September 29 2017
Greater Good

The Case for Compassion

Americans never fail to be swept by a collective moral imperative to help people when disaster strikes.  There is some genuine compassion at the core of who we are as a nation. After a hurricane (or at least a hurricane on the mainland), our government mobilizes to make massive federal funds available to help remove people from danger and to rebuild their lives.  On top of this, everyday Americans open their wallets and donate millions of dollars to help those in need.

But for some reason, we do not have the same moral imperative when it comes to a different kind disaster that strikes people every day.  One that is no less deadly: illness. And without health insurance, a cancer diagnosis is a category 5 fuckstorm.

I’ll leave it to others to argue about how to pay for healthcare, as well as legitimate arguments about what we, as a country, might have to sacrifice for every man, woman and child to get the medical attention they require.  But the point I won’t concede: human decency means that in the richest nation on earth, we do not allow people to die for lack of medical care.

And yet, we do.

I don’t want to hear “we don’t let people die on the streets, we have emergency rooms.”   Until you can start getting chemotherapy in the emergency room, let’s lay this disingenuous argument to rest.

My dad is a super republican.  He is one of the “35%.”  He has always been conservative but I have always respected his pragmatic East Coast interpretation of republican dogma.  (NY values!) He never spewed talking points. His arguments always were about the story underneath the things politicians said in public, and always far more sophisticated.  So I didn’t agree, but I respected him. Unfortunately, much of that independent thinking is gone, now that FOX News has taken hold of him in his elderly years. As a younger man and father of three girls, he wouldn’t so easily have gotten past the pussy grabbing comment.  And definitely not the toddler-esque geopolitical ignorance.

But you still won’t find a more honest republican than my dad, when it comes to healthcare.  “The only way to bring medical costs down is to deny people access and to reduce usage of services,” he tells me.  Having worked at a health insurance company his entire career, he understands better than most.

And there it is. The truth from an honest republican and an honest ex-health industry executive that I love with all my heart: you bring down costs for the people who have coverage by denying others, especially old or sick people who are expensive. They do raise costs for all of us. So you kick some of these Americans to the curb, oh say 30 million or so, and viola!  Cheaper health insurance for you and me. The plan is as elegant in its simplicity as it is bestial in its brutality. My dad will say it, but, understandably, people hoping to get elected are rather loath to. They tend to say other things instead.

But once you get to this place of bare naked honesty, you can decide if, like my father, you can stomach sacrificing one group of people for another. Or, if you think, rather, that it is immoral to allow some people – young, old – yes, this includes innocent children – to be denied medical treatment when they are ill, and doom them to suffer.  And then to perish.

There are legitimate philosophical arguments about how to approach the cost of healthcare – single payer, medicare buy in, health savings accounts, empowering consumers, blah, blah, blah.  But there is only one argument that really matters:  should people in the richest nation on earth guarantee access to medical treatment, even to poor and sick people?

The thing about those who say that, no, we do not owe anything to those unfortunate people, is that there tends to be a deep down bias guiding this belief.

Why do we owe anything to the people of Houston after a hurricane? Why is hurricane relief a right, not a privilege? Why did my dad deserve a 5 figure check from FEMA after Sandy?

There was a great article recently in New York Magazine that asked this question. Why do some Americans feel it is necessary to help people who have suffered a spectacularly cinematic disaster, but not those suffering the less telegenic catastrophe of, say, getting cancer.

Is it because those people in Houston look like you?  Maybe you know someone living there? You can see their suffering and imagine how you would feel, if it were you?  Congratulations. That’s empathy.

Where we get into trouble is that, it’s harder to empathize with someone you can’t relate to.  If you’re not poor, poverty can be an abstraction.  Same with the rural white poor in relation to the urban black poor. They are different from you. You are poor because the factory closed. They are poor because they are lazy and have no values.

This phenomenon takes many forms.

Our country weeps with Paris and London when there is a terrorist attack. We see ourselves in their devastating news photos.  Their values are our values. But slaughter in Yemen?  Who are those people?  Their culture is backward, their religion is cruel to women, their government is an abomination. What do you think is going to happen when you can’t make a good country? Yemen is like the drunk driver wrapping himself around a telephone pole – no sorrow to waste on that guy, and his self-inflicted demise, right?

