Friday, February 08, 2008

Because only the morally worthy deserve good health

From 10 Myths About Canadian Health Care, Busted
By Sara Robinson, Posted February 5, 2008.

9. People won't be responsible for their own health if they're not being forced to pay for the consequences.
False. The philosophical basis of America's privatized health care system might best be characterized as medical Calvinism. It's fascinating to watch well-educated secularists who recoil at the Protestant obsession with personal virtue, prosperity as a cardinal sign of election by God, and total responsibility for one's own salvation turn into fire-eyed, moralizing True Believers when it comes to the subject of Taking Responsibility For One's Own Health.

They'll insist that health, like salvation, is entirely in our own hands. If you just have the character and self-discipline to stick to an abstemious regime of careful diet, clean living, and frequent sweat offerings to the Great Treadmill God, you'll never get sick. (Like all good theologies, there's even an unspoken promise of immortality: f you do it really really right, they imply, you might even live forever.) The virtuous Elect can be discerned by their svelte figures and low cholesterol numbers. From here, it's a short leap to the conviction that those who suffer from chronic conditions are victims of their own weaknesses, and simply getting what they deserve. Part of their punishment is being forced to pay for the expensive, heavily marketed pharmaceuticals needed to alleviate these avoidable illnesses. They can't complain. It was their own damned fault; and it's not our responsibility to pay for their sins. In fact, it's recently been suggested that they be shunned, lest they lead the virtuous into sin.

Of course, this is bad theology whether you're applying it to the state of one's soul or one's arteries. The fact is that bad genes, bad luck, and the ravages of age eventually take their toll on all of us -- even the most careful of us. The economics of the Canadian system reflect this very different philosophy: it's built on the belief that maintaining health is not an individual responsibility, but a collective one. Since none of us controls fate, the least we can do is be there for each other as our numbers come up.

This difference is expressed in a few different ways. First: Canadians tend to think of tending to one's health as one of your duties as a citizen. You do what's right because you don't want to take up space in the system, or put that burden on your fellow taxpayers. Second, "taking care of yourself" has a slightly expanded definition here, which includes a greater emphasis on public health. Canadians are serious about not coming to work if you're contagious, and seeing a doctor ASAP if you need to. Staying healthy includes not only diet and exercise; but also taking care to keep your germs to yourself, avoiding stress, and getting things treated while they're still small and cheap to fix.

Third, there's a somewhat larger awareness that stress leads to big-ticket illnesses -- and a somewhat lower cultural tolerance for employers who put people in high-stress situations. Nobody wants to pick up the tab for their greed. And finally, there's a generally greater acceptance on the part of both the elderly and their families that end-of-life heroics may be drawing resources away from people who might put them to better use. You can have them if you want them; but reasonable and compassionate people should be able to take the larger view.

The bottom line: When it comes to getting people to make healthy choices, appealing to their sense of the common good seems to work at least as well as Calvinist moralizing.



andante said...

Not to mention the personal responsibility one has to avoid being in the path of drunk drivers, manufacturer's defects, being born with a disability or affliction, and so on.

I just really, really don't understand what planet these people live on.

hipparchia said...

they live on our planet, and we need to take it back from them.

of course, they feel the same way about us, that we're taking up space on their planet and that they need to protect it from us.

Anonymous said...

"The least we can do is to be there for each other as our number come up"
is, I think, an important philosphical difference between us and them. IMO, they don't do real compassion, because they can't see it serving any productive purpose.

I have some experience with chronic medical conditions, and I can tell you, the stigma can be worse than the condition itself. We should have public policies that allow people who are medically debilitated to receive treatment with no hassles, to be as productive as their conditions allow them to be, and to have a decent quality of life.

Instead, our policies tend to punish people who find themselves in that situation. They limit treatment options and often bring financial catastrophe. But just as bad, people are taught to feel guilty about their conditions and taught that if they cannot work 40 or 50 hours a week, they are worthless and have nothing to contribute to society. So they disengage.

A lot of people who can't work could spend a few hours a week doing things that would both increase their own self-worth and make life better for others. Spending an afternoon or two a week giving neglected children some attention, for example. But we have this system that encourages people to believe that if they're not fully-functional in the economy, they should just stay home and wait to die.

All this is my loquacious way of explaining why I think the analogy to Calvinism is very apt. People with long-term disabilities are treated like sinners to the point that, if they're not careful, they start believing it themselves. It doesn't have to be this way, and it makes me very angry when I think about it.

It's terrible that so many people just don't see the connection between the policies and the attitudes. If we could make better policies and protect them for a generation once they were in place, it would go a long way toward changing the attitudes.

Thanks for posting this.

hipparchia said...

and i thank you for your eloquence here, geneo.

[and i always approve of loquacious!]

i agree, a generation's worth of better policies would go a very long way. i'll even be optimistic and suggest that 10 years of sane health care policies [france and canada are my two favorite models] would make a huge difference.

Anonymous said...

I spent several years adapting computers to be used by people with brain injuries. It many cases it was their mobility that was affected, not their cognitive abilities. If someone would would hire them based on what they can do, rather than what they can't, the whole place would be better off.

The current policies trap them in uselessness, which leads to other problems. They need a purpose, and there are things they can do.

hipparchia said...

adapting computers to be used by people with brain injuries? wow. that's wonderful.

otoh, :twisted: this means that between you and steve, i'm going to have to take back all the terrible things i've ever said about contract programmers.

The current policies trap them in uselessness, which leads to other problems. isn't that the truth.

Anonymous said...

I heart geneo.

'Nuff said.

(that would be me, Andante. For some reason Bloggity won't accept my password.)

hipparchia said...

heya, andante. i heart geneo too. and if it makes you feel any better, bloggity won't even let me into my own blog sometimes.

Anonymous said...

I heart you guys too. :)

And i think hipparchia's right about 10 years' worth of health care policies making a big difference.

hipparchia said...

i'm thinking the first 5 years could be a pretty bumpy transition period, but that things would start smoothing out after another 5 years, at which point a number of folks will no longer be willing to settle for what they had [or had not] before.

andante said...

If I've said it twenty times, I've said it fifty.

When you explain to the knuckledraggers that they would simply be paying a (typically smaller) premium to a government agency with very little overhead rather than a greedy insurance company with a CEO who needs a new yacht, it brings them up short.

When you tell them doctors, nurses, etc. would still earn their money and not work for the gummint, it makes them stop and think.

Maybe not enough to actually accept single-payer, but enough to stop screaming 'socialized medicine!!!'

Oh, thank God I'm Bloggity-legal again.

hipparchia said...

i've tried those talking points before, without a lot of luck. then again, i've never tried adding the new yacht part in there. that might do it.

bloggity-legal... somehow that sounds just a tad... disreputable.

andante said...

I must try the talking point about "would YOU be worthy of good health care?".

I can't think of too many people (actually, probably none) who don't drink, smoke, overeat, etc., etc. at one time or another in their lives.

Not to mention the absence of a built-in potential catastrophic accident protector.