Thursday, September 10, 2009

Thinking about Health Care

There’s context and then again there’s real context. And so there I was at my desk in my study shortly after the president’s health care address to Congress and the nation Wednesday evening reading the transcript of his remarks at the same time Joan was sitting at her desk listening to the Moscow Men’s Jewish Cappella’s marvelous recording of Avinu Malkeinu and making the notes she plans to share with our choir at their next rehearsal.

So that’s the tableau to have in mind: Joan and I seated at our respective desks, the issues surrounding health care reform swirling around and filling the space inside my head as the hoary strophes of one of our most ancient hymns fill the room outside my head, the air in the study thick with words that have outlived every generation that recited them but (at least so far) our own. Divine Progenitor, holy Sovereign, we have no God but You. Avinu Malkeinu, rid us of tyrants. Rid us of pestilence. Pardon our sins. Send complete healing to the sick. Avinu Malkeinu, remember that we are dust. Have pity on us and our children. Show us mercy. Act for Your own sake if not for ours! And while those hoary lines are making thick and heavy the air outside my head, a different set of words sent into the world not an hour earlier (and already available for download) are filling up the interstitial spaces inside. Not to clean up a crisis but to build a future. Thirty million who live without health care coverage. Fourteen thousand who lose their coverage every single day. Washington at its best and at its worst. Scare tactics instead of honest debate. Security and stability. Broad consensus. Choice and competition. Waste and abuse. Waste and fraud. Waste and inefficiency. Affordable. Nine hundred billion dollars over ten years. A moral issue. The character of our country. Nine hundred billion! Affordable!

In the course of my life, I have lived in five countries: our own great country (where I was born, grew up, and now live) plus France, Israel, Germany, and Canada. All but the United States have national health programs. All also have dramatically higher tax rates than we do. But the care in all those places is first rate, and I personally only experienced excellence in the care I received or my family did. Of those countries, we lived the longest—thirteen years—in Canada and while it is true that none of us needed intensive medical care during our years in British Columbia—and that is what they say, after all, isn’t it: that all these systems work fine as long as you don’t really need them?—we did have two children while living there and those two plus their older brother and the two of us underwent countless medical tests and examinations and procedures over all those many years.

As far as I can see, the system there works no less efficiently than ours. We felt well looked after. We had confidence in the doctors and specialists we needed to see. When we looked around, we saw our friends and neighbors receiving the same first-world treatment we were getting and complaining about the occasional glitch in the system at about the same rate (and with the same level of righteous indignation) that I hear people here complaining about this or that detail connected with the care they have received. So it seems to me wrong when I hear people talk about a national health system as though it were the first step on a nation-wide journey to socialist perdition. And what the president proposed Wednesday night stops a long ways short of dismantling our current medical system and replacing it with anything like what they have in Canada or the U.K. Okay, so some fairly crucial details remain missing from the picture the president was attempting to outline for our co-citizens. But whatever shape the proposal eventually takes, the bottom line has to be that we simply cannot go on with a system in which scores of millions have no coverage and almost a hundred thousand people lose their coverage every month just when they are finally sick enough actually to need it. That much even the Republican congressman from Louisiana, Dr. Charles Boustany, conceded in his formal response to the president’s remarks. So the question isn’t so much where we need to go, but how exactly to get there. And how to pay for it.

Or maybe that’s not quite right either. The problems the president outlined in his remarks are more or less indisputable. But for me the larger issue is neither who pays for what nor how the system the president wants to invent will actually work as much as it is the simpler moral question that underlies, or that should underlie, the whole discussion: can there be any moral justification for selling health to the public the way Best Buy sells televisions or Dunkin’ Donuts sells coffee? You don’t have to own a television. You don’t really need another cup of coffee. (I personally almost never need another cup of anything with caffeine in it.) So why should you need a preventative colonoscopy or an annual or biennial mammogram?

Of course, no one really thinks that. The notion that people who can’t afford adequate health care should just go without appeals to no one at all…and yet we have allowed our country to behave as though just the opposite were to be the case. And the proof of that pudding is truly in the eating: as a nation, we have blithely allowed ourselves just not to care all that much that there are literally armies of people in our midst whose access to health care is minimal, who only receive treatment in times of disaster (and then at an outlandish price either to themselves or society) and no preventative care at all, or who (supposing they do have insurance) have no idea when or if whatever coverage they have might be terminated upon moving to a different state or leaving a job or discovering some previously unknown, thus also previously undisclosed, medical ailment.

For me personally, the words at the center of the matter come directly from the Torah, where, in its account of Israel’s first days in the wilderness on their way from the miracle at the Sea of Reeds to Mount Sinai, Scripture offers the words ki ani Hashem rofekha (“For I, God, am your source of healing”) as part of its explanation of how Moses, a mere mortal, was able to sweeten the waters of desert oasis so well known for the rancid taste of its spring waters that its very name was Marah, the Hebrew word for “bitter.”

How exactly Moses managed to transform the bitter springs of Bitter Springs into potable drinking water for a nation, the Torah reveals without going into too much detail. But the point is clearly not to teach us how to sweeten acrid water but to remind us that all wellbeing, physical and otherwise, comes from God. The health care professionals in our midst are therefore doing God’s work on earth as they serve as the agents of therapeutic healing in our midst. And that concept has to balance our sense of health care as a commodity. After all, we sell bread in our supermarkets yet do not expect those who cannot afford even a loaf of bread to go hungry, much less to die of starvation. We sell clothing in all sorts of stores for all sorts of prices, yet we do not expect people who cannot afford clean work clothes to stay home rather than trying to earn a living as best they can. And so should it be with healthcare, I believe. There is no reason not to expect people who can afford to pay for decent health care to pay their fair share of the bill. But that does not mean that we should expect people who cannot afford adequate health insurance to go without. The right to decent, affordable health care is in the same category, or should be in the same category, as the right to drink clean water or breathe fresh air or send one’s children to school. At different moments in history, each of these has been perceived as something reasonably to be purchased by those who could and regretfully done without by those who couldn’t. As a society, we have moved far past thinking of clean drinking water as perk of wealth. Adequate and affordable health care should be considered in the same category.

As our nation wades ever deeper into this debate, my prediction is that the level of vituperative discourse will also increase. My suggestion is that we adopt the four Hebrew words ki ani Hashem rofekha as our mantra, then repeat them softly to ourselves a few times before entering the discussion. To know God the Healer, we can do no better than to become agents of healing in the world by working towards a world in which health care is denied to no one because of prior illness, age, or wealth.

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