Healthcare’s price in the ‘Land of the Free’

Posted: September 10, 2009 in Health, Society

Why America’s belief in freedom is the biggest obstacle to healthcare reform.

Anyone who has been to US recently will know that the word on everyone’s mind and every newspaper front page is ‘healthcare’. While vested interests battle pro-reformers at heated town-hall meetings across the country, I’ve thought about the language they use and have realised that this isn’t just about a controversial new policy. It’s about what it means to be free in America today.

The relatives I visited in the States are staunch Republicans, and therefore strongly opposed to Obama’s proposed health reforms – even though they would benefit enormously from them. My grandmother for example pays thousands of dollars every year for the medical treatments and prescriptions which aren’t covered by her health insurance.

My uncle Steve was in the process of changing doctors while I visited him. Steve has suffered from bi-polar disorder for most of his life. Since his last breakdown he’s spent four years taking a cocktail of drugs, most of which are sedatives. He finds it difficult to wake up in the morning and although he wants to get back to work, he knows it’s impossible if he continues with the same medication.

Steve decided to transfer to Western Psychiatric Institute and Clinic in Pittsburgh – one of the country’s leading psychiatric hospitals – but his insurance wouldn’t cover the transfer, meaning he could have to pay up to $1,300 a week for treatment.

Knowing this about my grandmother and uncle I couldn’t understand why they are against public health insurance. Initially I thought it was out of a dislike of Obama’s new administration – and although this probably plays a part – the real reason goes much deeper.

Many Americans have a deep distrust of government intervention. While some see this as a reaction to the current administration’s corporate bail outs, I see it as a long-standing element of the American psyche.

The philosopher Henry David Thoreau wrote in 1849, “That government is best which governs not at all”. Thoreau’s anarchism seems extreme but it underlines a perception of freedom which continues to dominate America today.

Thoreau’s idea of freedom was heavily influenced by Ralph Waldo Emerson’s belief in the importance of individuals living a life of physical and mental ‘self-reliance’. “It is only as a man puts off from himself all external support and stands alone that I see him to be strong and to prevail”, Emerson wrote.

Emerson’s self-reliance continues to influence the meaning of freedom today. It is this freedom which opponents of public healthcare believe they are defending. Ronald Reagan held up this freedom, along with America’s “traditional free enterprise system”, when he attacked Kennedy’s plan to extend social security and create what Reagan called “socialised medicine”.

One letter to the editor of a newspaper expressed a Reaganesque argument against Obama’s reforms: “If I want to give my money to help others I am free to do so, but I don’t want the government giving my money to other people without my consent”. It boils down to the question, “Why should I pay for that person’s healthcare?”

It’s true that there are charities which provide healthcare to some of the 47 million uninsured Americans, but these charities will never be able to satisfy the vast need for free treatment. One of America’s most well known healthcare charities is Remote Area Medical (RAM). RAM operates on a shoestring budget of $250,000 per year. That’s less than one cent for every uninsured American.

Opponents to reform argue that charities like RAM should deal with the uninsured. This argument assumes that if you can’t afford healthcare it’s your own problem. Yet the lack of adequate health insurance isn’t just felt by the uninsured, it’s felt by society as a whole.

If an uninsured person becomes ill, it affects their family, their friends and their employer. It affects utilities companies – if they fail to pay their bills due to hospital fees – and eventually the government, if they go bankrupt and become unemployed. (Half of all bankruptcies in the US are at least partially caused by medical costs).

If we leave the unfortunate to deal with ‘their problem’ we are denying our responsibility to those in need. Aneurin Bevan, the chief architect of the National Health Service (NHS), said that refusing to treat a person who cannot afford it “may be sound economics [but] it could not be worse morals”. Without public healthcare, millions will go on untreated.

At the heart of this debate is a freedom which concerns itself with the individual and rejects any notion of community. It’s a freedom which has been influenced by Emerson, but one he would never approve of. Emerson argued for people to be self-reliant in every aspect of their life – from their thoughts to their work. The mass dependence upon corporations which typifies American life today is a far cry from self-reliance.

Today’s definition of freedom is the only freedom that can exist in a capitalist society where people are routinely pitted against each other in the ‘spirit of competition’, and where profits hold more value than relationships.

I’m sceptical that healthcare reform will happen in America, unless maybe there is a national emergency like the Second World War – without which the NHS would not have been founded – but even then it seems unlikely. The American lexicon won’t allow it. Not without a fundamental change in the values underpinning the language. Not without a change in what it means to be free.


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