{"id":13,"date":"2020-02-22T19:07:00","date_gmt":"2020-02-22T23:07:00","guid":{"rendered":""},"modified":"2022-04-27T18:33:15","modified_gmt":"2022-04-27T22:33:15","slug":"were-not-ready-for-single-payer-healthcare-because-we-disagree-on-basic-morality-warning-this-is-a-draft-of-a-much-longer-paper-i-hope","status":"publish","type":"post","link":"http:\/\/blog.cmhughesmd.com\/?p=13","title":{"rendered":"We\u2019re not ready for Single Payer Healthcare (because we disagree on basic morality)*"},"content":{"rendered":"
\u201cA common incantation during debates on health reform\u2026 is \u2018that we all want the same thing; we merely disagree on how best to get there.\u2019 That is rubbish.\u201d <\/em><\/div>\n
\u2013 Uwe Reinhardt<\/em><\/div>\n
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In a 2011 Republican\u00a0Presidential debate<\/a>, candidate Ron Paul was asked a pointed question about what to do with someone who needed expensive healthcare but did not have insurance: \u201cAre you saying that society \u00a0should just let him die?\u201d Some in the crowd jeered \u201cYeah!\u201d<\/a>\u00a0Paul indicated that as a physician, he did not find it acceptable to do so and offered charitable care from \u201cchurches\u201d based on his experience of practicing medicine in the in the early 1960s, before Medicare and Medicaid, eliciting applause from the crowd.<\/div>\n
Last year, I attended the Keystone Progress Conference in Pittsburgh, PA for a few hours. I attended a panel discussion of progressive candidates who lost their elections in deep red districts.\u00a0One of the things I heard was straight out of this Ron Paul universe \u2013 all four of these candidates said they were surprised that so many of the conservative voters were afraid, of having others \u201cget over on them.\u201d That these others would get free healthcare and\u00a0they were going to have to pay for it, for \u201cthose people\u201d to be freeloaders that they would have to subsidize, etc.<\/div>\n
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In 2013, Dan Munro,\u00a0writing for Forbes magazine<\/a>, on the anniversary of Martin Luther King, Jr.’s \u201cI have a Dream\u201d speech, pointed to several myths so common to conservative thought about America, in particular our\u00a0backwards interpretation of the \u201cbootstraps\u201d fable<\/a>:<\/div>\n
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\u201cthe myth that literally anyone \u2013 through hard work and determination \u2013 can rise out of any poverty and become rich and prosperous. We salute, praise and deify everyone who does. But there\u2019s a dark side to this myth. Anyone who doesn\u2019t isn\u2019t working hard enough \u2013 or doesn\u2019t have enough determination. In effect, they\u2019re a loser \u2013 and nobody wants to pay for the healthcare of those losers.\u201d<\/div>\n<\/blockquote>\n
Veronica Combs\u00a0paraphrased it<\/a>\u00a0as \u201dThere is a real meanness in the conversation about who should have healthcare, an implication that people who need help somehow don\u2019t deserve it, or that they are taking advantage of \u2018the rest of us.\u2019\u201d<\/div>\n
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All of this, of course, is not really news. Making a moral case for universal health care in any form is denounced as socialism or \u201cnot the job of government,\u201d or as Ron Paul said, that we must \u201cassume responsibility for ourselves.\u201d The American Medical Association has famously opposed movement towards universal healthcare, from the Truman Administration to the passage of Medicare and Medicaid and through opposition to major parts of the Affordable Care Act.<\/div>\n
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Martin Luther King, Jr., noted that \u201cOf all the forms of inequality, injustice in healthcare is the most shocking and inhumane.\u201d Many have railed about the inhumanity of Americans towards each other regarding healthcare, and the late Professor Uwe Reinhardt has\u00a0asked for decades<\/a>, \u201cTo what extent should the better off members of society be made to be their poorer and sick brothers\u2019 and sisters\u2019 keepers in healthcare?\u201d Americans, capable of unbridled generosity in helping\u00a0individuals\u00a0pay for a transplant or some other services when the individual in question is\u00a0deserving,\u00a0are ruthlessly coldhearted when compassion is requested for those they deem undeserving, as the Tea Party crowd showed us in 2011.<\/div>\n
