As I reflect upon most of my writing, I’m realizing that most of it is much more serious than I had intended or hoped for. Six months ago I was aiming for humor infused with a little bit of serious. Instead, it has been mostly serious with a little humor sprinkled in. I don’t know what this says about me. Maybe I need a stiff drink and a can of nitrous, but that’s probably not a permanent solution. This ratio won’t change with this piece, but perhaps the next one.
I still find healthcare and medicine fascinating, maybe even to a greater degree as I’ve stepped back. The recent happenings in the United States Senate illustrates the point. We had two sides completely talking over and around each other, and a president with a need for attention that rivals a spoilt toddler. I fail to recall a “debate” where so little was actually discussed about the problem(s) at hand. The debate was disjointed, much like Kevin Pollack performing a Christopher Walken impersonation. It would have been funny had we, the people, not been held up in the middle of it.
My wife, Sonia, had an opportunity close to 15 years ago to listen to an Alan Greenspan (or “Greenie” as I like to refer to him) speak at the Federal Reserve Bank of Chicago. She came away impressed with Greenie. Part of this was due to the fact that he broke script and took unscreened questions from the audience. He also revealed that he believed in the healing nature of “long baths”. I recall her saying that he took a good, prolonged soak daily. That’s an image of the former Fed chairman that I still can’t burn from my neurons.
In particular, the discussion of social security came up. He made a comment to the effect of that our nation responds well in a time of crisis, but we essentially STINK at advanced planning. I sort of agree. If I examine some of the biggest issues on the table (solvency of social security, healthcare), there’s a nugget if truth, maybe more. Social security has a funding formula that’s a bit out of date. The ACA clearly needs refining. But there seems to be an inertia. An initial solution is created, and then our leaders have an instinct to yell, “DONE!!” But the initial legislation should be the starting point, not some fragile piece that cannot be deviated from. It’s just the beginning.
Rather than focusing on the specific issue, I’m more interested in the issue behind the issue. What makes changing things, especially healthcare, so damn difficult to even entertain as a concept? Some of these points may have overlap in other arenas. And I’m not saying I’m 100% correct or have an exhaustive list, but I think these are factors in why getting things done is such a struggle.
1. Our system is designed to change slowly, and this is no accident. The philosophy of “checks and balances” is ingrained in the system. Why? To keep one person from becoming too powerful. To avoid a tyrant. Sound familiar? Our country was formed as a reaction against to unilateral power. Therefore, it is very good at keeping various factions from over running things.
Before I go further, I’m not saying these things are good or bad. They just ARE. So a system that does not allow one person to become to powerful is very stable. The converse to this is that it does not change rapidly. There certainly are occasions and issues where this really is a hinderance, if rapid change is valued. There are other governmental systems that do change rapidly. If you want a dictator, you can get rapid change. I don’t think many of us find this palatable.
Parliamentary systems do change rapidly. A party comes to power. The coalition holds together for a while. If they make it to the next scheduled election, great. If not, the government dissolves and elections can be called for early. This gives you the ability to change. You do give up stability. (You also need more than two viable parties, something we have needed for at least 20 years. I could think of at least five, but I digress). Which option is better? I don’t claim to know. But we do sacrifice adaptability for stability.
Furthermore, I am not trying to take shots for or against the mechanics of our government. Compared to the system we came out if, it was a clear improvement. However, I will point out that any system is flawed that counted anyone as three-fifths of a person, and then took 60-70 years to correct that in writing, and THEN took another 90+ years to really attempt to enforce equality (and begin to disassemble segregation, which we are still working on). The point is to take an unemotional look at how our government functions. I won’t be overly negative, nor overly reverent.
A corollary to this is the social media factor. One great thing about social media is that it can bring attention to issues that might be ignored otherwise. This is really a good thing. The down side is that issues can be blown out of proportion quickly. And, because information disseminates quickly, it feels like things can change quickly, when frequently they don’t, or even can’t. This exacerbates the weakness in our system, and it’s much easier to become aggrvated about issues than it was even 20 years ago.
2. Who is worthy of help? This touches on pieces of earlier blogs. We are a bit of a selfish nation. I wrote my “Bootstraps” piece because the self made man is a myth. But collectively we drink that Kool-Aid. A lot of people need help, but we want people to fit some kind of mold, a pre-test for receiving help. We want to deem people worthy of receiving help rather than just giving help. There seems to be an ever growing “get off my land” mentality.
