Tag Archives: equality

Health Care is a Moral Issue

T.R. Reid, author of “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Healthcare,” recently wrote an article for Newsweek comparing the American health care system to the systems in other developed countries. The subtitle of the article is “To judge the content of a nation’s character, look no further than its health-care system,” and you can imagine where it goes from there. Reid notes that the U.S. is the only developed country that does not provide universal health care, and he quotes the facts that result: 22,000 Americans die per year because they can’t afford a doctor, and 700,000 Americans go bankrupt each year due to medical bills.

Reid compares this to Europe, where they approach health care with an emphasis on equality, on providing service to everyone. Here are some key quotes from Europeans regarding their view on health care:

  • A French physician: “But when we get sick – then, yes: everybody is equal.”
  • A former president of Switzerland: “Because it is a profound need for people to be sure, if they are struck by the stroke of destiny, they can have a good health system.”
  • A Swedish health minister: “The formula is so simple: health care for everybody, paid for by everybody.”
  • The Czech constitution: “health care for all.”

Reid sums it up: “The principle seems so obvious to people in Europe, Canada and the East Asian democracies that health officials asked me over and over to explain why it isn’t obvious to Americans as well.”

In America, on the other hand, we approach health care with an emphasis on freedom of choice, particularly during this summer of health care debates. But it’s not true freedom, since those without insurance are, in fact, denied any choice at all.

Reid again: “In the U.S., in contrast, some people have access to just about everything doctors and hospitals can provide. But others can’t even get in the door (until they are sick enough to need emergency care). That amounts to rationing care by wealth. This seems natural to Americans; to the rest of the developed world, it looks immoral.”

Republicans this summer tried to frame the issue as industrious workers supporting the lazy unemployed and uninsured, but that’s a canard. This frame ignores reality. To look at reality, take two factory workers: one is employed by GM, and has thus insurance, and the other is employed by a small local factory which doesn’t provide insurance. They are equally industrious, equally hard working, but the one without insurance is more likely to skip his doctors visits and – statistically speaking – more likely to die. Or take Nikki White, who was industrious and employed, until she became too sick with lupus to work, thus lost her insurance, was unable to afford the care she needed, and soon died.

The issue is not one of who works hard. The issue is whether we, as a society, want to let the people who randomly get sick (or randomly don’t have insurance) go bankrupt or die, simply because of their random bad luck. As Reid notes, this is a moral issue, and I don’t believe that American morals have decayed this far. We are better than this. We live in America, the greatest and richest country in the world. This country was founded on the premise that “all men are created equal,” remember? Not “all healthy men” or “all wealthy men.” Do we really want to live in a country that allows people to die purely because of their financial situation? I don’t think we do.

FYI, here is a New Republic article on the moral dimension of health care.

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U.S. Is Not A Meritocracy

George Will recently published a column in Newsweek about taxation. It was his usual supply side pabulum, about how nobody will work or invest if marginal tax rates go up. Ironically enough, a guy whose only thought ever is cut taxes says the following: “But people with only one idea really have no idea.” Whatever. I am happy to take on George Will; he’s a moron whose view of the world is that everybody goes to Exeter and Yale and thus they can all fend for themselves. For Will, higher taxes means waiting a year to remodel the kitchen in your weekend house on Nantucket.

But in his column, Will quoted Richard Posner, a judge on the US Court of Appeals and professor at University of Chicago Law School. Taking on Judge Posner is something I do with trepidation. He is among the smartest of America’s public intellectuals, with knowledge that is both deep and broad, and he is insanely prolific. He seems to publish a book about as often as I can write a blog entry. However, I have no choice but to take issue with what he was saying in Will’s column. Here is the quote in its entirety:

“As society becomes more competitive and more meritocratic, income inequality is likely to rise simply as a consequence of the underlying inequality—which is very great—between people that is due to differences in IQ, energy, health, social skills, character, ambition, physical attractiveness, talent, and luck.”

Judge Posner is not entirely wrong. Smart, hard-working people can get ahead in America, and that can take the form of higher salaries or greater wealth. But this is true more often in theory than in practice. There are many Americans who are very smart, very hard-working, chock full of merit, who for a variety of reasons don’t manage to get ahead. Those reasons include geography, family, or education. But the reason I most want to focus on is generational. When you include the impact of inherited opportunities, it is difficult to call America a pure meritocracy.