I am guilty of this thinking too!  It makes the human suffering seem less relevant.  The compassion doesn’t quite flow the way it does for cultures we can relate to. This is human nature, for better or worse. It is simply easier to empathize with people who are more like us, or that we know.  Think of the many politicians who had extremely belligerent views toward homosexuality and gay marriage.  Until their brother’s son came out.

If my husband and I both lost our jobs, lost our health insurance and had no access to a healthcare exchange, we would suffer. And this suffering would lead my dad to have some different ideas about how reducing access to medical care is a net positive for the greater good.  I can guarantee it.

Even though our biases muddy things up, human suffering is human suffering. If we owe it to our citizens to protect them from a hurricane or a terrorist attack, why do we not also owe it to them to protect them from an attack on their health, which is just as existential a threat?

I love my dad.  I love all my fellow Americans.  I was heartened to see the groundswell of activism that drew people into their senators’ office hallways during the healthcare fights.  Democratic politicians applauded the activists and there were lots of refrains of “you did this!” and congratulations all around about the power of the people.

But the truth is not as rosy.  Even though people protested in all 50 states, and even though only 20% of Americans supported their bill, only two or three republican senators heeded the pleas for mercy. The vast majority were not moved by the activism.  This alarms me.  Republican healthcare legislation will come up again. Once more, Americans around the country will have to call their elected officials daily, beg, plead and share their most intimate personal health details to explain what is at stake.

John McCain is on the verge of extinction.  What if he is not there next time to stand in between 30 million people and the doomed wasteland of the uninsured?

Though I have health insurance and my children are healthy, I worry away over the thought of this.  It breaks my heart to think that so many people dangle over this man-made abyss, even in a country so rich.  A country that has the capacity to show such compassion.  When it chooses to.

 

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  • Thank you for this. People never break the healthcare debate down like this. It is always framed as Obamacare vs. some other system. It is not framed as healthcare as a right vs. healthcare as a privilege. We need to learn compassion as a nation. We need to learn to empathize with people that we’ve never met. We need more people talking about this.

    “After a hurricane (or at least a hurricane on the mainland)” This was a gut punch. It is crazy how little prep work was done before the hurricane in Puerto Rico even though we knew that the results could be this devastating. And there is nowhere near the rush to fix things as there was in Texas and Florida. Again – there’s a feeling of otherness, so we don’t care as much. It’s painful to see.

    • I just think even calling something a right as opposed to a privilege conceals the blood and guts of the matter. Are you ok with a child who has used up her lifetime medical cap by the time she is 4 dying because her parents can’t afford heart surgery when she is 5? Are you ok with a nursing home evicting an alzheimers patient once we decide that person no longer gets Medicaid? Are you ok with a mother of 3 dying of a treatable cancer because she can’t afford health insurance? If not, than you are for universal healthcare. Some people are obviously ok with this. For them it is zero sum. We cannot both survive. So I choose me. I would just like to see honesty about what we are really talking about. Sentencing our fellow Americans to certain death. How have people managed to whitewash this bombshell at the heart of the healthcare debate with words like “freedom”? It is all so painful. To see the ideas that are taking hold in our country. It is hard to stomach.

  • I have a feeling this comment is going to meander somewhat, Linda, as your post has triggered so many thoughts and emotions. First of all, regardless of my fiscally conservative nature ie. lower taxes, smaller government, less ‘programs’, I believe that the overwhelming pursuit of any society and it’s government MUST be the protection of it’s most vulnerable, full stop. The sick, the poor, the elderly.

    So if that means higher taxes (and it does), and more government spending, then I’m in full support, although I often am frustrated with how poorly those taxes are managed.

    As a Canadian, I am very thankful to live in a country that protects universal access to healthcare, yet I am keenly aware that our system isn’t without it’s flaws. UHC is held up as such a fundamental ‘right’ that the very notion of introducing limited privatization alongside the public system has often been considered political suicide. I think there are opportunities to create efficiencies with the aim of improving the availability of care for all, but out-of-the-box thinking isn’t something governments do all that well.

