Thursday, July 30, 2009



I have written about health care for three straight days now. Everyone agrees that it is a significant issue; The New York Times seems to run an article about it every day. So far this week, I have explained, lampooned, recommended and even dismissed things concerning the "health care debate." To be blunt, I am frustrated that Congress cannot see the simple truth about health care. Rather, "politics as usual" threatens America's best opportunity to bring meaningful change to a profoundly unjust system.

Health care reform is steadily losing steam in Congress. You can just sense the fatal impasse. Representatives and Senators--even Democratic party allies--cannot agree on costs. They cannot agree on regulation, nor can they stomach the idea that "people can't choose their own doctors." They recoil from raising taxes because they worry they'll lose the next local election if they do. They flee from the talismanic specter of "socialized medicine" as soon as they perceive a tad too much "government involvement," even if proposed legislation is not remotely socialist in nature. Republicans, of course, simply refuse to do anything the Democrats want. So the fate of health care rests in the Democrats' hands. And they just bicker endlessly about costs and fine print. No one has the political courage to demand sweeping change.

Politics, politics, politics. Cowardly and pathetic as usual. It is even more pathetic when you consider that many representatives oppose health care reform because they worry about their own political futures. In other words, it is "all about their jobs," not beneficial decisions for the country. At times like these, it would be nice to have an Aristotelean Philosopher-King who wisely does what must be done for the people, vested interests be damned. But alas, we are stuck with stooges worried about their goddamned two-year jobs.

Yet there is something else going on here, something even more vexing. According to a New York Times article today about Obama's struggles to get a bill passed before the summer break, many Americans say they don't want universal health care reform because: "they [are] concerned that the quality of their own care would decline if the government created a program that covers everyone." See N.Y. Times, New Poll Finds Growing Unease on Health Plan, July 30, 2009.

This is rank selfishness in its most unabashed form: Americans don't want to allow others to get health care if it would somehow complicate their own access to health care. They don't even know whether universal care would restrict their existing health plan; they just "think" it will. God forbid. We certainly don't employed people to wait 40 minutes in the doctor's office instead of the usual 25 so that a lousy unemployed bum can get a free flu shot. That would affect "the quality of existing care."

I do not deny that I am intractably cynical on many issues. I am committed to cynicism as a "belief system" because it reliably explains human behavior as we observe it through experience. See, e.g., Cynical? Or Just Realistic? published September 25, 2008. Cynicism provides a reliable framework to analyze human motivations. Put simply, cynicism assumes that everyone acts selfishly. It doubts people's sincerity, mocks their claims to nobility and explains all their behavior by reference to crude self-interest. It may be lazy to be cynical. But in case after case involving economic questions (as almost all social questions do), experience reveals that cynical assumptions generally prove correct in the end. After all, people are selfish. They act to better themselves. Their actions merely reveal their motivations.

Cynicism works. It provides a clear explanation for America's hesitancy to embrace sweeping health care reform. Politicians might quarrel about amortization, costs, interest, long-term savings, expenditures and even "socialized medicine." But all these catchphrases are mere chaff to cover the real explanation: People just don't want to suffer inconvenience to help others. Universal health care is a revolutionary proposition because it challenges America to put others before themselves. It will not necessarily reduce the "quality of existing care." Yet it is precisely the selflessness inherent in the idea that repels the American mind. After all, Americans generally don't like doing anything that makes their lot more difficult. Helping others is simply not very lucrative and it requires effort. It pays no bills. If helping people is not somehow profitable, Americans typically won't do it. They have their own "responsibilities" to worry about.

Universal health care involves "helping" people on a grand scale. Strictly viewed, there is no individual, selfish reward for accomplishing it. At most, the reward for universal health care will be justice and humanity in a society that claims to treasure both. Yet justice and humanity are "just words;" no one does anything in this country if it brings home no bacon. Universal health care brings home no bacon. It gives bacon to people who traditionally could not get it, and those with bacon resent the idea that they might not have as much bacon as they used to. The idea that we might achieve a society with just access to bacon does not compensate for the anger that wells up in a bacon owner who loses his bacon hoard.

This is the cynical explanation for American resistance to universal health care. It is based in selfish notions of property entitlement and personal convenience. And it is absolutely accurate.

I really have no idea how the health care debate will turn out. When Barack Obama won the White House last year, I really thought that America wanted to re-order its value system. But if the bitter recriminations over health care reform are any indication, it is clear that America has a very long way to go on value change. We're just as selfish as ever. And no promise of justice for all will convince anyone to give up their "entitlements" or "existing advantages."

Cynical? Yes. But I'm just being realistic.


SteveW said...

Is there room for debate here whether universal health care is a good idea? Are the only two positions 1) I want to get mine, or 2) everyone should get some?

Imposition of an insurance product model on health care which does not have the characteristics of an insurable product in most of its aspects is destroying the system, private or public. De-coupling the consumer from the cost of any product will cause a run on the product and turn the system into a shambles. You can't create a right to someone else's work product without conscripting someone to do that work.

Those are true, regardless of my motivations. I have a strong personal interest in gravity holding me to the surface of the planet, and nevertheless gravity holds me to the surface of the planet.

This is the limitation of cynicism - it can help you understand motivation but it cannot lead you to the truth.

Balthazar Oesterhoudt said...

I could care less whether cynicism helps me find "the truth." I have difficulty positing "truth" in absolute terms; unless a person actually experiences something, it is almost pointless to talk about "truth." The better term is "accurate recollection." That's the funny thing about "truth." It masquerades as objective "fact," when in reality it is nothing more than subjective impression (cf. Nietzsche: "There are no truths, only interpretations."). Maybe we can step back on the abstraction level and agree that some things are true, such as "World War II happened" or "my mother was born." Yet those, too, are simply recollections that external evidence tells us "must have happened."

For me, understanding motivation helps me arrive at the impression I call "truth." Cynicism helps me do that. While it may not help me find "the real truth," (assuming such a thing actually exists... it would be nice if it did), it gives me a reliable analytical structure to form a coherent interpretation about the world. Yes, it's my interpretation. But it is also coherent; and in many cases it correctly interprets commercial behavior. If we step back again on the abstraction scale, we might even say that understanding motivation DOES give us truth, to the extent that people "truly" have self-interested motivations. If "true" means a person is actually selfish, then cynicism does help us find "truth."

But what do I know? It's all unverifiable. I just observe how people act. And I make conclusions based upon things they say/argue.