Tuesday, July 28, 2009



I saw a documentary on cable a few weeks ago about health care in India. It drew attention to the “cleft palate epidemic” plaguing Indian children. For some reason, much greater percentages of children in India suffer from this disorder than they do in Western countries. The filmmakers showed that children with cleft palates suffer social ostracism and cannot effectively contribute to society. In many cases, their parents even let them die or give them to orphanages rather than try to raise them.

According to the film, the Indian government made a concerted effort to combat the epidemic. It mustered its best doctors and nationally advertised a program to “repair cleft palates.” These advertisements urged parents with ill children to bring them to designated hospitals, where trained surgeons would repair cleft palates at no charge. Parents simply had to come up with the transportation costs to the nearest hospital. Once they arrived, doctors consulted with them, determined the best surgical procedure and carried it out. In most cases, the surgeries were successful.

After the operations, nurses gathered parents and their children in a conference room. They thanked them for coming and for allowing the surgeons to help them. Finally, they asked their patients to tell all their friends about the government effort to heal cleft palates, and to send them to the nearest hospital for care. After all, said the nurse: “Without patients, a hospital is useless.”

No one ever talked about insurance or money. No one threw anybody out of the hospital because they couldn’t afford it. There were no “care approvals” or “administrative investigations” into “patient solvency.” In fact, all the parents who responded to the government advertisement were destitute. They came to the hospitals because the government told them it wanted to heal their children. After all, it was in the national interest to cure diseases. Money did not even enter the question.

To an American viewer, this seems incredibly foreign. It is impossible to talk about health care in this country without talking about money, insurance, profit, deficits, bankruptcy, debt, loans, Republicans, Democrats and even class distinction. The simple humanity of curing sick people fades into obscurity as policymakers battle over fiscal responsibility, fraud, overbilling, cost analyses and insurance practices. Yet isn’t health care about health? How did health care turn into a vast money game in this country? What happened to the “health” in health care? And what happened to “care?”

Health care is an enormous issue in the United States. America has dubious notoriety as the only major industrial power without some guaranteed health coverage for all its citizens. While it offers the best care in the world to those who can afford it, it also allows millions of others to go without any care at all. This is a profound national embarrassment, especially in a country that has long prided itself on respect for human dignity, equality and “general goodness.” After all, it is hard to argue that “America cares” on the world stage when it does not even provide medical care to millions of its own people.

For decades now, politicians have attempted to address this embarrassment. Many have tried to introduce legislation that provides basic care for all. They have all failed. For better or worse, health care in America is a private commodity, like wheat or oil. Insurance companies and private hospitals dictate policy, prices and access. They compete with one another for “patient business,” just as auto manufacturers compete for customers. Like any private commodity, you can’t buy health care if you can’t afford it, and that commercial reality has frustrated every effort to reform the system. After all, in the eyes of private business, providing universal care would be like giving away oil or wheat for free. That doesn’t happen in other commercial fields, so why should it happen in health care? It just “wouldn’t be fair” or “fiscally responsible” to give commercial goods away. That, at least, is the response from private enterprise. And that response has derailed every attempt to bring more humanity to our health care system.

Barack Obama promised that he would “reform health care” during the 2008 Presidential campaign. He publicly said that he will “get it done,” no matter the opposition. He even acknowledged that many have failed before him. He rode to victory on such noble-sounding promises as these. In 2009, Congress drafted health care legislation. It now founders and threatens to collapse before it even comes up for a vote. Everyone is complaining. The momentum is waning. No one likes the price tag. No one likes the handouts. No one likes the subsidies. No one likes the rules. No one likes the mandatory employer coverage or penalties for refusing to cover employees. Republicans resent any attempt to undercut private enterprise and insurance companies. Democrats are fatally divided between those brave enough to demand universal coverage and those who run in political terror from the costs. In essence, the objections all boil down to money and “responsibility.” Again, the health care debate in America has degenerated into a money debate.

When will our politicians understand that health care is about health, not money? Is it really that difficult to formulate a system in which all Americans can obtain medical care without fearing bankruptcy? Is it really that difficult to change our minds from profit to humanity? Our government should care as much about whether its citizens are healthy as it cares whether its budgets are sound. If citizens die, what good is a budget? In short, the health care debate has lost all focus. As politicians bicker and wage war over costs, Americans continue suffering because they cannot see a doctor. Hospitals care more about their budgets than they care about people’s health. Hospitals are corporations in the United States. I suppose we should have expected nothing less. Humanity, after all, does not produce dividends for the shareholders.

If we really want to solve the health care mess, we need to change our focus. We need to stop hemming and hawing about costs. We must be brutally honest: Health care for all costs a lot. But if we really want it, we have to pay for it. If that means giving things away, then so be it. Health care must be about health and care, not cost and profit. If these values are inconsistent with private enterprise, then we must take power away from private enterprise. I venture that it is foolish to trust private enterprise to handle health care anyway, precisely because private enterprise and humanity are mutually exclusive. After all, private enterprise is private. Humanity is public. Try telling the shareholders that their money is paying to help the public. It won’t fly.