    I haven’t written much, anything actually, about what’s going on in your wonderful country right now, as I don’t really feel qualified to comment, but I will share this. I love America with all of my heart. If Canada is the best country in the world (I’m a tad biased :), America is the greatest, by all accounts. I have a lot of American family and many, many friends. I look at the current mess in Washington, it’s so very sad, but the nation and it’s people are SO much greater than a broken leader(ship), and will rise above it in due time.

    One thing I love about Americans is how honest and real they are. Collectively, there are no skeletons in the closet, it’s all out in the open for everyone to see. That means that things are not always pretty, but there’s always been a capability to reach the highest of heights.

    Sometimes it’s important to see the beauty in the broken.

    My apologies for being so long-winded. 🙂

    • I just have so much respect for Canada. I have also never met a Canadian person who wasn’t thoroughly reasonable. Thank you for your usual thoughtfulness MMM, for always having something meaningful and smart to add. This is the thing about liberal and conservative positions: does anyone believe that it is good to fund poorly managed, wasteful programs? Does anyone think that we should not help poor, sick elderly people? Is anyone not horrified when people, rich or poor take advantage of tax payer generosity? I think we all agree on a lot of things, in theory. It is the emotional, guttural stuff that tends to get in way, color our arguments and foster division. So yes, I am as liberal and progressive as a person can be. Yet when it comes to basic, fundamental human ideals, I have a feeling you and I probably agree on just about everything.

  • Hey, Linda. Love your passion, and your compassion. I don’t believe health care is a right. But I do believe there should be a safety net for those who are poor or for those who are uninsurable. So here’s my plan.

    1) 25% of the federal budget would be earmarked for healthcare subsidies.

    2) Healthcare subsidies, in the form of vouchers, would go to the poor and those who are uninsurable (i.e., the elderly and those with pre-existing conditions).

    3) The poor and uninsurable would be entitled to a “share” of the federal healthcare budget, not a particular amount or benefit. If more people become eligible for subsidies or if healthcare services become more expensive, the federal healthcare budget would remain the same. It wouldn’t grow. The value or purchasing power of individual healthcare vouchers would simply go down

    4) States would be free to augment federal healthcare subsidies at whatever level they deem necessary.

    5) Federal healthcare vouchers could be used to buy healthcare insurance or healthcare anywhere in the world. If Americans can get a better deal buy using their vouchers overseas, so be it. The purpose of healthcare subsidies is to get the poor and uninsurable healthcare. It’s not to enrich domestic hospitals and doctors.

    6) Price transparency. By law, doctors, pharmacies, and hospitals would be required to disclose what they will charge for their goods and services. Patients should know beforehand what their bills will be. The cost of healthcare shouldn’t be a mystery.

    7) No discrimination. Doctors, pharmacies, and hospital would no longer be able to charge a patient with health insurance X and a patient without health insurance 3X.

    Okay, Linda. There’s my warped plan. I don’t think healthcare is a right. But you, like many of my fellow Americans, do. And you’re not evil, stupid, or necessarily wrong. But here’s the rub. Healthcare may or may not be a right. But protection against involuntary servitude is a right. And I take that right very seriously. I refuse to be a slave to the military-industrial complex. And I refuse to be a slave to compassion-industrial complex (i.e., food stamps, Section 8 vouchers, public education, Medicaid, Medicare, Social Security, etc.). My plan strikes a healthy balance between the need to help the poor and uninsurable and the need to make sure freedom isn’t extinguished from this land.

    Let me know what you think when you get a chance, Linda. I always appreciate it when one of my favorite “commies” unearths a weakness in my reasoning. Cheers.

    • Oh Mr. G. I love you like I love my dad. You two would truly get along! I’m sure you have some good ideas for reigning in costs here, which is a very important aspect of the healthcare debate. But no argument will help me stomach letting my fellow Americans suffer and die for lack of medical care in the richest country in the world. If we can’t guarantee medical care, we should least legalize assisted suicide so that people who can’t have their illness treated can avoid pain and suffering. We do that for our dogs, so we should at least think of people in terms of what is humane and what is not.

