Connecting American Values with American Health Care Reform

The Hastings Center, a nonpartisan bioethics research institute, recently asked me to write an essay to help launch their new group blog, The Values and Health Reform Connection. The website focuses on American values, and why they matter to health care reform.  Here is the link to the blog

Below, an excerpt from the piece that I wrote:

“While many speak of health care as an individual ‘right,’ I prefer to think of universal coverage as something that we, as a civilized nation, desire for all members of our society because we recognize each other as equally human, vulnerable, and in need of care.

“As a society, we have a moral obligation to provide access to medical care for all of our citizens. When we frame health care as a “right,” we shift responsibility from society to the individual. It is up to him to demand his due. At that point, the word “entitlement” comes to mind, along with the conservative image (so artfully drawn by President Reagan), of an aggrieved, resentful mob of freeloaders dunning the rest of us for having the simple good luck of being relatively healthy and relatively wealthy.

“‘We didn’t make them poor or sick,’ some libertarians say. ‘Why should they have the “right” to demand so much from us? And just how much care are they entitled to? Should they get the same care that wealthier Americans expect? Wouldn’t it be sufficient to give them care that is “good enough’?

“Put simply, the language of individual ‘rights’ doesn’t seem, to me, the best way to build solidarity. And I am convinced that social solidarity is key to improving public health.

“A friend who lived in France for many years once explained to me: ‘Healthcare is so good in France because the French believe that nothing is too good for a fellow Frenchmen.’ Unfortunately, in this country, many of us do not feel that way about each other. . .

“If health care is, in any sense, a ‘right,’  I would argue that it is what the Declaration of Independence named an ‘inalienable right’ conferred on us, not by government, but by someone the authors of the Declaration referred to as ‘Our Creator.’ The point is that inalienable rights are natural rights: something we deserve simply by virtue of being human, so that we can be free to pursue life, liberty and happiness. These are affirmative rights which empower us to become part of society. Without our health, we cannot participate as members of a political community.

“An ‘inalienable right’ is very different from a constitutional right (to free speech, for example ) which gives the individual the right to be free from interference by government or their neighbors—to be protected against unreasonable searches, cruel and unusual punishment, or invasion of privacy. Those rights are designed to protect us, as individuals, from society. By contrast, universal health care acknowledges each of us as equal members of society.”
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Go to the website to read the rest of my post, and  other provocative essays  focusing on what  terms such as these mean when applied to health care reform: “ justice,” “fairness,” “solidarity,” “liberty,” “stewardship,” and “responsibility.”

Health Affairs is the media sponsor for this website and will publish a selection of posts  from the site.

11 thoughts on “Connecting American Values with American Health Care Reform

  1. Oh my. It seems obvious that making this a “good progressive” vs “bad libertarian” is simply a very very bad idea.
    Can’t we see that this is providing fodder to those who wish to make excessive money on healthcare? Isn’t this about what is the best most effective treatment? Isn’t this about changing money driven medicine?
    This “health insurance reform” isn’t “health care reform.” Sure it is a part of it, but it is not the complete picture, nor may it be the imporant part. There is paying for volume, defensive medicine, fraud, abuse, excessive compensation, money being spent to avoid healthcare rather than fund it, etc. etc. etc.
    Oh my, please don’t buy into the notion that just because someone identifies with libertarian values that they are bad people.
    Republicans aren’t bad people, Democrats aren’t bad people, nor are libertarians or progressives. Sarah Palin isn’t a bad person, nor is John Edwards. David Letterman isn’t a bad person, and neighter is O’Reilly. I believe Rachel Maddow and Glenn Beck both mean well.
    Let’s follow what President Obama says and stop the veiled implications that some people are good and some clearly wish evil on their fellow citizens.
    Oh my, please.

  2. Maggie Mahar urges us to think collectively. This is always a good idea, but I am not sure the relationship between “me” and “we” is that simple.
    Here is what she says:
    “This means that it is essential to think about healthcare collectively. Asking, “What will reform mean for me and my family?” is not the way to achieve universal care. We should ask “What will it mean for all of us?” How can we allocate resources to achieve affordable, sustainable, high quality care for everyone? No movement that urges history forward has ever been built on narrow self-interest.”
    Is asking how reform will impact someone and their family a sign of narrow self-interest? I think not. Morals and values and religious tenets usually start with the “me”, not the “we”.
    Here’s one approach, from Rabbi Hillel: “If I am not for myself, then who will be for me? And if I am only for myself, what am I? And if not now, when?”
    The same approach in Luke, 6:31: “And as ye would that men should do to you, do ye also to them likewise.”
    Or from #13 of Imam Al-Nawawi’s Forty Hadiths: “None of you [truly] believes until he wishes for his brother what he wishes for himself.”
    Each begins, but does not end, with the “me.”
    So asking what health care reform means to me and my family is a reasonable, even moral place to start. The experience of the last go-round on health reform shows that starting health reform from what we will do to help others when the listener is likely in deep trouble themselves is a recipe for defeat.
    Equating self-interest with “narrow self interest” also does not urge history forward.

