2009 Blog Posts Healthcare Social Issues

My Best Case for Using Worst Possible Case Thinking While Designing The National Health Care Program

As a person who strongly supports the establishment of a high quality, efficient, intelligently managed, and honorably functioning system of health care in the United States that includes every citizen on an equal basis, I feel obligated to offer the following line of thinking regarding dangers inherent in such a system.

My sense of obligation in this particular area has been heightened in recent weeks as a result of pondering the ramifications of some of the end or life issues raised by Conservative participants in the great health care reform debate currently mesmerizing large segments of the populace, elite and otherwise.   In response to their fervent remonstrations, I have been moved to think long and hard about the proper role of national health care systems.

The good things they should do are rather obvious, and all of them are more or less easy to achieve by a wealthy nation such as the United States.  Despite the protestations of Conservatives and ethically obtuse Blue Dogs, we can easily afford the kind of system we need. One of the most obvious indications that this is indeed the case is the fact that many nations endowed with far less wealth than the United States provide excellent health care for their citizens of the sort that would be appropriate in this nation.

Thus, the decision looming before us is not about the money, it is, instead, about morality and basic Human Rights.  As a result, we have wandered, almost aimlessly, into a confrontation with the necessity of making a major decision about what we are as a people, and what we might hope to become.  Moreover, the decision before us has ramifications just as important as those associated with the anti-slavery debate, or the one that resulted in women receiving the right to vote.

Health care for everyone, from cradle to grave, will fundamentally enhance the nature of human life in this society.  As a result,  it is imperative that those of us who support the cause, as the late Senator Edward Kennedy eloquently noted, need to be seriously engaged, and doing our level best to make honorable health care reform happen.

Having said that, I want to address some of the problems inherent in massive, nationalized health care systems that we need to anticipate, plan for appropriately, and hopefully avoid.  I should begin by noting that we in the United States who are alive today have experienced a golden era.  Despite widespread, endemic poverty, and all that the existence of such a problem implies, the nation as a whole has prospered for many decades in a relatively auspicious manner.

In addition, we have enjoyed a relatively stable political climate.  We have experienced assassinations, riots, and many kinds of violence associated with politics.  Nonetheless, the basic framework of government has remained stable, and the social fabric of that which has come to be known as “the American way of life” has evolved in many positive ways.  Most people probably agree that Barack Obama’s election to the highest political office in the land is proof that this is true.

As we move forward with noticeable, and uncharacteristic, uncertainty into this new century, we need understand that some better days are ahead.  But most certainly, and this is where the worst possible case thinking comes into play, we also need be aware that some unavoidable, troubled times lie dead ahead.

The key point to understand is that the health care system we need should be designed to withstand all the worst possible scenarios we can reasonably imagine.  For example, it needs to be designed such that it remains functional during times of massive economic dislocation.  It also needs to be designed such that it can withstand the inevitable pressures to do wrong, which will almost certainly accrue from any sort of extreme ideological swing to the right or left that may occur in the national political system.

During this relatively tranquil moment of domestic peace, and Liberal Democratic goodwill, it is proving relatively easy for most of us to focus almost entirely on all the good things associated with well-managed national health care programs.  Nonetheless, it is vitally important for us to understand during times of stress, turmoil and widespread paranoia such programs can be transformed into grotesque venues for exploitation, suffering and death.  Any cursory review of the ways in which such programs have been used to abuse citizens over time in countries around the world will reveal that there are good reasons for us to be cautious, and to insist on the establishment of strong protections for the rights of citizens.

We also need to devote much more attention at this particular moment in time to carefully examining all the ways in which the U.S. health delivery establishment has violated the rights of citizens in the past.  Such investigation will reveal that the infamous Tuskegee Experiment is/was the tip of an iceberg of abusive practices by health care personnel here in the U.S., who have perpetrated many oppressive, and probably illegal, abuses against U.S. citizen, including widespread, forced sterilization.

Such personnel also have a long history of conducting unconscionable, and sometimes deadly, experiments on unsuspecting, uninformed citizens.  In addition, the health care system has historically accommodated prevailing systems of endemic oppression involving caste, class and race in ways that continue to have devastating consequences on the lives of those who hail from targeted groups.   Given this, I am particularly concerned about the manner in which the death penalty is used here in the United States.  Separate and apart from that issue, I recommend that  increased critical attention be devoted to the role of health care personnel in the capital punishment industry.

Anyone doubting the validity of this assertion should take the time to read Medical Apartheid, by Harriet A. Washington.  Furthermore, I hope I am not the only one deeply concerned about the role that some U.S. medical personnel have played during the past few years in Iraq, Afghanistan, and other black sites around the world, in connection with the so-called War on Terror.

It seems reasonable to ask whether the U.S. medical personnel who are, or have been, engaged in such activities are disqualified from participation in the national health care program currently being constructed in Washington?  Under what set of circumstances might they be disqualified?  Before any new programs are established under the heading of health care reform, we need to know whether the civilian and military spheres of health care will ever be permitted to merge, and if so, in what ways?

Do medical personnel who move back and forth between the two systems experience ethical conflicts?  If so, what are they, and how might they be precluded from occurring in the first place?  This is the time to address such e issues, and we need to thank Conservatives for forcefully bringing them to our attention.  And in direct response to t valid concerns they have raised about potential abuse, I recommend that the program currently being developed in Washington include a provision that specifically prohibits government participation in end of life decision-making at any time, for any reason.

Finally, I want to reiterated my strong conviction that the best way for the nation’s political leaders to show their good faith regarding the high standards that should be associated with every aspect of the emergent national health care program is for them enroll the rest of us in the system that protects their health and well-being.

That’s what equal opportunity is all about.  Either they believe in it, or they don’t.

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Robert Terrell

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