      I promise you that the compassion-industrial complex is a much more decent crew than the military industrial complex. They are not perfect but their goal is to help people (not to make rich people richer at your expense), even if sometimes they are guilty of waste or poor execution. I’m not a bean counter or administrator or politician with a 5 point plan. I’m just a useless philosopher who thinks we should stop overthinking the implications of helping people that we may deem undeserving. Like giving a few bucks to the guy on the subway. Will it solve the homeless problem? No. Will he buy booze with it instead of food? Do I really care? Who am I to judge? I’d probably want to be drunk instead of full if that were my reality. If that wretched soul has one moment of relief from misery thanks to my $3, why think it through any further? Is there any harm in a small act of mercy?

      God forgive me, I see my tax money the same way. Every day the government takes your money and uses it to prop up mono-culture agriculture, disease-causing chemical polluters, oil companies and gun manufacturers. I would prefer it go to easing human suffering instead.

      My grandmother had alzheimers at a relatively young age and spent years in a nursing home. Once it bankrupted her, she needed medicaid. Same will probably happen to my mom. Probably same to me. No one can afford long term care in this country. To think that being in that nursing home is not the worst case scenario – that not being able to afford it is. Unbearable.

      Thanks for your always thoughtful point of view, Mr. G. I do understand that you don’t want to be overburdened. I know you and Mrs. G are good people. We just respectfully disagree on this one.

  • Hey, Linda. I tried to respond to your reply by hitting the reply link but it didn’t work. Anyway, your reply was beautiful. I love doing intellectual battle with you–even though I always lose.

    P.S. Your dad sounds like a great guy. The next time I’m up in New York, I’ll have to grab you for an episode of Talking Trash and him for some grappa and pinochle.

  • Hey Linda, I’m coming to this party a couple of weeks later, and healthcare is still in the news today. Not in a good way for those of us without employer-sponsored insurance.
    I wonder when the concept of American Greatness lost its idea of sacrificing for the greater good of the community and became something inherently about “me and mine.” Admittedly, our reality never matched our rhetoric, but now even our politicians give little notice to the idea that American greatness requires us all to pull together, compromise, and not gleefully take away from the vulnerable. Our country is indeed missing compassion, community and civility, and I’d love to get it back.

    • Oh Emily, well said. Mean spirited selfishness has become a strange badge of honor somehow. I will never understand it. All I can do is try to teach my children that that there is more to life.

    • Oh you’re the best, Mr. G. Work is such a bitch and I have been so overwhelmed. I am so jealous of all you retirees! Plus I’m not very good at those smaller no-missives-here topics. I am stopping myself from writing about women and men and how men are terrified about having a woman as president, even though it is clearly women who have far greater cause to be terrified of men. But everyone will hate me, so I’m shutting up instead!

    1. Mr. Groovy 10:20am 23 October - 2017 - Reply

      Hey, Linda! What’s up? I’m dying for another post. I’m nothing without my weekly ration of Brooklyn Bread.

      • Brooklyn Bread 11:56am 23 October - 2017 - Reply

        Oh you’re the best, Mr. G. Work is such a bitch and I have been so overwhelmed. I am so jealous of all you retirees! Plus I’m not very good at those smaller no-missives-here topics. I am stopping myself from writing about women and men and how men are terrified about having a woman as president, even though it is clearly women who have far greater cause to be terrified of men. But everyone will hate me, so I’m shutting up instead!

    2. Emily @ JohnJaneDoe 10:39am 13 October - 2017 - Reply

      Hey Linda, I’m coming to this party a couple of weeks later, and healthcare is still in the news today. Not in a good way for those of us without employer-sponsored insurance.
      I wonder when the concept of American Greatness lost its idea of sacrificing for the greater good of the community and became something inherently about “me and mine.” Admittedly, our reality never matched our rhetoric, but now even our politicians give little notice to the idea that American greatness requires us all to pull together, compromise, and not gleefully take away from the vulnerable. Our country is indeed missing compassion, community and civility, and I’d love to get it back.

      • Brooklyn Bread 12:20pm 17 October - 2017 - Reply

        Oh Emily, well said. Mean spirited selfishness has become a strange badge of honor somehow. I will never understand it. All I can do is try to teach my children that that there is more to life.

    3. Mr. Groovy 08:03am 04 October - 2017 - Reply

      Hey, Linda. I tried to respond to your reply by hitting the reply link but it didn’t work. Anyway, your reply was beautiful. I love doing intellectual battle with you–even though I always lose.

