It’s bubbling up again. The questions of health care and the debate over its reform is once again finding its way onto the air waves and into the “top headlines” on my Google homepage. The debate has thundered on for months, each side seemingly believing that volume rather than substance will win support. Yet in all of the voices I’ve heard promising plenty and predicting pogroms, only one has made perfect sense to me.
The person interviewed was, surprisingly enough, a doctor. Questioned about the practicality of the lumbering behemoth of a bill that was, at the time, working its way through the legislature, he gave his interviewer a single, simple answer: nothing will fix the problem as long as demand is so outrageously high. He went on to explain that, in his opinion, much of the difficulty with healthcare, and the reason that American healthcare is proportionately outrageously priced and overloaded is that Americans expect healthcare to take care of every problem they or their family might have, and doctors want to make money, so they meet demand with supply. He also pointed out that doctors feel the need to meet demand because they fear legal repercussions from failing to test everything and provide the medication results promised in a pithy television advertisement.
I remember the doctor’s words because he reached beyond political partisanship to point out a deeper, simpler truth. Part of the problem with healthcare is cultural, not financial. We can legislate the hell out of our system, but until we can change cultural attitudes, costs are not going to drop.
The cultural attitude that costs us so much in medical bills is one that frightens me. It is an attitude of entitlement; a slide of responsibility out of individual hands and into the hands of some, not quite defined beneficent power that has, despite its human origin, risen above human concerns to absolute altruism.
Practically, such an idea sounds ridiculous. Ask just about anyone, regardless of political leanings, whether they trust the government, and you’ll get a hoarse laugh and an incredulous look. Trust the government? Of course not. Yet many of those same people are more than willing to allow the government to assume responsibility for their safety, their medical care, and their job security. That rising gap between practical understanding and government responsibility is chillingly visible to me. Every semester my students tell me that the constitution guarantees them the right to happiness; they justify everything from gay marriage to carrying a gun under that promise. You can chalk that up to the failure of our education system; you can laugh at student ignorance, but in the end, I believe that the mistake is the highest form of Freudian slip. It represents an increasingly prevalent attitude in American society; we have the right to be happy, and someone needs to make it so. Whether that happiness is the result of financial disbursements of money, the guarantee of safety for a small price of privacy, or pills to make us happy and well behaved, more and more people believe that happiness is a right, not a responsibility.
In those three small words, “the pursuit of,” the founding fathers definitively put happiness in the hands of individuals. They guaranteed us the right to chase our dreams, to pursue happiness with all of our substance, but they did not guarantee we would get it. Obtaining happiness is, in the end, up to us. It is our individual responsibility and choice – and in the grander scheme of things, history teaches us that it is often the pursuit, not the obtaining, that makes men great.
Yet that greatness is increasingly lost. Many authors have speculated on the impact of antidepressants on creativity and suggested that many of the great artists in history, had they lived today, would have been medicated out of their misery and, along with it, their creativity. More and more often, our culture focuses on a top heavy structure of responsibility that promises the right to happiness guaranteed by a well organized social system that increasingly combines with science to take the place of religion. Individual greatness and heroism is good, for what it is, but such greatness (particularly when based on actual actions rather than media creation) is damaging, for it makes others more responsible and less happy, wishing for something they may not have. Take, for example, the attempted bombing at Christmas this past year. The bombing was foiled by individuals on the plane, individuals who took responsibility for their lives and that of their fellow passengers. Those women and men acted heroically. Yet I do not know the name of a single one of those people. Instead, modern culture immediately sought a hierarchical response. Rather than focusing on the heroism of the individuals who stopped the bomber, cultural media immediately began contemplating what part of the machinery of airport security had failed and how the government could step in to guarantee safety. It was not enough to honor the idea that individual responsibility saved lives. It was the job of some great benevolent machine to prevent the need for individual heroics because, of course, individuals cannot always be counted upon to be heroic.
On the radio several weeks ago, I heard a commentator discussing an article which examined the overall negativity of American culture. “I don’t see a difference,” he declared, “being critical of the country and its leadership is a healthy part of our culture. We’ve always done that.” Indeed, we have, but as I told my uncaring radio, the sense of helplessness, of loss of ownership, has never been so intense. As we lose individual responsibility as a cultural value, we also lose our sense of cultural empowerment. The idea that the government actually represents the people in any meaningful way is fading, replaced by a sense that there is an inevitable power structure, having very little immediate connection with the people, whose purpose is to enable the individual right to happiness. There is a rising sense of fate, a notion that the leviathan of government is far too massive for individuals to influence, and that notion of accepting the inevitable seems to be rapidly tumbling into nationwide depression and the evolution of a culture of systemic, rather than individual, responsibility.
Ironically, that loss of responsibility finds expression in practical terms as well. We find ourselves in the grip of structural responsibility, in a place not unlike that created by Soviet authority. In his book The Unquiet Ghost, Adam Hochschild tours a Russia emerging from the shadow of Stalin, and he notes the general state of collapse of the cities and even the public areas of the apartment buildings. He writes that in stark contrast to the squalid public areas, Russian homes are immaculate; those spaces are theirs. It is their “feeling about public property that was the problem. Until this changes, real democracy in Russia, a democracy that does not just go through the motions of holding elections but is built on people’s confidence that they themselves control the state, and not somebody else, is far off” (187). Sadly enough, the same could be said of modern America. We have lost the confidence that the people control the state. Instead, we feel impotent, coddled in the promise of happiness provided by the state, yet frustrated by the endless ineptitude of a bureaucratic dragon we feel we cannot slay. We are not emerging from the shadow of some tangible regime; we are sliding into the shade of cultural irresponsibility, seeking happiness that we view as a right, yet have no desire to pursue and make our own.
So when the radio begins to tell me about the impact of healthcare reform, I switch to the 80s station. It is not that I don’t care – quite the opposite. It is simply that I do not believe that healthcare, or much of anything else, can be meaningfully reformed until someone has the courage to face up to the cultural illiteracy that lies beneath the partisan dog and pony show. Until Americans realize that they are responsible for their own health and that their time is better spent in pursuit of happiness than pursuit of populism, legislation isn’t going to change a thing. People will continue to demand pills to solve everything and social safeguards to protect them from failure – and from spectacular success. As long as we live in fear of the effort and risk it takes to pursue happiness, we’re never going to catch it, and we’re never going to be mentally or emotionally healthy from the effort of the pursuit – no matter what they legislate.