What Do We Owe Each Other?

Two weeks ago, twenty-two year old Kimberly Young of Miami, Ohio got sick.  Like millions of young Americans, she did not have insurance. A doctor’s visit was out of the question. Ten days later her roommate could see things weren’t right and drove her to the ER.  It was too late. She died on Sept 23^rd.

This story is not uncommon. An “Institute of Medicine” report estimated that 18,000 a year die due to a lack of insurance.

A more recent study by researchers at Harvard puts the number at 45,000.

Yes. Most of these people dying do finally get care, but it’s too little, too late.

In addition to a legitimate fear of bankruptcy, these people must deal with the shame and embarrassment of being unable to pay the bills. They often don’t seek treatment until their condition is irreversible. Ironically, this often ends up putting a greater burden on the health care system, as end of life care is so much more expensive than preventive medicine.

This is the other side of “smaller government” the right doesn’t like to talk about. It’s easier to say “I want lower taxes” than it is to say “I don’t want to pay for that girl’s treatment”. But we need to be clear, the heart of this debate is about the ethical propriety of letting poor people suffer and die because we don’t want to pay for their care.

Those arguing against health reform aren’t going to come out and say this. And when you can’t voice the true nature of your opinion, you have to make things up, like shocking, ugly lies, , imaginary death panels, or death books (See also, 26 lies about Healthcare).

It’s a shame because the real debate is quite interesting.

How much do we owe each other?

What should we provide, free of charge, to every citizen in our nation, regardless of their contribution to the tax revenue?

Currently, we provide roads, police and fire protection, military protection and 12 years of education to everyone, no questions asked. Some of these services are simply easier to provide to everyone than they are to provide to “paying subscribers”, but education in particular is considered an “investment”. We’ve decided, as a nation that it will benefit us all to educate our citizens.

We have also decided to offer the bare minimum of healthcare to the very poor and very sick via Medicaid, but we’ve let millions, like Kimberly Young, too rich for Medicaid, too poor for health insurance, slip through the cracks.

Do we owe her treatment? Should someone like Kimberly be able to head to the doctor’s at the first sign of illness? Receive yearly physicals? Get care for chronic disease? Or is bankruptcy and illness a necessary prerequisite for treatment?

Is health care a basic human right? Or is any attempt to provide it to those in need a “communist” act worthy of a Hitler moustache?

Perhaps to truly explore this issue, we need to talk about the ethical propriety of true universal health care. That is to say: health care for the world. For if health care is a basic human right and it’s selfish and cruel to deny it to  anyone because they cannot afford it, then it’s difficult to see how it’s any less selfish and cruel to deny it to someone who just happened to be born outside our imaginary lines that we use to segregate the world.

Any moral truth ought to be universally applicable. How can we be outraged about the mistreatment of a working waitress in Appalachia who has Huntington’s disease, but be mildly indifferent to the plight of the sick Somali?

Charles Darwin, while discussing the evolution of morality in The Descent of Man, laid out the basic path of maturation of an individual’s ethical sense. It begins with a care and concern for your family, extends to the tribe, then to the nation, and finally the whole of humanity.

Conveniently, the United Nations isn’t asking for tax revenue to support truly “universal” health care. If they were, I suspect it would test our moral fortitude. I can see the moral reasoning in providing health care for the world. I can cognitively see how the world would likely be a better place, with less terrorism and war if everyone was supplied with adequate health care. I do feel immense sympathy for these individuals when their plight is made clear to me. But in practical terms, when it comes to pulling money out of my paycheck, I admit, I start to see the problem as “too big” to tackle. In 2006, half the world’s population made less than $2,600 dollars a year. The average industrial society spends about $3000 per person on healthcare alone (the United States spends over $7,000). I don’t have all the facts to do the math, but clearly the responsibility of paying these bills would rest squarely on our shoulders. It’s easy for a sense of helplessness to come about. To begin with, I believe there are fundamental changes that need to take place in those 3^rd world countries before we start taking responsibility for their well being. First and foremost is population control. If a suburban family in America can’t afford a third kid, they don’t have one. This is responsible parenting. This isn’t happening in the third world and it needs to.

This sort of shrugging and eyebrow furrowing is no doubt what’s going on in the minds of the typical Republican when we talk about offering healthcare for the whole of America. The inner city youth in Chicago or rural Mexican American is as foreign to Sean Hannity as the Somali pirate is to us. They fall outside the lines of Sarah Palin’s “Real America”. In fact, they aren’t thought of being American at all, they are thought of being a threat to America. Conservatives have little sympathy for their pain and suffering. They don’t live near them, they don’t see them every day, their only exposure is given to them by the mass media where they are stereotyped as lazy free loaders. And Obama, by having brown skin and a funny name has become the match point for their scorn. The “Birther” controversy is playing out like a cheap metaphor used to illustrate this point. A majority of Republicans are literally not sure if Obama IS an American.

I’m not suggesting that racism is at play in everyone’s mind opposed to universal health care. There are more nuanced reasons to oppose government funded programs, and I’ll be talking about them in my next post, “An open letter to Conservatives”.

Right now, I think it’s important that the left put themselves under the microscope. I think it’s important for all liberals to discern why it is that we care so deeply for our own citizens, yet propose far less reaching programs for citizens of 3^rd world countries. This, more than anything will elucidate the underpinnings of our “Moral” opinion.

I propose 4 obvious reasons.

1) The closer proximity of our own citizens’ suffering puts a greater burden on our sympathetic nature. To put it simply, we don’t like watching people suffer and die. We don’t expect doctors to have the callous disregard necessary to  deny treatment. We are only human.

2) The well being of our citizens has a greater effect on our own well being than someone half way around the world. This is why we provide education free of charge. It’s simply a good investment in our nation (and thus, us).

3) We might one day find ourselves being the ones sick with no insurance.

4) It is easier to take care of our own citizens. The hospitals are built, the mechanisms are already in place, and there are only a relatively small percentage of people falling through the cracks.

Yes. The pain and suffering of those overseas does affect our sympathetic nature. But as heartless as it sounds, a viable solution for many is to simply change the channel. And yes, the health and well being of all citizens of the world has some effect on our well being.  Surely the poverty and disease prevalent in 3^rd world countries creates an environment ripe for the recruitment of terrorists. But this threat is somehow more diffuse than the idea of the sick and injured dying on our streets.

Whether or not these four reasons are more “selfish” than liberals would like to admit, it illustrates the curious nature of all morality. It’s difficult to think of a “moral” decision that doesn’t, in the long run, benefit oneself. Returning a wallet full of cash you find on the sidewalk might seem like a sacrifice, but it upholds the “social contract” we have with all of society. It creates trustworthy friends. And by doing our small part, we make it more likely for our wallet to be returned when we drop it. This is why Plato suggested, “If you know the good, you will do the good”.

There’s no question that our sympathetic natures can be counter productive at times. We must remember when our government gives anything to anyone, we are taking it from someone else. There’s a strong argument that “tough love” for the poor will motivate them to work harder. Wealth must be tied to work in order for our nation to succeed. So it’s a good exercise to ask ourselves, what is the “bare minimum” we can give all our citizens, regardless of their contribution to our tax revenue. It seems like alleviating their pain and suffering and keeping them alive is a modest proposal… and one that reflects our humanity.