rely on charity. Charity relies on our moods and our moods are inconsistent. We need to be made to pay higher taxes.

I don’t understand why citizens have to carry guns to rallies and why politicians have to spread blatant lies. (Chuck Grassley.)

Either you care about what happens to strangers or you don’t.

I guess I’m just naïve.

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[Update: I don’t mean to suggest that health care costs are not important at all. There’s no need for our taxes to go toward inefficiencies or for us to pay more taxes than are necessary. But reduced health care costs are a means to an end — health insurance for as many people as possible — and not the end in itself.]

2 thoughts on “Health Care Basics

  1. Great post. The culprit is alienation, but that’s a topic for another day.

    One problem is that our minds are still wired for the kind of social group with evolved in: the small, tightly knit tribe or clan in which everyone knew everyone else and the survival of the tribe depended on the survival of each member of the tribe. The people we see every day and interact with — the members of our tribe — we can feel natural empathy for. It’s a lot harder to feel this empathy for people we’ve never met, in another part of the country, of a different race or ethnicity from us. Modernity has given us the means to break down these artificial barriers to human interaction, but it takes a lot of effort to do so and most people are unwilling to put in that effort.

    However, the problem is that this “debate” has long since ceased to be about health care or costs. Costs are an important aspect of the problem because our health care system is so inefficient that we collectively pay double what, say, the British pay for equal or lesser quality care. Money represents resources and unnecessarily high costs are a waste of resources that could better be distributed elsewhere.

    But as I said, this isn’t about health care any more. Health care has become just another football in the game between the two dominant factions for power and influence. The people who are being classed as the “Other,” as the “subhuman” are those who belong to the opposite faction from oneself. It is no longer possible for two citizens to simply disagree on a political issue. One of them, the wrong one, is not just wrong but the embodiment of pure evil. If you opponent is Evil Incarnate, there can be no respect, no dialogue, no compromise.

    Worse, this demonization of the Other is not logical or rational: it cuts straight to the visceral, emotional, animal parts of our psyche. That’s why logic and reason don’t work, and why Barney Frank trying to have a conversation with one of these anti-health care nuts would be better off having a conversation with his dining room table.

  2. Right on, Dan, with all of what you say. What frustrates me is that so many people let themselves be driven by that visceral, emotional part of themselves instead of the part that knows how to think.

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