  3. Nick:
    I agree with your statement
    that “me and my family” is a reasonable place to start.
    However, using Hillel’s words, “If I am only for myself (and my family), what am I?”
    Health insurance is a cooperative-type dynamic.
    The benefits for the individual and family are dependent on the collective (the cooperative) remaining financially healthy.
    You cannot separate one from the other.
    In fact, if one is to err, he should err on what’s best for the cooperative, not what is best for himself and his family.
    For without the coop, you have no insurer.
    Without others, what are you – nothing.
    Don Levit

  4. I agree we have a moral obligation to provide our citizens with health care. Is this a guaranteed right such as freedom of assembly? Is personal responsibility part of the equation? Should an individual who rides a motorcyle without helmet be entitled to this right? Should an individual be forced to buy health care if he does not desire to do so, or can he waive this right? How much health care is every American entitled to? Who will decide the basic level of coverage? How can we pay for this noble objective since we can’t even afford the current system. I want every American to enjoy Cadillac health care. I fear, however, that we are aiming for ‘jalopy’ health care in an effort to expand access. Incidentally, the Declaration doesn’t stipulate a right to happiness, but a right to pursue happiness, an important distinction.
    http://www.MDWhistleblower.blogspot.com

  5. Michael, Don, Brady, Nick & Ed.
    Michael,
    Thanks for your comment.
    IN the post, I suggest that the right to healthcare is quite different from a constitutional right (llke freedom of assumebly) that protects us from bullying by government (or the majority of our neighbors who don’t agree with our point of view and so don’t want us to assemble or march to express that point of view.)
    This is an inalienable “natural right” like those decribed int eh Delcaration of Independence. Quite different from legal constitutional rights. These are rights that we posses simply by virtue of being human.
    Without our health, we wouls be unable to pursue life, liberty and happiness.
    (I didn’t suggest that the Declaration guarantees happiness–simply the opportunity to pursue)
    How much health care? All necessary and needed care, for all human beings.
    But that doesn’t have to be unaffordable.
    The reason our health care costs twice as much as in the average developed country is because we waste so much money on unnecessary, unneeded and uproven care that does the patient so good.
    That’s why our outcomes are no better–sometimes worse–even though we spend so much more.
    We would have enough money to proivde high quality care for everyone if we didn’t overpay while over-using cutting-edge medical technoologies (which includes not just diagnostic testing equipment and medical devices, but drugs, new tests, and surgical procedures.
    As for personal responsibility: if your 18-year-old son drove a motorcyle without a helmet, and split his head open, do you think he shoudl get medical treatment?
    We have laws rewquiring people to wear helmets; if they don’t, they can be fined.
    But of course, we would still treat the victim of the accident, however foolish–just as we treat people who have heart attacks because they foolishly stres themselves out worrying about becoming super-wealthy . . .
    Don–
    You are entirely right. When it comes to health insurance, you cannot separate the individual from the collective.
    And as you write: “Without others, what are you – nothing”
    That is exactly what Hillel meant. That is why he wrote: “And if I am only for myself WHAT am I?
    He didn’t says WHO am I.
    Because if you are only for yourself, you are no longer a “who”–you lose your selfhood and humanity –you are a “what,” a thing, nothing.
    Brady–Thanks
    Nick & Ed
    Since yuu posted your comments on the Hasting Center blog where the full essay appeared– I replied there (where I first saw your comments)
    Go to http://valuesconnection.thehastingscenter.org/2009/10/05/thinking-collectively-about-health-care/

  6. Wow. This post is fascinating and resonates deeply with me, having only recently recovered from volunteering on a 4-year failed attempt to amend the Massachusetts State Constitution and recognize comprehensive health care as a right. This campaign was attempted after a statewide ballot for universal health care lost 48-52% in the year 2000 after health insurers outspent us 100-1. BCBS of MA, a so-called “non profit public charity” led the pack in spending against it.
    We then undertook the constitutional amendment initiative campaign in the hopes that leading with the values of health care for all, it would help build social solidarity around the issue and if we achieved the amendment, it would provide a legal platform to advance policymaking that would be somewhat more protected from the insidious reach of moneyed interests that now largely control policymaking in the health sector. The outcome was beyond belief and if you care to read about it look here http://www.healthcareformass.org
    Ed in his comments here and over at Hastings, and Maggie in her replies, are bringing out important details on the national reform public dialogue that just yesterday I was discussing with another nurse and longtime health reform activist. He happens to be a “don’t divert us from what’s needed” single payer/improved Medicare-for-All activist, while I share the improved Medicare-for-All goal I’m willing to work toward it in large steps while attempting to reclaim American politics from excessive corporate influence (e.g. I focus now on getting a strong public option using Medicare Rates, open to all in short order, etc etc).
    What I was saying just yesterday, after we both had participated in a “Insurance Company Crimes” demonstration, that applies to the conversation here is this:
    BOTH of the major components of health system reform are needed now, and they have inter-related components but can be thought about as standing side-by-side: 1. The Financing piece, how we pay for health insurance (single-payer aims at taking out the wasteful abuses of the private, market-driven insurance sector) and
    2. the Delivery of care piece (reining in over-treatment by changing the fee structure by putting docs on salary, utilizing Comparative Effectiveness Research, etc).
    It seems like more often than not these 2 major components of reform get talked about seperately and in different circles, when both are essential and must be undertaken in tandem if we are ever to achieve fundamental, justice-based, and effective healthcare system reform! Great discussion, Maggie and others–thanks.

