Five More Ways Health Care Increases Freedom
Truth, dignity, the future....
This is the fourth in a series of five posts about how access to health care would make us more free. In posts one and two, I argued that health care is a human right, and used examples from around the world to suggest that health and freedom work together. In the last one, I have the first five ways universal access to care would make us more free. In this one, I will complete the list. In the next post, I will mention a couple of other values, patriotism and security, that would be supported by universal access to care.
6. The end of fear. Anxiety makes us less free. When you do have access to health care, a layer of worry is lifted from your daily life. This is the hardest one to explain, because in the United States this anxiety runs so deep in us that it is hard to imagine life without it. Let me try then to illustrate with an example.
Not so very long ago, I nearly died in an American hospital. Some of the symptoms of my illness trailed me afterwards for some time. Here in Austria, if something is wrong, I call my doctor, and I see her right away. Actually, that's not true: I don't even bother to call any more, I just show up and am seen. The last time that I went to see my doctor, the assistant apologized because I had to wait for fifteen minutes. When I needed surgery here, I was offered the next week. When I saw a specialist, I got an appointment within a week. I don't pay for these visits, because I have insurance, which is inexpensive. To be sure, the system does not always work so seamlessly, and in other countries with universal access to care wait times can be significant. Nevertheless, the basic issue is clear: when you know that the system is there for you, rather than for profit, you breathe more freely all of time. Now imagine that on the scale of an entire society. That is a freer country.
7. More truth. You are not free when you are lied to. When you are lied to, you are dominated by someone else, or by something else. The subject of health is tricky and sensitive enough without distrust being added to the mix. In the American system of commercial medicine, lying has to be part of the deal, because no one will tell you that your treatment is affected by considerations of profit. And yet it very likely is.
8. Freer physicians. Doctors should be liberated. We would like to think that physicians are acting freely, on the basis of their training and judgement, but in many cases they are not. Medical school debts drive many of them into specializations that are already crowded, and away from the basic fields of internal medicine, pediatrics, and geriatrics. The complication of private insurance drives them out of family practices, where they would actually know their patients over years and decades, and into big groups and big hospitals. Very often, their actual employers are staffing companies. Their contracts include gag orders, which means that they cannot discuss medicine in public without risking their jobs. Doctors were penalized for speaking up during the pandemic. Commercial medicine makes doctors less free, and so makes us all less free.
9. Dignity. The essence of freedom is being seen as a human rather than as an object. There are wonderful cafeteria workers, patient transporters, nurse assistants, nurses, physician assistants, and physicians in our medical system who do treat people as people, or do their very best to do so within the constraints of the system. But at the very top of the medical pyramid are very often private equity firms who see health just another way to make money. For the people who matter the most, you are a widget. It is sad to live as a widget. It is even sadder to die as a widget.
10. The future. Freedom means the ability to see multiple futures, and to realize some of them. When you know that you have health care, you are much freer to make decisions on the basis of what you would actually like to do with your life.
If people cannot start businesses because they cannot afford the health care costs, then they are far less free than they might be.
If people are in bad jobs because they need the health care, then they are stuck, not really free.
If people are in marriages or relationships because they need the health care, they are surely not free.
If young people have to direct their lives on the basis of how they can be insured, those lives will be far less free.
Children who grow up with guaranteed access to health care will be more likely to lead free lives. Freedom involves emotional and physical capacities that we gain, or do not gain, when we are very young. Much of this has to do with parenting and with other forms of social contact. But parenting is far easier to do when a child has access to health care.
This concludes my list of ten ways that universal access to health care would make us freer as a people. I reflect more on these themes in my book Our Malady. In the next post, I will say a few words about universal access to health care relates to security and patriotism.
When your private companies selling garbage online are more customer-obsessed than your healthcare system you may have a problem! They act like healthcare is "too big to fail," but when we're wasting resources like time and money, the astronomical number of jobs and money being spent isn't a good thing, it's literally a bad thing. We're working so hard to keep a broken system going.
I am thinking about a book by Robert Martensen who was a doctor, historian, and ethicist. Book is called “A Life Worth Living: A Doctor’s Reflections in a High-Tech Era”. In it, he presented a number of case histories describing how people handled their various very bad diagnoses and how they, and often the medical profession dealt with their issues. The most poignant was the first story about Marguerite who in her 40s was diagnosed with breast cancer snd her subsequent tragic journey through our very flawed health system. It is worth reading. It is even hard now to overcome the path the current world of medicine wants to take you. Also read “Breaking the Iron Triangle” by Robert Duggan and “The Last Well Person: How to Sray Well Despite the Health Care System” by Norton Hadler. And, more recently, “Being Mortal” by Atul Gawande.