Talking with my friend Tristan about the state of health care in the United States recently, he pointed out that he finds the position of conservatives in terms of health care and social obligation deeply puzzling. As a society, we have decided that we, generally speaking, do not want to let people die. Yes, there are some outliers who genuinely think that society doesn’t owe any health care, not even emergency services to people who are about to die, but by and large, even conservatives who are against government health care programmes support the idea that people should not be allowed to bleed out in the emergency room.
This is a very costly approach to health care. Constant reactions to crisis are extremely expensive. Preventative care would be much more cost effective and much more appropriate than allowing people to reach crisis, stabilising them, and releasing them again. Many patients are released in a very fragile state, when they clearly need support, and they show up again a few days or weeks later, back in crisis. Mental health care really starkly illustrates this, by making no community-based mental health services available but hospitalising people in mental health crisis, and then releasing them with no support to let them get sick again and repeat the process.
Numerous studies show that it would be more cost effective to administer a universal single payer health system in the United States. As a utilitarian at heart, I don’t understand why we are not doing this, but Tristan pointed out the error in my ways. ‘You,’ he said, ‘are thinking about what is most cost effective, beneficial for public health, and also socially responsible.’ Silly me.
Because much of the resistance to the provision of health services in this country is actually about moral panic. Many people firmly do not want to pay for things that they feel strongly about, and I am not talking about abortion here. People do not want to pay for services for drug addicts. People do not want to pay for nutritional counseling (it might be related to !obesity!). They do not want to provide health care services to immigrants, let alone immigration detainees. They do not want to pay for anything that they can blame on personal responsibility and personal moral failings, which is pretty much every health care problem ever, because people are very good at shifting blame from society to individuals; if prisoners don’t want to get HIV/AIDS, maybe they shouldn’t have gone to prison! Etc.
I had understood the moral panic issue on an intellectual level before, but Tristan really highlighted it for me and crystallised it for me as a significant problem. I’d understood on some level that we will never get single payer in the United States, that we will never implement a logical, rational, cost-effective, simple, clear system that would provide access to health care for everyone. I had trouble grasping why, though, until we started talking about moral panic and the role that it plays in how people think about political and social issues.
For me, health care is not just a human rights issue, it’s just a basic utilitarian one. Healthy people have better quality of life. Better quality of life results in a better quality of life overall for society. Workers who are happy and healthy do better work. Creative professionals who are healthy do not have to compromise themselves out of desperation for money. Healthy children experience better cognitive and emotional development, which means they are more likely to have opportunities as adults, to have more options available, should they choose to pursue them. If I live in a generally healthy society, herd immunity comes into play and I am less likely to get sick. With health care, I am less likely to contract something that could be dangerous, and pass it on to a person with cancer who has limited immune function. Healthy societies are just cheaper.
I’ve stuck to economic arguments when it comes to health care because I prefer arguing to reason rather than trying to get engaged in emotional arguments. I’m not a very emotional person. I don’t really care if you don’t think that people deserve health care, as long as you can agree with me that the current administrative and social costs of the health care system in the US are too high, and it needs to be reformed, and there is an obvious solution that would be appropriate and cost effective, and cheaper to run than what we have now. You can merrily go on resenting people whom you think don’t deserve health care, as long as you don’t stand in their way.
This fact about me seems to surprise people; as someone active in social justice, obviously my end goal is to get people to acknowledge that all humans have value, and to treat all humans with respect, to provide people with dignity. But my more immediate need right now? Is to stop my people from dying. And that means that I don’t have time to argue with people about whether or not I am a human being; I don’t need them to recognise me as human, I need them to acknowledge that social supports, like health care, should be readily accessible. Appealing to emotion is a waste of my time.
It’s not just that it is a waste of my time, but that it is difficult and emotionally draining. If you have never been in a position where you are being fundamentally dehumanised, you do not know what it is like. You do now know what it is like to be told over and over again that you are not human, that you do not exist, that you do not deserve even a modicum of respect. You do not know what it is like to have to put yourself in danger to fight for a better world. One of the reasons I appeal to rationality is that it does not actively harm me.
But, as Tristan pointed out, I can’t appeal to reason because the fundamental objections here are not reasonable. This is not about what would be best for society as a whole and what would be cheapest. It is about moral panic—it is about the fact that some people believe that health care is a personal responsibility, and that they don’t want to pay for people who need health care, no matter what the reason is, but especially if the reason is tangled in moral issues.
Which forces me back to square one, of having to go through the grueling and constant experience of exposing myself to ask people to treat me like a human being, because I cannot appeal to the base rationality that apparently does not exist in all of us.