Commitment to education, legacy admissions to elite colleges, career networks, wealth – these are all things that parents can pass to their children, and they all tilt the playing field against merit. Economist James Heckman, another University of Chicago professor (and a Nobel Prize winner) has produced significant work showing how early childhood treatment (eg. having parents who use a large vocabulary) correlates to adult success skills. But as important as nurturing an infant may be, I don’t think it compares to having a father who is a partner at Skadden Arps and thus helps gets you in the analyst program at Goldman Sachs.

Consider two teenagers, both equally smart and hard-working. One lives in Brookline, Massachusetts, where he goes to an excellent high school and his parents, who met when they were undergrads at Harvard, support him in his studies. The other lives in Oak Hill, West Virginia, where his school is terrible, and his high school dropout parents are too busy earning a living to help him with his coursework. Of these two teens, which do you think is more likely to go to a good college, join a hedge fund and become wealthy? Sure, the West Virginian could, in theory, make it to Wall Street, but we all know that his odds are low.

So for Judge Posner to argue that meritocracy inevitably leads to an acceptable inequality is to completely miss the point. Success in America’s meritocracy is correlated as much to parental merits, or grandparental merits, as it is to any individual’s merits. This is precisely why Bill Gates’ father (whose partner position in a corporate law firm helped send young Bill to computer classes and then to Harvard) is such a full-throated proponent of the estate tax. He knows that America’s meritocracy is skewed by inheritance. Judge Posner is more than smart enough to know the same thing.

Politics and Culture, Part 2

Tuesday’s post was about Lee Siegel’s theory that Republicans win by focusing on heartland culture while Democrats waste their time talking about policy. Today’s post addresses what Democrats can do about this problem.

Some of the easiest, fastest responses are tactical. For example, Democrats should divide and conquer: they can discuss policy with standard liberal audiences and talk culture to the heartland. In addition, they should be advancing their own cultural narratives, particularly those that tap into Siegel’s call for “vicariousness.” Show Obama and Biden being regular people: shopping, going to church, driving their kids to soccer practice. Distribute the message via the cultural milieu itself rather than through the media. Have the candidates talk about their personality and their dreams. And Obama, please, lighten up a little. The Democrats should take Spiegel’s trope of “ordeal and humiliation” and use it, playing up their own descent and rebirth narratives. Obama has the single mom/neglectful dad angle, and Biden has his car crash (yes, it’s utterly debased to use it, but his son already opened that door during the convention).

But these tactical moves don’t really turn Siegel’s thesis to our advantage. A larger solution is to emphasize the Democratic culture. Fortunately, that culture actually synchronizes with policy, unlike the Republican culture, which fundamentally conflicts with Republican policy. But what is this Democratic culture, and is it lived like the Republican one?

I posit that the Democratic culture is the culture of the founding fathers, which is so ingrained in the American psyche, so elemental to our identity, that we live it every minute of every day. The Democratic culture is one of equality and opportunity, where people who work hard deserve a better life for themselves, regardless of class, color, creed or gender. This is a culture that takes seriously the words “all men are created equal, that they are endowed by their Creator with certain unalienable Rights.” The Declaration of Independence is one of America’s totemic documents, and I think just as powerful as the Jungian archetype of descent.

For the Democrats, this culture is not a political strategy but the very essence of the party, the manifestation of their values, and thus is inseparable from policy. This is a culture, backed by policy, which favors hard work over family connections. It sides with student loans, not yacht owners; with sick children, not insurance companies; with producers, not paper pushers; with main street, not Wall Street. During a week when financial debacles are destroying value at unprecedented rates, it is worth remembering whose culture, and whose policies, support a market that is free but regulated. Democratic culture lives in churches that help the needy, in safety nets that help the disadvantaged, in methods of supporting families’ choices, and yes, in the ability of a mixed-race man with a single mother to become president.

If indeed people respond more powerfully, more viscerally, to culture than to policies, then let’s talk culture. In both red states and blue states people believe in the culture of forming “a more perfect union,” but only one party includes everyone in that union.  The Democratic culture is built on supporting the average American, on making real a “government of the people, by the people, for the people,” so don’t hide that culture – embrace it, spread it, and follow it to victory. Because what’s great here is that Democratic culture can speak to the heartland just as forcefully as the Republican culture can, and the Democrats can back their culture up with policies that reflect and actualize their culture of equality and opportunity.

Many thanks to Septa for her thoughts and edits.