      P.S. Your dad sounds like a great guy. The next time I’m up in New York, I’ll have to grab you for an episode of Talking Trash and him for some grappa and pinochle.

    4. Mr. Groovy 05:54pm 03 October - 2017 - Reply

      Hey, Linda. Love your passion, and your compassion. I don’t believe health care is a right. But I do believe there should be a safety net for those who are poor or for those who are uninsurable. So here’s my plan.

      1) 25% of the federal budget would be earmarked for healthcare subsidies.

      2) Healthcare subsidies, in the form of vouchers, would go to the poor and those who are uninsurable (i.e., the elderly and those with pre-existing conditions).

      3) The poor and uninsurable would be entitled to a “share” of the federal healthcare budget, not a particular amount or benefit. If more people become eligible for subsidies or if healthcare services become more expensive, the federal healthcare budget would remain the same. It wouldn’t grow. The value or purchasing power of individual healthcare vouchers would simply go down

      4) States would be free to augment federal healthcare subsidies at whatever level they deem necessary.

      5) Federal healthcare vouchers could be used to buy healthcare insurance or healthcare anywhere in the world. If Americans can get a better deal buy using their vouchers overseas, so be it. The purpose of healthcare subsidies is to get the poor and uninsurable healthcare. It’s not to enrich domestic hospitals and doctors.

      6) Price transparency. By law, doctors, pharmacies, and hospitals would be required to disclose what they will charge for their goods and services. Patients should know beforehand what their bills will be. The cost of healthcare shouldn’t be a mystery.

      7) No discrimination. Doctors, pharmacies, and hospital would no longer be able to charge a patient with health insurance X and a patient without health insurance 3X.

      Okay, Linda. There’s my warped plan. I don’t think healthcare is a right. But you, like many of my fellow Americans, do. And you’re not evil, stupid, or necessarily wrong. But here’s the rub. Healthcare may or may not be a right. But protection against involuntary servitude is a right. And I take that right very seriously. I refuse to be a slave to the military-industrial complex. And I refuse to be a slave to compassion-industrial complex (i.e., food stamps, Section 8 vouchers, public education, Medicaid, Medicare, Social Security, etc.). My plan strikes a healthy balance between the need to help the poor and uninsurable and the need to make sure freedom isn’t extinguished from this land.

      Let me know what you think when you get a chance, Linda. I always appreciate it when one of my favorite “commies” unearths a weakness in my reasoning. Cheers.

      • Brooklyn Bread 09:02pm 03 October - 2017 - Reply

        Oh Mr. G. I love you like I love my dad. You two would truly get along! I’m sure you have some good ideas for reigning in costs here, which is a very important aspect of the healthcare debate. But no argument will help me stomach letting my fellow Americans suffer and die for lack of medical care in the richest country in the world. If we can’t guarantee medical care, we should least legalize assisted suicide so that people who can’t have their illness treated can avoid pain and suffering. We do that for our dogs, so we should at least think of people in terms of what is humane and what is not.

        I promise you that the compassion-industrial complex is a much more decent crew than the military industrial complex. They are not perfect but their goal is to help people (not to make rich people richer at your expense), even if sometimes they are guilty of waste or poor execution. I’m not a bean counter or administrator or politician with a 5 point plan. I’m just a useless philosopher who thinks we should stop overthinking the implications of helping people that we may deem undeserving. Like giving a few bucks to the guy on the subway. Will it solve the homeless problem? No. Will he buy booze with it instead of food? Do I really care? Who am I to judge? I’d probably want to be drunk instead of full if that were my reality. If that wretched soul has one moment of relief from misery thanks to my $3, why think it through any further? Is there any harm in a small act of mercy?

        God forgive me, I see my tax money the same way. Every day the government takes your money and uses it to prop up mono-culture agriculture, disease-causing chemical polluters, oil companies and gun manufacturers. I would prefer it go to easing human suffering instead.

        My grandmother had alzheimers at a relatively young age and spent years in a nursing home. Once it bankrupted her, she needed medicaid. Same will probably happen to my mom. Probably same to me. No one can afford long term care in this country. To think that being in that nursing home is not the worst case scenario – that not being able to afford it is. Unbearable.

