Sunday, October 4, 2009

In it Together? The Real Health Care Debate

When Dante lost his way and descended into hell, he found himself face to face with all the human depravity that his cultivated and poetical nature had previously resisted. In this same way, when a civilization falls apart, it, too, will eventually find itself face to face with its own fractures and contradictions, with the things that, in its rise to greatness, it conveniently set aside or ignored. Prison culture is one of these. But at this moment in the United States, there are few places where our contradictions and shortcuts are more in the limelight than in the health care debate.

Obama’s recent speech reminds us that the health care debate is a moral one, says an editorial in the most recent issue of The Christian Century. “Access to health care is something that we owe one another simply because we are all human and because ‘we are all in this together.’” The article goes on to cite T.R. Reid in The Healing of America who tells us that there is one major difference between the U.S. and the countries that have provided universal coverage: those countries have concluded that health care is a human right. Finally, the editorial says, “In the culture of readical individualism, the moral argument needs to be made again and again.”

These questions are important, but it has recently struck me that they are not the essential questions. Beneath ideas of rights and community lies a far greater question. How, in the United States of America, is the worth of a human being determined? The answer is that there is no single worth, no single human condition. We are not created equal. Some humans are worth a great deal more than others. Or, as a wealthy matron remarked to her hairdresser, "If we have universal health care does that mean that a homeless man can get a heart transplant?"

If you read the literature of health and sickness, there is one consequence of illness that emerges with greater frequency than any other: health and sickness affect productivity. Therefore, for example, obesity or smoking are bad, not just because they make people sick and miserable, but because they result in lost work hours and the bad habits of some cost honest people money. (In fact, these conditions pay for themselves, if you were worried.) I could give many other examples of how productivity dominates our social dialogue, but you have read the same articles that I have and the drift is clear: in this country, a human being is considered valuable in proportion to his or her ability to generate product and profit for the economy. Workers are paid a salary in consideration of the hours they put in at their jobs, but their purpose in working is not for their own dignity, but to generate profits for the company and its shareholders. This results in a kind of double taxation: you give a large proportion of your productivity to the company and then you pay another proportion to the government. (The Republican Right channels all the rage at the government when rightly, among the working class, it should be shared between capitalism and government.) When a person in this economy gets sick and cannot produce output, his or her ability to generate profits is greatly diminished and he or she is less valuable.

But – and there is a very big but here – if sickness itself can be made profitable, all is not lost. The for-profit insurance model apparently solved this dilemma, but it did not take long to discover that some illness is more profitable than others and that some things, like chronic conditions, can actually eat up your profits. Thus to insure a pre-existing condition, in the for-profit model, is like hiring a worker that you know will cost you. It’s not a good investment. The business model says to keep costs low and profits high. When the worth of a person is measured by his or her ability to generate profit for self and others at minimum cost, it only makes sense that even in sickness, a person must remain productive.

But if there is more to being a human being than mere output, to value us in this way not only makes no sense at all, it may actually be very dangerous.