Co-authored by Eric Haas and Joe Brewer, consulting partners at Cognitive Policy Works. They offer consulting and coaching services based on insights from the cognitive sciences to health care advocates and progressive organizations.
Health care and food processors are different.
When it comes to health care, it is both right and smart for me – and everyone I come into contact with – to have health care. On the other hand, I couldn’t care less about my parents’ food processor.
I should be embarrassed to say the same thing about my parents’ health care. It would be both wrong and dumb to say so. Why?
When (not “if”) my parents get sick and injured, my life and my family’s life and the life of my brothers and sisters will change dramatically, especially if they do not have good health care. If they lack secure health care, it is highly likely if not certain that:
- My parents will suffer terribly because good care will be beyond their financial means;
- My family and the families of my brothers and sisters will likely go bankrupt trying to help them.
This is immoral and it’s bad economics.
How many people have parents who do not have good health care coverage? Millions of Americans (including one of the authors) are in this situation right now. Are you one of them? If so, you understand how frightening it can be to think about them getting older and eventually getting sick. If not, you can easily imagine what this situation is like.
But this is how our current market-based, for-profit health insurance system has been working for decade upon decade. Health care is not seen as a basic human need; it is a food processor, an extra—good to have if you can get it, but not essential. As a result, hard working people and their families are suffering, dying, and going bankrupt every day, while insurance companies make billions in profits.
This is wrong. Which is why no other industrialized country acts this way.
So, let’s start with some basic ideas:
Good health is a human need.
While many think of health care as a privilege to be “earned”, others with more compassion consider it to be a basic human right. But even this doesn’t go far enough. Good health is a basic need. Abraham Maslow, back in 1943, presented the hierarchy of needs for human beings. The foundation for living in this world begins with the most basic things we literally can’t live without – including food, water, air, and shelter. Having these needs met leads to the next level – what Maslow called “safety needs” – which include all forms of physical security. Health is one of these. If these needs are not met, all higher forms of living become secondary – including financial security, friendship, pursuit of happiness, and personal fulfillment.
Without health security, a fulfilling life is impossible.
Everyone should have the care they need to be healthy when they are sick or injured.
The denial of basic needs is wrong, plain and simple. One of the guiding moral principles of the United States is the guarantee of “life, liberty, and the pursuit of happiness.” This idea is so deeply engrained in the American character that we feel it in our bones. And yet, at the most basic level of health security, we have failed our American family. This is a moral failure. And it must be righted to remove the blemish from our souls. How can we live with ourselves when we let private greed dictate the lives of our loved ones, especially when it leads to senseless suffering and death for so many?
We all benefit when it happens, whether the people needing care are our parents, our kids, our co-workers, people sitting next to us at church, the restaurant employees who serve our food, or ourselves.
Universal health care is more than the right thing to do. It is also the smart thing to do. An economy can’t run when sickness is widespread. Small businesses can’t grow and thrive when their employees are at risk of bankruptcy from an unexpected illness. Large companies can’t compete in the global marketplace while carrying the risk of private health for their workers. The only way to secure economic health is to guarantee that everyone has the capacity for physical health.
Can anyone really support the idea that Americans don’t deserve health care when they are sick or injured?
So, how do we get it? Single payer. Or, at a minimum, a rigorous public option.
We know that the current system doesn’t work for over 100 million Americans who are underinsured or don’t have insurance at all. These are people who need it like pregnant couples, sick people (from cancer victims to people with toe fungus), and small business owners. Insurance companies have had over three decades to work this out and they haven’t been able to do it.
But they’ve made some good money in their failure.
So, let’s go back to the basic issue here. Everyone gets care when they need it. Period. Single payer or a robust public option are the only real solutions because health care is decidedly NOT like a food processor. Those who act otherwise need a lesson in compassion.
Now is the moment of truth. It is un-American to sit idly by and allow our neighbors to suffer needlessly. It is un-American to allow our neighbors to lose their homes to pay for medical expenses. It is un-American to condemn millions of people to agonize about money in the face of life-threatening illness.
We must rise to our moral aspirations and guarantee a basic need for ALL AMERICANS. Or, we can judge our brothers and sisters unworthy of basic health and condemn the pursuit of life, liberty, and happiness to the shadows of history.
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I think it is important to find a way address the issue of limits. The vision is obviously false, but it is powerful.
One one hand it is obvious that nobody would undergo chemo therapy on a lark because they were bored that day, but there is concern that without limits someone might want an MRI on a sprained ankle, or if they had it refused raise the cry of unreasonable rationing.
Add to that the less expressed idea that a less used MRI is more expensive per use than a heavily used one, and the picture is complex. And still more so beyond that limited example.
So while the fear of the present is shoved aside by propaganda, that the current system is worse, still the idea that others less privileged than themselves will "use up" the resource or run up costs remains no matter how much you say that health care is not a toaster (or FP, or Ipod).