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Reinhardt was clearly stung by the idea that his adopted countrymen (he was German born US citizen) rejected this solidarity, in contrast to every other nation\u2019s resounding \u201cyes\u201d to the question. He also pointed out that the way Americans avoid the moral question that faces us is to play the game framed by the introductory quote: we pretend that the problem is that we disagree on policy, writ small and large, and find ourselves down rabbit holes about the reimbursement for an anesthesiologist for a fifteen minute unit of time with or without a nurse anesthetist!<\/div>\n
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Every other nation has started with the moral and ethical question over their values as a society and worked towards a solution to provide healthcare to all their people, \u201cdeserving\u201d or not. As another\u00a0professor noted<\/a>:<\/div>\n
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“The last time I taught in the Semester at Sea program, I found it necessary to interpret for our students the rich \u201csocial capital\u201d that runs through the Northern European societies we were visiting. What they knew and had read in their guide books was that not many people are in church on Sunday morning, especially compared to the florid religiosity of the United States. So their working assumption was that Americans take religion seriously and Europeans don\u2019t. The new thought that amazed them was that the unchurched Europeans live in social democracies deeply saturated with historic Christian values, while the much-churched Americans celebrate a society characterized by a ruthless social Darwinism that the God of the Bible, Old and New Testament alike, denounces.”<\/div>\n<\/blockquote>\n
What is preventing us from having the basic moral argument about our values regarding health care? The answer is three-fold. The first is a strong puritanical streak in American culture that prompts many of us to divide our fellow citizens into camps of deserving and undeserving people. The second is a now unfathomably large industry that has much to lose should efficiency and order find their way into the American Healthcare system. The third is our human cognitive biases that lead us to sloppily assume political and moral positions that will take years of work to overcome, using cognitive psychology to reframe the debate and convince people that doing the right thing is the right thing to do \u2014\u00a0for everyone.<\/div>\n
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\u201cA common incantation during debates on health reform\u2026 is \u2018that we all want the same thing; we merely disagree on how best to get there.\u2019 That is rubbish.\u201d \u2013 Uwe … Continue reading “We\u2019re not ready for Single Payer Healthcare (because we disagree on basic morality)*”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"sfsi_plus_gutenberg_text_before_share":"","sfsi_plus_gutenberg_show_text_before_share":"","sfsi_plus_gutenberg_icon_type":"","sfsi_plus_gutenberg_icon_alignemt":"","sfsi_plus_gutenburg_max_per_row":"","footnotes":""},"categories":[7,4,144,152,17,6,5],"tags":[],"class_list":["post-13","post","type-post","status-publish","format-standard","hentry","category-socialized-medicine","category-universal-health-insurance","category-cognitive-science","category-corroborating-evidence","category-medical-professionalism","category-moral-arguments","category-single-payer-health-care"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"http:\/\/blog.cmhughesmd.com\/index.php?rest_route=\/wp\/v2\/posts\/13","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/blog.cmhughesmd.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/blog.cmhughesmd.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/blog.cmhughesmd.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/blog.cmhughesmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=13"}],"version-history":[{"count":7,"href":"http:\/\/blog.cmhughesmd.com\/index.php?rest_route=\/wp\/v2\/posts\/13\/revisions"}],"predecessor-version":[{"id":1088,"href":"http:\/\/blog.cmhughesmd.com\/index.php?rest_route=\/wp\/v2\/posts\/13\/revisions\/1088"}],"wp:attachment":[{"href":"http:\/\/blog.cmhughesmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=13"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/blog.cmhughesmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=13"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/blog.cmhughesmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=13"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}