Health Care Blues

I read today in a post from the News and Record blog, from a Mr. Stephen van Vuuren, the following about the health care issue. I think it is very instructive.

“There is no greater issue of security in America then the health of our people. Creating a system where every person is guaranteed complete health and well-being, free and accessible, is the most important issue facing our nation today.”

I would like to respond in some detail to the particulars, but before I do I would like to address the assumption that lies behind this and many other statements about health care.

Human beings live in a fallen world. Part of this fallenness is the experience and reality of the natural decay and degeneration of all biological organisms. Our bodies fail in so many ways, from breakdowns within and assaults from without. This decay always and inevitably results in senescence, or death. Usually this process involves pain and great difficulty. Plus, death results, for the survivors, in deep and profound loss. It is the biggest enemy we have as persons.

Because advances in modern medicine involving both tests, procedures, and medication, we have been able, thankfully, to forestall this process for many, and alleviate the physical pain of it for others. But we have also developed certain expectations and hopes. The expectation and hope is that we will not be brought low by this process. We hate pain and loss. We want out of that bargain.

But so many of the tests, procedures, and medications that can help us are horribly expensive. We want to blame someone for this – blame the greed of pharmaceutical companies, insurance companies, equipment manufacturers, and doctors. But the truth is that this stuff IS expensive. And the terrible and difficult truth is that we cannot make good health for everyone affordable and accessible. It is simply impossible. We can either resign ourselves to a common lot of mediocre health care for all, or to inequalities in health care between some people and others.

The basic longing expressed in Mr. van Vuuren’s letter is a phantasm, a dream, perhaps one we understand and relate to, but a dream nonetheless. It is beyond utopian.

This itself becomes a problem - that what we want is impossible – individually and societally. Until that sinks in there will be no real progress in health care discussions.

Above and beyond what I have said already, I would take issue with several assumptions or comments in Mr. van Vuuren’s short letter.

First, there are issues of security greater than the health of the American people. Nuclear holocaust might be one. Protection against massive terrorism attacks might be another. I would venture to say that a rigorous education of a semi healthy population may also be a greater security risk. American people, even in days when they died much younger and knew much more pain, knew also that there were greater security issues than health. And they gave their lives accordingly.

Second, there is no system that can guarantee complete health and well being. OK, let me assume that this statement is hyberbolic. Complete health is beyond our reach no matter what we do, but even almost-complete health is impossibly non affordable. And of course, true health and well being is a matter that goes way beyond our physical circumstances.

Third, the idea that any such system is free is just a fantasy. I assume by "free" that this is an allusion to universal and governmentally provided health care. Well, that is certainly not free. The total increase in taxes required to provide such a guarantee would be massively expensive for everyone, not just “the rich.” And if the government is running it it would likely be much more expensive than what we have now.

I agree that this issue is crucial. It is crucial for several reasons. It is crucial because health is indeed important. It is crucial because utopian dreams cannot provide the basis of our governance of ourselves. It is crucial because we have to decide whether we want equally mediocre health care for all or inequality in health care based on income. The problem with the latter “choice” is that those people with means will always have access to immediate health care not available to everyone else. Just go to Canada for a while and you will see that. The wealthy will not wait months and months for an important procedure: they will just head down to the United States and get it done here. So equal mediocre health care is also an impossibility. Such socialist notions of equality are a phantom – there will always be those “more equal than others.”

But inequalities are hard to swallow, especially when what we need to be better and to feel better may be closed off to us yet available to another. This inequality itself breeds much discouragement and disillusionment and envy and hatred, and drives much political debate.

So I agree that the issue is very significant. It is significant in my personal life. It is significant for us as neighbors. It is significant for us as a culture. It is hugely complex and to a great extent intractable. But we must continue to seek ways to make more health care accessible to more people at less cost. We are looking at a gradual process, working toward a goal which itself is not attainable. Sort of like how I look at my life as a Christian.

Somehow it seems to me that we need to step back and recognize the impossibility of the goal and the anxieties, fears, and even unrealistic expectations we carry as human persons into this debate. For really this issue cuts to the core of our predicament as human beings. This debate is not just about health care; it is about death itself; the dark specter that hovers ruthlessly over our lives.

Somehow we have to simultaneously strive with much earnestness together toward greater equality and accessibility, while at the same time reminding ourselves that that which we most desire is not to be had. And we do this not in some detached philosophical way, but in a way whereby we let ourselves be truly touched by the human pain around us; desiring and seeking to alleviate it; not exploiting it for the sake of our political goals. And I think we ought to demonize others less. Less demagoguery would help a lot in this debate.

At the core of it “complete health and well-being” is much more than a health care issue, or a political issue. It is, in the end, a religious issue. It is the goal of most all the great religions; and certainly mine. How it comes to be attained, well, we discuss and debate that at a religious level too.

Let us each and all pray for incremental steps in the right direction, improvements that will touch the lives of many people, while also pray for that great idea that we have not thought of yet, that idea that can help us reach a semblance of the goal in this life expressed by Mr. van Vuuren.

I appreciate his letter.

Joel Gillespie