Empathy is the argument, but it is a tough sell to those lacking that commodity.
Hi Freedem,
I agree that the scarcity mindset deserves careful consideration in discussions of health care. Eric and I gave a workshop last Friday to a group of single-payer advocates in California where we explored several key frames that are central to any reform effort.
One very important concept we discussed at length was the containment frame that presumes a finite container of a commodity – in this case the amount of health care available. The activation of this frame creates a perception of the world as filled with limited amounts of health care that are "rationed out" in a zero sum game.
Of course, health care delivery is not actually a contained quantity. More can be delivered in some circumstances, less in others. So the "amount" of health care available is influenced by the overall health care system. And yet such a containment view remains prominent in the minds of many people today.
This notion of containment needs to be replaced by a health care frame where emphasis is given to the significance of guaranteeing that everyone should get the care they need (and any health care system that fails to do so should be modified until it does). In this frame, the emphasis is given to the moral mission to deliver adequate care. If some people are excluded now, improvements to the system are needed… meaning the "amount" of care available is variable and can be increased to meet the needs of people (but only in a universal health care system).
The ability to see health care delivery as something other than a zero sum game is very important to successful advocacy for universal health care.
Best,
Joe
Hi Joe,
I have seen many discussions that folk talked past each other in exactly those two frames, each stubbornly sticking to their side and wondering why the other side is so stupid.
In some cases there may in fact be no sensible argument that will penetrate, but without a bridge that addresses their mind set, they will still consider that either someone will get "Their" care, or that the cost will bloom out of control and "they" will be the ones paying for it.
I have tried to take the approach that profitability and waste steal care in excess of the cost of that care and that Insurance bureaucrats are literally living very well on the bodies of their victims, and that the waste would more than provide the excess cost that they are worried about.
Since such folk are predisposed to hate bureaucrats in any form, and those living off the pain of others especially, that part is an easy bridge.
What gets difficult is to frame the Insurance company as an unelected nonchosen government no different than any dictatorship where your rights are limited at best and all decisions favor the dictator.
This often gets epithets of "crazy Socialist" to which I respond by demanding the definition be based on the original "Socialized child" or "Socialized dog" frame that all power needs to be empathetic, empowering of the least powerful, and the most powerful held accountable for their promise of agency, that they have power to make decisions for all and not just to embezzle all the goodies and leave the mess for others.
I do find myself quite left out alone with such "extremism" however and wonder what your suggestions might be.
I am extremely disappointing that most of the Left seems to have accepted the Republican frame on Socialism and run away when they should be shoving it back in their faces.
Hi Freedem,
Representative Anthony Weiner takes an interesting approach in this interview with Bill Mayer when the "socialized medicine" concept is brought up. He clarifies (briefly, as a side point so as not to detract from the point he wants to make) that the means of production are kept in private hands – and not through the government – so we're not talking about socialism.
He then goes on to talk about insurance companies as middle men who siphon money off the top without adding anything of value to the health care exchange.
It's an interesting approach that seems to work well in the "friendly" environment of talking with someone predisposed to agree. In other situations, things get more challenging of course. Still, perhaps this will be helpful for you to think about.
Best,
Joe
I indeed do see that all the time and think the progressive cause is hurt every time they let that happen. The Original concept was the Socialized Society as socialized child as opposed to feral or unsocialized.
To do this there needs to be accountability, and the national government is usually the "accountant of last resort" be it through a judicial or executive branch (occasionally legislative if they invent a new crime). This is the definition of Socialism mostly spoken of as action, and they will usually conflate Government run and Soviets into the argument. Every time liberals agree, the connection is stronger.
The Soviets were of course not at all "Socialist" by that definition as there was no Democracy or accountability. The Soviets of course claimed both Democracy and Socialism as Orwellian definitions. The antisocilaist American Right was happy to keep the Orwellian version of Socialism even as they vehemently denied the equally false democracy.
I have blogged this extensively at http://freedemocrat.blogspot.com/
Excellent points… the historical context (as a revisionist story today) plays a very important role in the current health care debate. False stereotypes were used to "paint" Soviets in the nemesis role of pro-capitalism frames during the last century. The same frames are active in the minds of people today – with the new "enemy" role filled by liberals today.
Unfortunately, many progressives don't understand how this happens. Thus they are ill-prepared to counter its faulty assertions when they come up in conversation today (which occurs all the time). The typical response is to reason within the faulty frame and distance themselves from the "enemy" role. Instead, what is needed is a different frame that places health care advocates in a morally righteous role as promoters of compassion… a much more honest and truthful depiction.
Indeed Progressives do get rolled constantly, and I have been one at least who has tried to be antiroll.
I start with the Socialized Child and look at why they are presumed to be "Socialized" and another child "unsocialized" and why Socialized is a good thing.