We especially have this attitude toward the poor. One thing that became abundantly clear to me in my years working in urban, poor areas is that the stereotype of the poor is just that. Are there poor people that are just “cashing checks” from bring poor, expecting handouts? Yes, there are, but they are a vast minority of the poor. So why the resistance to help out?
Maybe it helps to think about insurance is/was actually for. Before medical costs went haywire (and there are A LOT of fingers to point on this one… aging population, big pharma, doctors themselves, the rising cost of medical education, malpractice expenses, and that’s for starters), health insurance was really there for two things. One is to save people from random, catastrophic bad events. No one plans for needing a bone marrow transplant at age 40, or having a child afflicted with CF, or getting secondary pneumonia after getting influenza. Why? Because you can’t. We agree to collectively protect ourselves from random as much as possible. Like home owner’s insurance, health insurance gives you a chance to fight random, except it actually can keep you alive, as opposed to replacing “stuff”.
It also saves us against our own stupidity. Imagine a system that refused to administer care to a patient who suffered a traumatic brain injury in a motorcycle accident because the rider wasn’t wearing a helmet? Do they deserve to die (or be charged a much, much higher rate for their care) because they didn’t try to mitigate risk for their accident? Does a one month old child born to anti-vaccination parents deserve to die (or have their parents pay for care out of pocket) because they didn’t get a TdaP booster should the child need life saving care? These would be regarded as cruel consequences, undue consequences. So why do people that have more money deserve to be saved from their short sightedness, but not the poor?
I want to believe that most people don’t want the poor to be treated differently, but rather are afraid that the government won’t “screw this up.” But I think there is something more sinister afoot. I think that some people deem the poor as not worthy, and therefore it’s not their problem. I think there is an unspoken “worthiness” clause, and given what insurance is for, that just doesn’t make sense to me.
3. Taxes vs. giving. Before giving a presentation to our church back in May, I did a bit of research on this one, but didn’t present it in my talk; it just didn’t fit. I read and hear about lowering taxes, so people have more discretionary income. I’m not against this in principle. But here’s the rub. If people were taxed less, would they give more to agencies, hospitals, non-for-profits, and churches to do the work of caring for people that benefit from tax payer supported programs? After all, it’s not like people that need help are just going to go away because needed programs disappear. We might ignore people in a segment if society, but they’re still HERE.
In my limited “meta-analysis”, the data is really unclear on the subject. It is far from certain that if people brought more money home, that giving would rise proportionally. That doesn’t mean that people wouldn’t help out more. There are checkmarks in both columns. But it is safe to say that one can’t bank on people individually doing more to assist people that are less fortunate. Collectively, we aren’t as generous as we think we are. In one manner of thinking (at least for Christians), the government supported programs are doing what we were supposedly commanded to do. I know it’s not a perfect analogy (hell, I’m well aware of government waste and inefficiency), but there’s some truth to it. We are way more comfortable with unforced giving. And, psychologically, that makes some sense to me. But that doesn’t mean that relying on individual generosity is the best plan either.
If we are going to be in a society that is truly together, there is always going to be a battle between individual rights against the needs of larger groups of people. The consequences of going too far to one end of the spectrum will always negatively impact the other. In my view, the extremes are libertarians and communists. Both communism and libertarians (theoretically) could work in small groups, where it us much easier to have everyone pulling in one direction. They both fail in modern, macro environment. Libertarian beliefs have cruel consequences to the masses by the few that have power, and communism destroys any individual rights and demotivated one from bettering their own position. It’s going to be a tricky blend that gets us closer to the goal of really treating people as equals.
The healthcare debate is just one example. But I think going into the “issues behind the issues” might be a good approach for more of our current, hot button debates. It’s a lot easier to yell “healthcare” or “policing” and draw lines, and then watch the sparks fly. You have to get into the philosophy behind the positions and then discuss. There’s more common ground than we realize, if people could calm down long enough and do two things: listen and discern. But if we continue to operate like the talking heads on Fox News and CNN, we aren’t getting anywhere, folks.
I know I didn’t solve anything. I doubt that most people will even agree that these are issues to them, or that my illustrations are even correct. And Lord knows, this is not exhaustive. I’m naïve for sure, but I don’t think it has to be a conservative vs. liberal thing. I really believe if we could start to break issues down into pieces that maybe, just maybe, we start to get some common ground to work from. I think these concepts outlined here are starting points. But there has to be a place to work forward from. It’s out there, and it’s definitely worth finding and fighting for.