The right eloquence needs no bell to call the people together and no constable to keep them. ~ Emerson

Wednesday, July 15, 2009

Physician, Repair Thyself

Neither Cheap Car Insurance nor Henry David Thoreau Make Good Arguments Against Universal Healthcare

Doctor Thomas Szasz, Emeritus Professor of Psychiatry at Upstate Medical University in Syracuse New York, pens an attack on universal healthcare in today’s Wall Street Journal. His arguments seem such healthy, common-sense libertarian wisdom at skin level yet suffer from such putrid and diseased logic underneath that they warrant a response.

Szasz’s first objection is that virtually all health insurance, as offered today, robs the individual of choice. He argues insurers must pay for protection against catastrophic costs of treatment against too many types of diseases, occurrences, and behaviors that society frowns upon.

While Szasz is sure any reasonable person would wish to bear the costs of protecting themselves against the onslaught of cancer or the accidental loss of a limb, he asserts many of us would decline protection against “voluntary, goal-directed behavior.” Szasz includes activities/conditions such as smoking and obesity in this latter category. He also includes depression and various other forms of mental illness.

Szasz allows that society mandating a person’s protection from all possible harms that might befall them is “a fine religious sentiment and moral ideal.” However, he insists, “As political and economic policy, it is vainglorious delusion.”

As an example, he points to auto insurance, in which an individual driver can achieve a lower premium, if desired, by limiting coverage of the possible types of injuries to their car well as the dollar extent of that coverage. “People who seek the services of auto mechanics want car repair, not “auto care,” maintains Szasz.

His example would probably have more traction if made in an antediluvian time when automobiles were little more than simple internal combustion engines covered by steel shells. In those days, any man with basic intelligence, decent hand coordination, and some simple tools might well keep the family car running smoothly, despite normal wear and tear as well as small, unexpected problems.

The modern car, by contrast, is a complicated, interrelated set of computer-driven electronic, hydraulic, and mechanical systems that are beyond the average person’s acumen and wallet to fix quickly, cheaply, and easily. What is more, many people lack the time and interest to perform their own maintenance. The concept of more comprehensive, albeit more expensive, “auto care,” of the sort that Szasz is so quick to deride, is fast on the rise to becoming, if it has not already become, the norm for most of us.

When we take a chance on car insurance and lose, it may be economically difficult for us to shoulder the burden but the stakes are very different where health insurance is concerned. A human being is not something that we can junk quite so easily.

Szasz has a ready answer to this as well. We make a mistake, he warns, in seeking universal healthcare that provides “the same low quality health care to everyone.” Yet he also admits that providing good healthcare to all is not only cost-prohibitive but also impracticable because “Not all doctors are equally good physicians and not all sick persons are equally good patients.” We must learn to accept that life is unfair.

Szasz concedes the affluent generally are healthier but not only because they can afford better/more healthcare. They are also smarter about taking care of themselves. The answer then, in Szasz’s view, is “educational . . . advancement for everyone.” Yet this is exactly the goal of “well care” and other types of healthcare programs that Szasz dismisses as unnecessary and burdensome mandates.

Presumably, it is the mandate part and not the goal of such programs to which Szasz objects. He quotes Henry David Thoreau – “If I knew for a certainty that a man was coming to my house with the conscious design of doing me good, I should run for my life.” – and concludes from him that government intervention is contrary to our native Yankee sensibilities.

Yet in his famous work, Civil Disobedience, Thoreau states, “I ask for, not at once no government, but at once a better government.” And he sets forth his famous dictum, “That government is best which governs not at all” as an aspiration that he believes will be achieved only “when men are prepared for it.”

Szasz, on the other hand, seems very much bought into the bromide that people should strive for continual self-improvement. Yet he shares the curious conservative revulsion of any attempt by them to do so collectively.

Moreover, while Thoreau would undoubtedly agree with Szasz so far as automobiles are concerned, much like any other tool or possession, it seems less likely he would be quite so cavalier on the subject of human health. This is the writer, after all, who proclaimed, “Every man is the builder of a temple called his body,” as well as, “I stand in awe of my body,” and “What is called genius is the abundance of life and health.”

Thoreau maintained a healthy skepticism of government but this did not mean he thought it immoral for one man or society to express concern for the well-being of another, even if he dreaded such occasional intrusiveness in his own solitude. “Every creature is better alive than dead . . . and he who understands it aright will rather preserve its life than destroy it.” Thoreau further understood that quality of life was often just as important as being alive. “To affect the quality of the day, that is the highest of arts.”

Even as an economic tradeoff, Thoreau has a rebuttal to Szasz regarding healthcare. “The cost of a thing is the amount of life which is required to be exchanged for it, immediately or in the long run.” It is easy to confuse the price of a thing today with its true value for the future, a confusion many in Congress are experiencing right now with regard to the affordability of universal healthcare.

Doctor Szasz is a psychiatrist and writer, among whose book is The Myth of Mental Illness. The need for universal healthcare in this country is no myth. The myth lies with the idea that such coverage is somehow inconsistent with the principles of democracy, egalitarianism, or even economy.

In the end, Szasz’s arguments all boil down to the same selfish precept so often made against universal healthcare – it is better for millions of individuals to remain without any coverage than for a single individual with coverage to experience decreased quality. The luxurious aspects of many private plans are now ingrained as necessities for too many of us. “Simplicity, simplicity, simplicity!” exhorts Thoreau. “Most of the luxuries and many of the so-called comforts of life are not only not indispensable but positive hindrances to the elevation of mankind.”

This seems a classic case of “Physician, heal thyself!” Or, to express it in terms with which Doctor Szasz can better relate – He is in desperate need of a tune-up, regardless of whether he realizes it and/or is willing to pay for it.

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