        Thanks for your always thoughtful point of view, Mr. G. I do understand that you don’t want to be overburdened. I know you and Mrs. G are good people. We just respectfully disagree on this one.

    5. Mystery Money Man 01:07am 30 September - 2017 - Reply

      I have a feeling this comment is going to meander somewhat, Linda, as your post has triggered so many thoughts and emotions. First of all, regardless of my fiscally conservative nature ie. lower taxes, smaller government, less ‘programs’, I believe that the overwhelming pursuit of any society and it’s government MUST be the protection of it’s most vulnerable, full stop. The sick, the poor, the elderly.

      So if that means higher taxes (and it does), and more government spending, then I’m in full support, although I often am frustrated with how poorly those taxes are managed.

      As a Canadian, I am very thankful to live in a country that protects universal access to healthcare, yet I am keenly aware that our system isn’t without it’s flaws. UHC is held up as such a fundamental ‘right’ that the very notion of introducing limited privatization alongside the public system has often been considered political suicide. I think there are opportunities to create efficiencies with the aim of improving the availability of care for all, but out-of-the-box thinking isn’t something governments do all that well.

      I haven’t written much, anything actually, about what’s going on in your wonderful country right now, as I don’t really feel qualified to comment, but I will share this. I love America with all of my heart. If Canada is the best country in the world (I’m a tad biased :), America is the greatest, by all accounts. I have a lot of American family and many, many friends. I look at the current mess in Washington, it’s so very sad, but the nation and it’s people are SO much greater than a broken leader(ship), and will rise above it in due time.

      One thing I love about Americans is how honest and real they are. Collectively, there are no skeletons in the closet, it’s all out in the open for everyone to see. That means that things are not always pretty, but there’s always been a capability to reach the highest of heights.

      Sometimes it’s important to see the beauty in the broken.

      My apologies for being so long-winded. 🙂

      • Brooklyn Bread 10:26am 30 September - 2017 - Reply

        I just have so much respect for Canada. I have also never met a Canadian person who wasn’t thoroughly reasonable. Thank you for your usual thoughtfulness MMM, for always having something meaningful and smart to add. This is the thing about liberal and conservative positions: does anyone believe that it is good to fund poorly managed, wasteful programs? Does anyone think that we should not help poor, sick elderly people? Is anyone not horrified when people, rich or poor take advantage of tax payer generosity? I think we all agree on a lot of things, in theory. It is the emotional, guttural stuff that tends to get in way, color our arguments and foster division. So yes, I am as liberal and progressive as a person can be. Yet when it comes to basic, fundamental human ideals, I have a feeling you and I probably agree on just about everything.

    6. Matt @ Optimize Your Life 08:21pm 29 September - 2017 - Reply

      Thank you for this. People never break the healthcare debate down like this. It is always framed as Obamacare vs. some other system. It is not framed as healthcare as a right vs. healthcare as a privilege. We need to learn compassion as a nation. We need to learn to empathize with people that we’ve never met. We need more people talking about this.

      “After a hurricane (or at least a hurricane on the mainland)” This was a gut punch. It is crazy how little prep work was done before the hurricane in Puerto Rico even though we knew that the results could be this devastating. And there is nowhere near the rush to fix things as there was in Texas and Florida. Again – there’s a feeling of otherness, so we don’t care as much. It’s painful to see.

      • Brooklyn Bread 10:35am 30 September - 2017 - Reply

        I just think even calling something a right as opposed to a privilege conceals the blood and guts of the matter. Are you ok with a child who has used up her lifetime medical cap by the time she is 4 dying because her parents can’t afford heart surgery when she is 5? Are you ok with a nursing home evicting an alzheimers patient once we decide that person no longer gets Medicaid? Are you ok with a mother of 3 dying of a treatable cancer because she can’t afford health insurance? If not, than you are for universal healthcare. Some people are obviously ok with this. For them it is zero sum. We cannot both survive. So I choose me. I would just like to see honesty about what we are really talking about. Sentencing our fellow Americans to certain death. How have people managed to whitewash this bombshell at the heart of the healthcare debate with words like “freedom”? It is all so painful. To see the ideas that are taking hold in our country. It is hard to stomach.

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