Friday, August 14, 2009
I have been a little bit reluctant to directly link the current health care debates going on in the U.S. to Buddhist teachings, but feel compelled to so following an article in yesterday's Wall Street Journal by Whole Foods CEO John Mackey Whole Foods Solution . The following post will address some of the issues I see with the approach outlined by Mr. Mackey, and also consider how spiritual practice might impact how one sees these issues.
First, my own story. I work at a small non-profit that cannot, due to funding, afford to give us health coverage. I have long been passionate about my work, teaching English as a Second Language, and feel strongly that it's been a good line of work for me. However, not only does my employer not cover me, but I can't afford to purchase a plan that doesn't also have a 5-10 thousand dollar deductible. More than once, I've been told "move on, get another job." And I am looking, but this brings up the larger issue of telling people to leave careers they are passionate about, or even which are “good enough” because of something like lack of health care coverage. It's kind of a stupid set up if you ask me. I have watched many talented teachers leave the adult basic education system I work in because of low pay and no benefits. And this isn't just our system's issue; people are losing their benefits, or getting much weaker plans, on a daily basis.
So, I support a single payer system. I don't believe that a government run system is a perfect answer because there are no perfect answers. I imagine my readers from Canada, England, and other places might have a few words to say about government health systems. But as far as our own goes , I truly believe it is driven by greed and profit margins, and that too many in the U.S. have forgotten that medicine isn't about making money, but about caring for people and reducing suffering. What I keep coming back is the question “What is most effect way to address the individual and collective dukkha in our society around health and health care?” And the answer that keeps coming back is single payer.
Now, to the Wall Street Journal article. John Mackey's position is fiercely in defense of "free market" system health care. The way he writes about it is exactly why I believe we are in trouble here in the U.S. Let's take a look at some of his lines.
1. "While we clearly need health-care reform, the last thing our country needs is a massive new health-care entitlement that will create hundreds of billions of dollars of new unfunded deficits and move us much closer to a government takeover of our health-care system."
When did health care become an "entitlement"? I just don't understand how we have gotten to the point where people can say something like this with a straight face. Here you have a rich, white male, who has assets in the hundreds of millions of dollars, who most likely lives in a gated community, and who has people in his company who do all of the “menial” and “lesser” work for him – and he’s speaking about entitlements. It’s laughable.
Here’s a few things for us in the Buddhist communities to think about. It’s definitely true that everything is impermanent, including our health. That we shouldn’t cling to anything, including our body, believing it will last, because it won’t. But isn’t it also true that we have teaching after teaching speaking about how this human body is a vehicle to enlightenment and that we better “take heed, and make use of this precious life!” And beyond this, what about the emphasis on generosity, and not being stingy? Obviously John Mackey is probably not a Buddhist, but I’m not about to think that all Buddhists disagree with his position, because I’m pretty sure he has some supporters among us out there. So, the question is “How is basic health care for all people ‘an entitlement’, and how does that square with Buddha’s teachings?” I think even if you disagree with Mackey, but support any form of health care system that leaves out large numbers of people – as the current one does – this question is for you.
2. The government should "Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs)."
Mackey argues that high-deductible plans are one of the wonder-drug answers to the health care problem. And sure, they're great for large companies because they cost the company less, but what about the individual who is supposedly covered? As if poor people, or even a lot of middle class people, have an extra couple thousand of dollar tucked away to pay for a medical exams, a broken arm, or even a handful of regular visits and follow-up visits. I paid nearly $200 for a ten minute exam at a low-income clinic four years ago, because my meager salary was over the federal “poverty” guidelines. That was just for the visit, with no exams, no medications, no nothing added. Mackey writes in a way that suggests Whole Foods is compassionate because they offer these crappy health insurance plans, and then give their employees some money to cover some of those costs they might incur.
What I don't understand from a business stand point is how all this red tape - having to set up HSAs, and having someone keep track of all the paperwork involved, is such a cost-effective solution for big business. Many of these companies have huge departments full of people whose main jobs are to deal with insurance claims, coverage for employees, and all the paperwork under the sun. How is that cost effective? Is it that they are so blinded by their belief in the power of the markets that they can't see how, in this case, they are being drained economically? Of course, for every CEO like Mackey, there is another one who sees this very thing, and decides to do away with health insurance for some employees all together. Or simply eliminates half the jobs in the company under the guise of “restructuring.” We have a serious compassion-deficit in corporate America, regardless of what people believe is the best way to address the current health care crisis.
3. "Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying."
This strikes me as a great way to increase the number of denials for coverage from the already denial-happy insurance industry. Let's face it: they love saying no because it increases their profit margin. And eliminating regulations that mandate certain issues and procedures be covered will only make it easier for these companies to throw ethics out the window in the name of the bottom line.
4. "Many promoters of health-care reform believe that people have an intrinsic ethical right to health care—to equal access to doctors, medicines and hospitals. While all of us empathize with those who are sick, how can we say that all people have more of an intrinsic right to health care than they have to food or shelter?
Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges. A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter. That's because there isn't any. This "right" has never existed in America."
Ah, the good old Constitutional argument. I guess while we’re at it, let’s go back to the days of slavery, the days when women and people of color could not vote, the days when Senators were chosen by the state government and not elected by the people. Whenever someone uses the "It's not in the Constitution argument," we should all pause.
Let's go further with the above statements, especially the line about no intrinsic right to health care, food or shelter. This is the end point of free-market capitalism - you toss the suffering of others to the wind. You say that they are personally responsible for their problems, for their lack of health care or food or whatever, and you deny that there is such a thing as collective responsibility. In other words, as Buddha might say, "You believe way too much in a solid, separate self."
5. "Even in countries like Canada and the U.K., there is no intrinsic right to health care. Rather, citizens in these countries are told by government bureaucrats what health-care treatments they are eligible to receive and when they can receive them. All countries with socialized medicine ration health care by forcing their citizens to wait in lines to receive scarce treatments."
This is the classic fear tactic being pummeled into the minds of Americans again in the drive to demonize any alternative to the privatized system we currently have. Never mind that people are routinely denied coverage for treatments deemed "unnecessary" by private insurers. Never mind that people are routinely denied the option of choosing doctors "out of network" by their insurers. Never mind that there are plenty of waiting lines for non-emergency procedures under the current system, run by these same private insurers. There is no such thing as complete freedom of choice, regardless of the system. And in terms of choice, I'd argue that in many cases, we living under the privatized U.S. system actually have less choice. As for the scarcity argument, it can't get any scarcer for me than the no access until I'm falling apart that I have now.
6. "Unfortunately many of our health-care problems are self-inflicted: two-thirds of Americans are now overweight and one-third are obese. Most of the diseases that kill us and account for about 70% of all health-care spending—heart disease, cancer, stroke, diabetes and obesity—are mostly preventable through proper diet, exercise, not smoking, minimal alcohol consumption and other healthy lifestyle choices."
Now, I agree that taking care of yourself, including making wise eating decisions and exercising, are beneficial to one's health. And that some people's decisions definitely have a negative impact on their health. I'm not going to argue against that.
But the above position is a privileged one, made by someone who:
a)probably lives nowhere near a toxic waste dump, commercially poisoned water supply, waste treatment facility, or nuclear power plant - all of which seriously impact people's health, regardless of what the do personally. People of color and poor whites generally face the brunt of these issues because they lack the resources to move elsewhere, and struggle to get their voices heard by decision makers who could change the situation.
b)has the economic resources to pay for healthy food at all times. Many people, especially poor people, live in areas where there are simply no grocery stores at all, or only grocery stores that sell low grade, highly processed foods. These same people, if given the opportunity to purchase high grade, healthy food often don't have the economic resources to do so. Farmer's markets, community gardens, and home gardens help to some degree, but aren't sufficient answers to the problem of obtaining quality foods, especially in northern climates, where the growing season is much shorter.
c. has access to preventative care, which can help stem problems like obesity and high blood pressure at a much early stage. This is not to say that those of us who are uninsured or under-insured can't learn to eat and behave healthier - we can. However, as a group, we often have less free time, and have to work more just to make ends meet, and thus have less time to research healthy solutions, or get help adjusting our lifestyles to better support our health. A lot of people forget that regular access to the internet is, itself, still a privilege not shared by many of those on the bottom end of the economic scale.
Frankly, personal responsibility only goes so far, no matter what one does. And using personal responsibility as an argument against something is often a smoke screen for something much less polite sounding: it's your problem, don't ask me to help you with your problem. It's not a very generous way to live, or to run a society. In addition, it weakens the ability to effectively use that argument when it's called for. Sometimes people do need to "take personal responsibility," but when it's applied to everything over and over again, the meaning gets diminished, and people either tune out, or follow blindly.
7. "Whatever reforms are enacted it is essential that they be financially responsible, and that we have the freedom to choose doctors and the health-care services that best suit our own unique set of lifestyle choices."
As far as I'm concerned, the best of the various options to fulfill this call is single payer. It eliminates the middle man (private insurers) and all the costs associated with their bureaucracy. It allows more freedom of choice in terms of doctors. And it extends these opportunities to all of us, not just those who have the financial resources and/or good fortune to have employers who offer coverage.
Beyond this, I personally feel that covering basic health care for everyone is most in line with Buddha's teachings. Maybe I'm wrong; maybe I'm a deluded treehugger or whatever. But those of you out in the Buddhist world who disagree with me, please tell what system you think might best address these issues, and also tell me how your spiritual practice aided you in coming to that decision.
If you haven't guessed already, I'm of the firm belief that if our spiritual practices don't aid us in how we approach the social issues of the day, they aren't really getting at the marrow of this life. This doesn't mean we all must become activists, or that monks living in seclusion aren't "doing the practice." But it does mean that our spiritual lives should lead us to care more about others, to pay more attention to issues that effect us collective, and to do what we can to lessen suffering and increase joy.
Posted by Nathan at 1:33 PM