The Wheel of Healthcare Goes Around and Around: Let’s Get Philosophical

An edited version of this article appeared first on elephant journal.

“It is of great importance in a republic not only to guard the society against the oppression of its rulers but to guard one part of the society against the injustice of the other part.” James Madison, Federalist Paper 51.

Healthcare in America: Here we are, standing under the ghostly shadow of the American Health Care Act, narrowly passed by House Republicans. It must now go through the Senate, but it’s one step closer to becoming law. I shudder at the heartlessness and absence of compassion that this bill reveals about the current White House occupants.

And yet, the foresight of our Founding Fathers to predict and attempt to prevent the rise of tyranny, or the “cruel and oppressive government or rule,” continues to astound me. It was as if they dared to look at the underbelly of human nature and, when writing the Constitution, took into account a future individual or group of people giving in to their worst impulses.

I can imagine people saying to them as they wrote in more and more safeguards: “Why is this necessary?” or “This seems over the top,” or “Fine, but that will never happen.” Yet this foresight is why today we have two houses of Congress, three branches of government, staggered election terms and various other means of checks and balances.

Rather than trusting that fairness and equality would sell themselves on their own merits over and again through the decades, Madison & Co. seemed to accept the truth that human beings have the capacity to be cruel to other human beings—especially when given power over them. Others maybe said, “People are good at heart, and their instinct is to take care of each other. We must trust that decency will prevail.”

But thank goodness they did more than just trust in goodness. Because in so many ways, Donald Trump and his administration are testing the institutions that underpin our democracy, trying to find out if they are, in fact, “tyranny-proof.”

They remind me of a bunch of unruly boys tearing down a goalpost after a football game. Like taking our “waterproof” cell phones into the ocean for the first time, we hold our breath and hope that indeed, the Founding Fathers really did block every door and bolt every window. That we will survive this time period with our house of democracy intact.

Democrats and Republicans alike agree that we face serious problems with our healthcare in this country. But it’s time we stop quibbling over the details and start digging deeper. We must do as Bernie Sanders does every single time he talks about healthcare: get down to the roots of the issue. If we want to improve healthcare, we must get philosophical.

In fact, Bernie Sanders is one of the few politicians who consistently and constantly looks at the debate from its roots. From the CNN Debate with Ted Cruz on Feb 7, 2017:

“This country finally is going to have to do, in my view, what every other major country does. And yes, I believe, Ted, healthcare is a human right. And I believe that this country has got to join every other major country and say, you can stay home and get quality care because you’re an American. You can run your small business well and get care because you are an American. That is where we have got to go.”

Contrast this with this from Ted Cruz in the same CNN debate:

“What I said is access to health care. Access to healthcare is a right.”

Cruz didn’t let himself be cornered into admitting that he does not believe healthcare is a human right, but I think by now we have heard enough from him to intuit this much. Republican senator Ted Cruz, and many others on the right, love to promote a picture of a world in which all Americans have equal access to healthcare. But we need to understand what this would mean for us. Like the Mercedes for sale on the car lot, we might all have access to it, we just wouldn’t have equal ability to pay for it.

The question at the root of the argument is this: do we, like Sanders, believe that all Americans are entitled to healthcare—regardless of their employment status, their race, their diet, their constitution, their health history, their access to funds? Regardless of their skin color, nationality, or gender?

Do we believe that healthcare should be an irrevocable right granted to every single person of every age, class, or religion?

Do we believe that healthcare should be a staple of American life?

Or, should healthcare be a privilege, a luxury item that sits on the top shelf for only those who can reach it without help or even a step-stool?

Many other developed nations have already asked themselves theses questions and answered them in the affirmative: Health care is a right for all of their citizens. While there are different models and various success rates, I counted over 60 countries that now have some form of Universal Health Care, defined this way on Wikipedia: “Universal health coverage is a broad concept that has been implemented in several ways. The common denominator for all such programs is some form of government action aimed at extending access to health care as widely as possible and setting minimum standards.”

