A Question of Character

Jacob Weisberg, in a recent Newsweek opinion essay, writes that "health-care systems are not just policy choices, but expressions of national character and values." If Weisberg is on target, as I think he is, then what kind of national character and values would our present health care system imply—assuming for a moment that our hodgepodge collection of procedures constitutes a system? I would suggest that our present, unreformed system implies the following:

1) We are more concerned about whether relatively affluent people can get the very best care as quickly as possible than whether less affluent people can get any care at all. We are very willing to live with stark inequality.

2) We are determined to look at health care as a collection of profit-making businesses, even though it is ever more clear that health care does not fit the standard business model and that providing health care as if there were a competitive marketplace for such services keeps driving prices higher and higher. We are very fearful of more cooperative and inclusive solutions, which are demonized as socialism.

3) We are in love with technology, the newer and more sophisticated the better. We believe that technology—not compassion, personal care, or finding lower-cost alternatives—is the solution.

4) We link health care to employment. This link may have been created almost by accident during the WWII era, but it fits strangely well with our history. The old pilgrim rule that "the one who doesn't work, doesn't eat" applies to health care as well. There is an unmistakable streak of judgment in our rationing of health care. What's worse, even those who work may still not get care.

5) We apparently do not believe that health care is a right, but rather a privilege for those who deserve it because of their station in life.

I may be overgeneralizing, but these are not far-fetched claims. They are also not very admirable characteristics. But all of this is now being challenged. The president claims that this overly selfish, profit-oriented, divisive system does not represent the real American character, does not reflect our true selves. I pray that he is right.

Apart from economic issues, which are important and challenging, and political issues, which are difficult and often nasty, health care clearly has a moral dimension. In Ted Kennedy's moving last letter to Obama, he lays out the case "that what we face is above all a moral issue; that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country."

What kind of a people are we? Are we compassionate or selfish? Do we seek justice or only self-interest? Will we care for all the people or just our particular tribe? Do only the few enjoy the huge wealth of our land, or the whole people? These are the questions of character to be answered in the next two or three months. I deeply hope that we will hear the call of what Lincoln called "the better angels of our nature" and discover a new sense of national community and caring. In the current president's words, "That is our calling. That is our character."