I’ve been thinking a lot lately, most particularly in the context of the health care debate in the United States, about how we frame conversations about social problems and the best ways to reform them. In the case of health care, we’ve identified a clear problem: There are serious inequalities in access to health services in the United States as a result of rising prices and a number of other factors, like limited availability of practitioners willing to work in rural or highly dangerous areas. Yet, people seem to have a lot of trouble coming up with a fix, even though there’s an obvious one staring everyone in the face.
Some people approach reform to social problems from the perspective of what’s morally right. In the health care debate, this starts on the grounds that all people deserve access to health services, that people should not die or experience serious complications because they cannot get health care, and thus that we need to come up with a way to get people access to the health services they need. This argument states that it is in the best interests of society, from an ethical standpoint, to not allow people to get sick.
This approach often relies on personalising everything. Rather than talking about lack of access in the abstract, people will bring up specific cases to use as examples. This focus, unfortunately, starts to make health care access look like a personal problem, rather than an institutional one. By keeping attention on individual stories and how sad they are, the big picture is missed.
Others approach reform from the perspective of what is economically and politically sensible. In the case of health care reform, reformers can illustrate how various approaches would save money. Oddly enough, the most ethical approach to health care is also the most cost effective one, and this holds true with a lot of other social problems. It turns out, being ethical isn’t just a good thing to do, it’s also an economical and sensible thing to do.
So, I’m disappointed that more people interested in the first approach aren’t willing to integrate the second approach into their work. Part of the problem with the health care debate is that it’s been turned into a personal issue: Is health care a right? Does everyone in the United States deserve to receive medical care? How much personal responsibility is involved in access to health care services and provision of health care?
This ignores the very real economic issues: Are we spending too much money? Is there a more efficient way to spend the money we have? Can we deliver more services to more people by changing the system? What is the right thing to do from a purely economic standpoint, and what would be the best way to make that happen?
The interests of both groups dovetail, but because the economics don’t get trotted out nearly as much as the personal stories, the people who have a personal and vested interest in denying access to people can dismiss it as a personal problem, and leave it at that. This is how we end up with things like a ‘reform’ plan forcing people to buy health insurance; because, fundamentally, people have come to view health care as a responsibility, and not as a right. And because of this, people can ignore the economic issues involved.
Personally, I am interested in achieving the greatest good for the greatest number of people. And what I find interesting is that often, this interest is in direct alignment with the ethical concerns with social issues, too. The personalisation of institutional issues has had a number of directly harmful effects, not least of which is that it turns out to be a highly ineffective way of convincing people to do the right thing. I suspect we would be better off showing people with numbers than we are right now, attempting to persuade people that something is the only logical ethical choice. Personal arguments can be appealed and ignored, while economic ones are much harder to write off.
The personalisation also means that people who want to make progress are often forced to personalise everything. People concerned with disability rights, for example, have to use a personal hook or tie-in to get people to care, and can’t simply say things like ‘you should care about the inequalities in the benefits system because they cost society a lot of money and there is a better way to do this.’ As a result, people who don’t want to expose themselves may be reluctant to engage in political discussion and debate.
And, of course, many people internalise the idea that social problems are a matter of personal fault, instead of being the result of institutional oppressions. As a result, it gets harder to fight these oppressions, because they have been personalised right out of existence. I see this perhaps most strikingly in conversations about disability, where there are radically different ways of viewing disability rights issues, and some people with disabilities genuinely believe that disability is a primarily personal problem and something that needs to be dealt with independently.
There’s a reason I like the social model of disability: Because it stresses that it is social attitudes that contribute to oppression of people with disabilities. It’s not that disabilities would vanish if we achieved social equality (some people don’t necessarily want their disabilities to disappear), but rather that, by addressing social attitudes, we could break down the barriers constructed around people with disabilities. A chronic pain condition will still be a chronic pain condition, for example, but someone with chronic pain will not be scapegoated as a drug seeker or slacker.