The answer is of course empathy (not Compassion as I will endeavor to explain) The entire golden rule "Do unto others as you would have others do unto you" is about as a succinct a definition of Empathy as anyone has come up with. To imagine haw you would feel in the position of another has even been shown to be a big part of how the brain works (mirroring)and thus a very good foundation.
The bridge break that the antisocialists used was to conflate empathy with sympathy arguing that the winner/victor never got sympathy and the loser/victim always did, and liberals were always out to change the outcome of a (supposedly fair) fight. This was the primary frame of the fight with Justice Sotomayor.
Compassion also fits their Sympathy frame, and liberals defend it because they do indeed have sympathy as a result of empathy, and do reach out to help those less fortunate for no other reason, but that leaves them open to attack from those without much sympathy.
However to speak about a Socialized Society based around the values of empathy, empowerment of all, and accountability for those given the power of agency by the collective acting for a uniform goal, to assign roles and benefits for each.
By that rule the commonplace violation of that role of agent to steal all the goodies is nothing less than embezzlement and should be treated as such.
From that description of a Socialized Society all the progressive/liberal agenda/policies falls naturally into place, just as most of the Conservative agenda/policies fall into place with the Libertarian arguments.
http://www.pnhp.org/news/2009/september/harvard_s...
How does 45,000 insurance caused homicides from denial of care fit into this conversation?
Hi Chuck,
I'd say that we are in the midst of a health care emergency because people are suffering and dying daily from the moral failings of our current health insurance system.
At the same time, it is important to be careful not to mis-characterize the problem. It is not the case that insurance company bureaucrats are going out and physically attacking would-be patients – as the homicide frame implies. A more accurate description of the situation draws attention to the extraction of wealth of for-profit insurance corporations that place earnings over the delivery of care. Those who might have sought the care they need if they felt safe that they wouldn't be strapped with outrageous debt while getting it would have been more likely to do so… and those additional deaths could have been avoided.
We don't have a situation where one agent (the insurance company) is violently killing another (the patient). Rather we have a situation where people are allowed to profit from the denial of health care in a manner that leads to the immorality of preventable human suffering and death.
Best,
Joe
A very dear friend was one of the 45,000 this past June. With no health insurance she did not see her heart attack coming, and when she had it they stabilized her and told her that there would be an approximately $200,000 down payment before they would operate, and when she could not supply that, they kicked her out of the hospital where she died at home the next day.
The individual culpability was more nebulous in her case than those rescinded, or otherwise denied care by individual bureaucratic fiat, but the folk who sent her out the door refusing to help knew that their actions made her death in hours an absolute certainty. Perhaps not criminal assault, but "criminal" neglect, by somebody, if no more than the folks who allow such things to be legal.
Hi Freedem,
My mother is in the midst of it right now. She was denied insurance she could afford due to a pre-existing condition. Now she has stage 4 cancer that was diagnosed way too late. She is participating in risky drug trials to keep her medical expenses down… but her life savings is dwindling quick.
It's a really shitty situation!
All the emphasis on economic frames in the national discourse makes me sick to my stomach when I think of my dying mother. Even more so when it comes from progressive organizations like HCAN.
This is my personal version of the Cassandra dilemma. I know what the problem is. I even know how to fix it. But so long as health care advocacy groups won't listen, the train wreck continues in slow motion.
We should be winning this fight hands down. Instead, we keep sliding backward because our side doesn't know how to engage in effective strategies. (Some groups do, of course, but there's not coherent movement to speak of with all key participants working together in an effective manner.)
Best,
Joe
Hi Joe
I am very sorry to hear about your story as well.
Another dear friend and ex-girlfriend died two years ago of breast cancer that went to bone cancer that went to leukemia. In her case there was a bureaucrat who should have known that the breast cancer was likely to become bone cancer, but insisted that it was arthritis and refused the test for six months till she paid for the test herself and then charged it back when it was proven to be bone cancer.
But a lot of damage had been done to her pelvis and spine in that six months and she was never again able to sit or stand without great pain and needed two canes to walk at all. Still she drove to work every day till three months before she died fearing that if she lost her job she would lose her coverage and be dead even sooner.
My own disability is not life threatening so I survived the two and a half years without job or insurance (and the ten years before that because I could not get a job with insurance, losing many possible jobs because of what my insurance would cost them) But SSDI pays only a quarter of my former income and will go away if I make more than another quarter, taking Medicare with it. So my life savings are dissipating also.
The answer is indeed obvious to most with any empathy for those around them. Kieth Olbermann got it almost exactly right, it is about life and death, and some day folk may look back in wonder as how folk could be so crazy, but it took them 50 years and billions of dollars to desocialize society, & it will take a lot more to socialize it again.
Until then it will take a lot of fighting for even minimal sanity. I am very happy with my Congressman Alan Grayson for cutting through the fog to hit that point, and show how it can be done.