Why would Americans, who like to see our country as the leader of the free world, who imagine America as a shining city on a hill, even be arguing about this? Why wouldn’t “health care for all” be something we would love to show off like a ring or a badge of honor, one even shiner than our tanks and missiles? While financial experts study the problem from a dollars-and-cents perspective, what interests me is this philosophical, human perspective; specifically, what drives us to make the determinations we make and hold the opinions we do? I think the health care debate can tell us a lot about who we are as people, good and bad. In other words, I think this healthcare debate has, perhaps unintentionally, revealed our not-so-pretty underbelly.

As a point of reference, let’s consider the reasons why the Affordable Health Care Act (Obamacare) is struggling right now. This can offer us clues as to why the overall healthcare debate remains stuck in limbo, destined to never get better, likely to only get incrementally worse.

First, consider the concept of America’s Individual Pursuit.

In America, we are all encouraged to set and pursue individual goals. We like do-it-yourselfers. We like heroes. We emulate and admire self-made people. We want to be able to say that we got where we are without any help. Without going on a tangent about how that’s never, ever true, we Americans (not just Donald Trump) have been taught and continue to see the world divided between wes and theys, winners and losers, bosses and employees, takers and givers, enemies and friends. When we look at the world and see only divisions, why would we not also see divisions between those we believe deserving of healthcare and those we deem undeserving? It’s simply an extension of our split worldview.

To focus on the Individual Pursuit and maintain a divided rather than a united worldview has a cost:

1) We lose sight of the value of the collective human journey, and the joys and successes available when we live from the perspective of strengthening the individual through strengthening the collective.

2) We fail to acknowledge how interconnected our lives are. None of us live in a bubble. None of our successes belong to us alone. We have all been given first chances, second chances, sudden breaks, surprise opportunities, and yes, hand-outs. What is a coupon if not a simple hand-out?

3) We have forgotten that it takes a village to raise a child, or care for an elderly person, or build roads, or keep measles at bay. Think of it like this: if we saw our country as united, and its people a single body with many limbs, wouldn’t we naturally pitch in to help raise, educate, and ensure that each child has food, clothing and healthcare? Wouldn’t we all care for those unable to care for themselves? To me, this is like asking if our liver has an invested interest in helping our heart.

Secondly, the failures of the ACA are not solely problems with the structure, but largely stem from to a misunderstanding (and a failure to fully educate the public) about how insurance is funded and what it needs to work. Think of a 401(k). We mix higher-risk investments with lower-risk investments to balance out our portfolio. With this diversification and over the long term, we can reach our goals. But if we choose only risky investments, our chances of success virtually disappear.

To follow this analogy, the ACA currently has far too many higher-risk stocks (sicker people) and not enough lower-risk bonds (healthier people). Too many healthy people, raised on a lifelong diet of the virtues of the Individual Pursuit, opted to pay penalties rather than be “forced” to buy insurance they didn’t (then) need. As the pool’s needs increased, the medical costs increased, the premiums had to follow.

During a recent debate over the ACA replacement, Rep. John Shimkus, R-Illinois, asked, “What about men having to purchase prenatal care? Is that not correct? And should they?”

The answer? Yes. For the same reason we pay school taxes, even if we don’t have kids in the school. For the same reason some of our taxes go toward fixing highways we don’t drive on. For the same reason we pay a flat tuition for college even if we don’t participate in all of its clubs and extracurriculars. For the same reason we all pay for the fire department even if, blessedly, our house never goes up in flames: We are a community. We take care of each other. We contribute to the pool. We support those who support us. Or at least, we should.

Just this week, Rep Mo Brooks, (R-Alabama), said this about the new proposed health care plan: “It will allow insurance companies to require people who have higher health care costs to contribute more to the insurance pool that helps offset all these costs, thereby reducing the cost to those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy,” explained Brooks. “And right now, those are the people who have done things the right way that are seeing their costs skyrocketing.”