  7. Maggie, I understand your view that health care is a natural right. You suggest that everyone is entitled to “All necessary and needed care, for all human beings.” Respectfully, I think this is more than we are entitled to as it absolves the individual of any personal responsibility. In addition, your comment suggests that every person is entitled to every available medical benefit. Not only does this call into question matters of societal fairness, but it is unaffordable. For example, should we provide the same high level of medical care to a reckless motorcycle driver who smokes and drinks alcohol excessively? In Ohio, for example, there is no law requiring a motorcyclist to wear a helmet. You suggest laws that would require helmets. Would you support laws that would require ideal body weight, no trans fat intake, mammographies and colonoscopies at recommended intervals, aerobic exercise three times weekly, etc?
    I agree to the core on your point regarding excessive medical care. I’ve written about this on my blog and have take some heat from medical colleagues. Two representative posts are http://bit.ly/q7ZuO and http://bit.ly/1NJqKS. Physicians and patients are in love with medical technology, which is expensive and overutilized. If patients had to bear a measure of the financial cost of each test ordered, they would become more inquisitive about the need for these tests and could serve as a brake on the system.
    These are some thoughts from a real live practicing physician.

  8. Michael & Ann,
    Thanks– I do think we should have helmet laws in every state.
    But there are some things we can’t legislate.
    You need to read about obesity. See this post which Alternet cross-posted from HealthBeat:
    http://www.alternet.org/healthwellness/108513/fat:_what_the_experts_don't_know_about_obesity/?page=entire
    We now know that obese individuals cannot lose weight and keep it off, even if they are dieting and exercising under physician supervision and are totally compliant.
    This is a very complex disease that involves brain chemistry, neurological commuications between brain and stomach, etc.
    Many overweight but not truly obese Americans also are not able to Keep the Weight Off–not matter how hard they try by dieting and exercising. Part of this is genetic. Part of this seems to be that if somenone dieted religously when she was young, by the time she hits menopause, and her metabolilsm slows down, her body is conditioned to ignore dieting (which it interprets as being starved)–and it fights losing weight.
    Given the stigma of overweight in our society, a great many people spend their lives battling overweight without ever succeeding.
    Finally, and most importantly, obesity is tied to poverty (lack of access to affordable nutritious foods, lack of safe places to exercise, etc. etc. )
    Smoking is also tied to poverty. Almost all of the adult smokers in the U.S. are poor. Dr. Steve Schroeder, fomer head of the Robert Wood Johnson Foundation, who has worked with smokers at UCSF for years, tells us that the vast majority are also suffering from one or more mental diseases.
    Do you really want to punish people who are poor and mentally ill?
    Schroeder believes that we should try to help them stop smoking –and he has shown that, while medicine doesn’t yet know how to help the obsese–smoking cessation programs with free nicotone patches etc, can help the poor stop smoking.
    But they need positive help, not financial penalities.
    The same is true of alcoholism–again tightly correlated with poverty.
    Bottom line: being poor is very stressful. You have very little control over your life, and many reasons to be both anxious and angry.
    Little wonder that the poor self-medicate.
    If we want to change these behaviors, what we really need is a war on poverty.
    We tolerate much higher levels of poverty than any other developed country.
    There is widespread agreement among health professions that if we made a major and conssitent investment in public education k-12 we could do more to improve health in this country than any healthcare reform prorgram.
    (Poor education is, of course, closely correlated to poverty, which in turn turns to poor health. The poor die 6 years earlier than the rest of us. And social mobility in the U.S. has slowed to a point that it is significantly lower than in Europe)
    This is in large part because, while spending far more on healthcare than other countries, we spend far less on K-12 education than those other countries.
    Our classes are larger–especially in poor areas–our teachers are less well-paid than teachers in some countires (where math and reading scores are much higher) and, in ghettos and poor rural areas, our schools are crumbling, unhealthy places (windows don’t open, invested with mice and cock-roaches –i have seen this first-hand in the Bronx)–not enough supplies (books, paper, pencils, crayons) few if any working computers in poor shcools, etc. .
    My daughter teaches 1st grade in Brooklyn. She has 28 students in her class–including one who is physically handicapped.
    She has enough desks for only 26 of the students– the others have to work in their lap.
    And this is a “middle-class” school in Broolyn– not in an impoverished neighborhood.
    Ann–
    Thanks very much for your kind words and thoughful comments.

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