Healthcare

 

Part 1: The Frontier

As we contemplate change in the United States, especially radical social reform movements like the idea of national health care, we must always consider our analysis of the issue in terms of how this nation was founded. America was founded, and its essential character built, during the time of the frontier.

The “frontier” is both a geographical and philosophical term. For the purposes of this essay, the best use of the term frontier is philosophical in nature, as the term itself in this context helps define, to a large degree, the essential ethos of this nation. Without understanding, or assessing the possibility of any level of social reform with this important tenet in mind, we will miss the opportunity to fully explore meaningful alternatives with social reform, whether they are health care related, or otherwise.

America’s early settlers became aware of the potential awaiting them in the part of the new world beyond the eastern coastal settlements and viewed it as a frontier. In this case, the frontier is a geographical term; however, it became clear rather quickly that the frontier itself became more of a “state of mind” - a means of conquering the unknown and of establishing roots. A migration westward to the unknown frontier began for many colonists from different backgrounds, leaving many of the Old World customs and traditions behind. Seeking a new life and unending possibilities to earn a living and to forge new settlements drew adventurous people from the east coast, where they initially settled in colonial America, to the west and to the unknown. Each mile further west offered new adventures, hazards and hardships. More importantly, the journey west promised unending possibilities to reinvent one self and pursue economic gain.

People on the journey viewed this frontier as terra incognita because everything before them was unknown and presented a number of challenges, including harsh climate, unfamiliar wildlife, difficult terrain and, most especially, Native American Indians. The Native Americans were indigenous to the land, giving them an advantage over the settlers. Their knowledge of the land, food sources, and hazards made them a most formidable obstacle to the people pushing westward, impeding the settler’s pursuit of wealth and prosperity.

As settlers moved further west the terminus of the western frontier changed with California and the Pacific Ocean being the natural goal. The vast majority of California was uninhabited but its abundant natural resources, available land and opportunities for settlement were extremely enticing to many people. The promise of a new way of life and boundless riches made it a natural destination for many of these adventurous folks. The pursuit of that elusive dream proved perilous and in many instances the challenges described above prevented many from reaching their ultimate goal, determining for a time where the frontier began and ended.

The Declaration of Independence served as the stimulus for defining and encouraging exploration of the frontier in America. No longer subject to British rule and the Crown’s laws and taxes, adventurous individuals sought out the unknown, pursuing a better life and independence. That sense of individualism became very important in the American psyche notwithstanding the fact that the British continued to meddle in the affairs of the new nation, for there were political “frontiers” still being defined by the Crown.

The War of 1812 ended with the Americans truly feeling as if they could definitely survive without British rule. The newfound American passion to remain free and independent was the basis for individualism. This sense of individuality helped give rise to democracy, as well as the main economic system in the United States: capitalism.

As this newly defined frontier became more inhabited, the settlers defined democracy for themselves. Individualism was incorporated as expected but the settlers learned to cooperate with one another in both activities and pursuits, recognizing the need to rely on one another for assistance to make their settlements stronger and more prosperous. Building on the cooperation forged when they first set out, they traveled in large numbers to protect themselves from the indigenous Native Americans and disease. Despite the fact that the settlers came from various colonies and backgrounds they cooperated in building new homes, towns and cities. Mainly making do with what they had as individuals, harsh conditions necessitated cooperation and assistance from others to ensure success in their endeavors. While capitalism was the basic economic principle, an economy founded solely on the notion of profit for profit’s sake, it is interesting to note the relatively magnanimous behavior of the early settlers.

Is this level of cooperation and behavior evident in today’s society?

The concept of individualism undergoes a renaissance in the nineteenth century. During the 18th century America possessed an abundance of land and natural resources, which the government distributed liberally. The Preemption Act of 1841 allowed individuals to purchase the land they already occupied for a relatively small price per acre. The Homestead Act of 1862 enabled individuals to obtain a title to the land by paying another small fee and establishing the claim by occupying the land for five years. Due to these enacted laws, people obviously had opportunities to exercise their individuality simply because Congress sold them the land and it was their responsibility to farm it and maintain it. People learned to cope more and more on their own, a true testament to an agrarian society, although, as mentioned, occasional help from neighbors was welcome. It was a time when the lack of an aristocracy, or monarchy, provided people with the opportunity to build a future, as there were no assessed taxes. The people developed their own individual conscience, which was essentially the birth of democracy at the “grass roots level.”