Over these last couple of years, I’ve sometimes wondered if I’ve become un-shockable. But no. My jaw dropped. Alone in my house, I waved my arms repeating, “What the—? What the—?” I turned to my cat who is dying of lung cancer even though she’s never smoked a single cigarette, and my dog who needed surgery so he wouldn’t go deaf even though he’s never attended a punk rock concert and said, “He’s blaming you for your illness!” They just looked at me and rolled their eyes. What is wrong with the soul of America when we are no longer interested in even trying to help each other out?

Health is like a wheel: sometimes we’re at the top, living through a period of great health in which we feel like we may never be sick again. But, like karma, the wheel goes around, and we will all one day find ourselves at the bottom. Whether it’s a disease that requires constant care, or expensive medications, or end of life costs, we will all find ourselves in a time and situation when we are taking more than we are giving.

Universal health care is a rational, logical and compassionate solution to our human condition. I agree with Bill Maher (though I use gentler words) when he said, “New Rule: Not everything in America has to make a profit. If conservatives get to call universal health care “socialized medicine,” I get to call private, for-profit health care “soulless vampire bastards making money off human pain.”

Our “what’s in it for me” approach to life is a uniquely American trait, and it is not one that people in other countries admire, to put it mildly. To this point, I offer this dialogue from Michael Moore’s documentary Where to Invade Next. In this segment, he is interviewing women about their role in the world. This interview, set in Iceland, has stayed with me, made me feel ashamed, sad, and angry, and haunted me like a Paul Ryan healthcare plan.

The Dialogue:

Moore: “If you had two minutes to say anything you wanted to the American people, what would you say?”

Woman: She is wearing a red zip-up sweater. She has short, brownish-red hair, a ruddy face. She has a determined but mournful look on her face. She is either on the verge of tears or an angry rant, it’s hard to know. She is silent for several moments. Then she sighs and looks away.

Moore: “And don’t be afraid of hurting our feelings.”

Woman: Frowns and says, “No.”

Moore: “We need some truth here,” he encourages.

Woman: “Yep.” Then, she takes a deep breath, and delivers this striking monologue:

“I wouldn’t want to live in the States, even though [sic] you paid me. The way that you treat people, the way that you treat your neighbors, I would never want to be your neighbor. Never ever. Because you don’t treat your fellow Americans the way you should. How can you—in a way—come home and feel well if you know there are so many people that can’t eat, they’re sick, they can’t go to the doctor’s, they can’t get any education? How can you come home and feel OK with that? I couldn’t.”’

Moore: Silent for several moments and then, “I don’t feel OK about it.”

Woman.  “No, that’s good. You shouldn’t feel OK with that.”

I don’t either. I don’t feel OK with any of this.

Right now, sitting at the top of the health wheel (knock on wood), I haven’t been to the doctor in about a year outside of check-ups for my Hashimoto’s disease. Now is the perfect time for me to contribute more while I am healthy and able. I neither resist nor despise doing so.

Because someday, when I am at the bottom of this wheel, old or sick, I hope someone who is healthy or needs less care will cheerfully care for me by buying into the pool of insurance. By that time, maybe those in positions of government will not see caring for me or my illness as a burden to bear, but as a duty to a citizen who is no less worthy of care and dignity than someone serving in the armed forces. By that time, maybe healthcare will be a right of all Americans. By that time, maybe we’ll have difficulty imagining we even argued about these things.

I hope my great-great-great-grandchildren read about our amazing country in the history books and are proud of us. I hope they see how we did the right thing, the compassionate thing, when we had the chance. If enough of us care, if enough of us speak up, if enough of us step up, it can happen.

Let’s not forget that in America, we consider ourselves to be “civilized” people. We call our country a “civilization.” But, if we will not guarantee healthcare for all our citizens, then I must quote Inigo Montoya from The Princess Bride: “You keep using that word. I do not think it means what you think it means.”