I simply do not buy the idea that reforming health care would be “prohibitively expensive.” If India can scrape together the money to surgically repair cleft palates for free, then so can we. India paid the money to heal children because India cared about them as human beings, not paying customers. India did not care whether these children could pay for insurance; it cared that they were suffering. That is a fundamental difference in values. If we really want to change health care in the United States, we need to start caring about our fellow man who suffers, not whether he can afford to pay $4,000,000 for a hospital stay. We need to stop worrying about whether it would be “fair” to treat a sick person who can’t afford it. We must simply have the courage to say: “These are our fellow citizens. They must be cared for because we care as a society, even if it costs a lot.”

Can we do this? Do we have it in us? Can we really change our values and free ourselves from the money spell? I think we can, but I know many people will say we can’t. They will say that universal care is far too expensive and would encourage irresponsibility. They will say it would require excessive taxes and kill American jobs. They will say it would be nice to care for everyone, but not nice enough to raise taxes for.

I think that caring for everyone in our society is nice enough to raise taxes for. If we can raise taxes for infrastructure, navies, wars, welfare and public services, why can’t we raise them for health? Wouldn’t health be a good thing to buy? Sure, it would cost a lot, but many other countries willingly pay the bill. You don’t read horror stories about poor people being thrown out of hospitals in France or England. These countries—like India—simply have different values. They care enough about their citizens’ health to pay to protect it.

Does it not seem callous—and even vicious—that we do not? At this point, however, the familiar objection arises: “But those countries make patients wait 75 years for care and people die in clinic waiting rooms. That never happens in America because doctors make enough money, pharmaceutical companies have an economic incentive to invent effective new drugs and hospitals are cost-effective…blah blah blah.”

While it may be true that a desire for profit impels medical breakthroughs and “top-notch” care for those fortunate to have expensive private insurance, the American system leaves millions without any protection at all. The “private market model” for health care may very well be efficient, but only for those who can afford it. I am deeply skeptical about arguments that link potential profitability to “effective health care.” If we really want to change the focus in health care, our desire to help our fellow man must be just as alluring as securing market shares and outdoing last year’s sales record.

Are there long waits for care in other systems? Probably. But I have a feeling that most invective against “socialized medicine”—especially in Canada—is pure propaganda. For every scary story about a bad waiting room experience in Canada there is another story about timely, effective care. I have a friend from Alberta who required bypass heart surgery and was in the operating room within a week. Since then, he has been fine. His “poorly-paid” doctors were not incompetent. He did not die in a waiting room. He never paid a dime for his care. He even got to take off two months from work—with pay. His story shows once again that health care can really be about “health” and “care,” not money and insurance.

Why can’t we do the same in this country? Why does everything have to generate a profit here? Why is it a national disaster if someone gets expensive, life-saving surgery but doesn’t pay for it? If we really want to fix health care, we need to stop thinking in profit terms. We can do it if we are willing to change our values. We simply need to pay the cost. Yet Americans dislike spending money on others as much as they like making it for themselves. They will do anything to avoid incurring additional costs, especially if they “get nothing” out of it. The psychic—and even moral—satisfaction that flows from living in a community that truly cares about everyone does not impress most Americans. They would rather have more disposable income for themselves. That is the sad truth about why this country does not provide basic health coverage for all.

But isn’t this pitifully egotistic? If a so-called “developing” country like India manages to provide free operations to its citizens, why can’t we? We obviously have more money, more technology and more facilities. Yet our government does not publicly call for “all sick people” to come get cured at State expense. Why not? Doesn’t it sound wonderful? Doesn’t it sound like the State actually cares about its own people when it does something like this? And doesn’t it make us look embarrassingly cruel because we do not do such things?

Put bluntly, we would rather let some people die than give “health care commodities” away for free. These are our values: No money, no beer.

If we really want to overhaul health care in this country, we need to stop thinking in economic terms. Instead, we must think in human terms, no matter how much it costs. I understand that this is politically difficult. But it is the only way to really change the system. There is simply no way to satisfy both private enterprise and humanity at the same time.

We need to start saying: “Without patients, a hospital is useless,” not “Without paying $600 a month for insurance, you can’t be a patient.”

1 comment:

Anonymous said...

"Americans dislike spending money on others as much as they like making it for themselves."
(I enjoyed that line)

Universal healthcare seems like such an uphill battle because improved care for the poor will likely result in lessened care for the rich. Universal care won't lead to more doctors, so all of the sudden there will be a room full of poor people waiting to see a doctor who used to only see a handful of rich.

getting into a position of power takes money.. so money will be behind those in power, and those in power probably don't want universal care

uphill battle