04 October 2017

Brilliant article on universal health care in the New Yorker

There is a longish passage in the brilliant article by Atul Gawande in the current New Yorker, about whether health care should be considered a right that is JUST SO WELL PUT that I take the liberty of transcribing it here in its entirety. IF THIS ISSUE IS IMPORTANT TO YOU, please take a few moments to read this.

The Berkeley sociologist Arlie Russell Hochschild spent five years listening to Tea Party supporters in Louisiana, and in her masterly book "Strangers in Their Own Land" she identifies what she calls the deep story that they lived and felt. Visualize a long line of people snaking up a hill, she says. Just over the hill is the American Dream. You are somewhere in the middle of that line. But instead of moving forward you find that you are falling back. Ahead of you, people are cutting in line. You see immigrants and shirkers among them. It's not hard to imagine how infuriating this could be to some, how it could fuel an America First ideal, aiming to give pride to "real" Americans and demoting those who would undermine that identity -- foreigners, Muslims, Black Lives Matter supporters, feminists, "snowflakes."

Our political debates seem to focus on what the rules should be four our place in line. Should the most highly educated get to move up to the front? The most talented? Does seniority matter? What about people whose ancestors were cheated and mistreated?

The mistake is accepting the line, and its dismal conception of life as a zero-sum proposition. It gives up on the more encompassing possibilities of shared belonging, mutual loyalty, and collective gains. America's founders believed these possibilities to be fundamental. They held life, liberty and the pursuit of happiness to be "unalienable rights" possessed equally by all members of their new nation. The terms of membership have had to be rewritten a few times since, sometimes in blood. But the aspiration endured, even as what we need to fulfill it has changed.

When the new country embarked on its experiment in democracy, health care was too primitive to life or liberty. The average citizen was a hardscrabble rural farmer who lived just forty years. People mainly needed government to insure physical security and the rue of law. Knowledge and technology, however, expanded the prospects of life and liberty, and, accordingly, the requirements of government. During the next two centuries, we relied on government to establish a system of compulsory public education, infrastructure for everything from running water to the electric grid, and old-age pensions, along with tax systems to pay for it all. As in other countries, these programs were designed to be universal. For the most part, we didn't divide families between those who qualified and those who didn't, between participants and patrons. This inclusiveness is likely a major reason that these policies have garnered such enduring support.

Health care has been a cavernous exception. Medical discoveries have enabled the average American to live eighty years or longer, and with a higher quality of life than ever before. Achieving this requires access not only to emergency care, but also, crucially, to routine care and medicines, which is how we stave off and manage the series of chronic health issues that accumulate with long life. We get high blood pressure and hepatitis, diabetes and depression, cholesterol problems and colon cancer. Those who can't afford the requisite care get sicker and die sooner. Yet in a country where pretty much everyone has trash pick up and K-12 schooling for the kids, we've been reluctant to address our Second World War mistake and establish a basic system of health-care coverage that's open to all. Some even argue that such a system is un-American, stepping beyond the powers the Founders envisioned for our government. 
The article goes on to recount how that is a total misconception, and how Madison and Jefferson, who disagreed on many things, both concurred in the near unanimous 1813 Vaccination Act, wherein the US government PROVIDED FREE SMALLPOX VACCINES to all citizens. Few realize that the idea of universal health care actually goes all the way back to the very early day of our republic. But even then, when a batch of vaccine was accidentally infected with smallpox and several died, there was great controversy and the law ended up being repealed. So both the idea of universal health care, and the tragedy of unrealistic realization of the ideal, have a long history in our country.

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