Families, although located at a distance from their neighbors and relatives, worked together with others to establish their homes in the new territory and assist others as needed. The socio-economic climate was such that it tossed aside the oligarchic or absolute type of government found in Europe for a democratic model. In the New World people expressed their views and opinions in town hall fora, unencumbered by the British Crown or the federal government in Washington. Today, the town hall forum is widely used, as evidenced in the recent Presidential election.

The settlers took up a variety of jobs to ensure economic stability. They relied mostly on an agrarian economy but also sought wealth by other means. There was a fur trade frontier, a cattleman’s frontier, a mining frontier, and, of course, a farming frontier. The latter attracted a pioneer who was out to conquer the land while having no apparent respect for it. In fact, when the good land became scarce and the population of a region increased, the people often moved on to new land and repeated the cycle again.

Be that as it may, no discussion of this nation’s early history can exclude the institution of slavery, which is important when we consider the frontier. In the south, slavery was seen as an economic necessity. In the north and expanding west, however, slavery was neither benign nor benevolent. In fact, northerners and westerners, by and large, believed in equal rights for men. This basic, yet fundamental difference was the cause for a philosophical split between the south and the north (and west). The word slavery essentially became an anachronism because in the minds of many pioneers slavery reminded them of what they left behind, of the economic dependence they or their ancestor serfs once had in Europe. Slavery was seen as a philosophical barrier to the frontier.

Today, the frontier is not necessarily a place, but remains a concept, a movement established by early pioneers who hoped to settle the new uncharted American land. The settlers set down the basis for democracy. They also laid the foundation that still is a part of the American people’s psyche today. They were success-oriented individuals. Led by their need to succeed in carving out a new life in a challenging and promising frontier, the settlers proved that they endeavored to not just survive but succeed in building a new life. This same level of visceral determination is evident in our society today. The desire to maintain individuality is inherent in our psyche and attempting to balance that with social reform movements has been difficult, as exemplified by the recent attempts at health care reform.

 

Part II – Health Care

When considering the state of health care in America today it is important to reflect on our history. Americans fought the monarchy to escape taxation without representation to pursue and create a new country founded with capitalistic principles.

Comparatively speaking, America is a young country, riddled by few wars, and no occupation by another nation. As a contrast consider the fact that Turkey occupied Greece for 400 years, or during World War II when Nazi Germany nearly destroyed Europe, claiming land and lives along the way, destroying several thousand-year old symbols and relics of once strong nations. Let alone the murder of millions of Jews. Certainly by comparison America's culture, and existence, is in its infancy.

When once-strong nations in what is known as central Europe today survived thousands of years of philosophical, political, and even economic turmoil, what remains is a noticeable fabric, a mind set we might label a “nation state” that has created tradition, folklore, and clearly societies that believe in themselves in a manner that far exceeds the acquisition of material goods, which is prevalent in America today. This is not a criticism. Rather, it is purely an observation related to the evolution of a mind set that has, essentially, not been required to create a nation state because there have been no occupations by other nations. As we evaluate the conflicts this nation has endured, such as Pearl Harbor or 9/11, while drastic and horrific, they pale in comparison to the conflicts other nations endured for hundreds of years. Those conflicts helped create a nationalistic state of mind, a need to band together.

The individualism and free spirit that has been a strong tenet in shaping our national conscience is in contrast to the European view of reliance on the government or consortiums (The European Union) for direct help to its citizens. This “requirement” by citizens of other nations, those whose history is largely the result of surviving multiple wars, is an ethic missing in the United States quite simply because the nation state frame of mind has not been built upon preserving a nation. Rather, it mainly is about the here and now, the tangible understanding of time and its relative value.

When we reflect on health care reform as an important social reform issue, America's individualism and lack of history is apparent, as the populace is leery of government involvement in their choice of insurance options. No one in this country appears terribly interested in government intervention. In fact, while there are indeed two main political parties with their varying degrees of “differences,” both parties espouse the view that less government is ideal. Certainly, in comparison to the Republican Party, the Democratic Party appears more interested in social reform movements, and this essential difference in view makes this party the one that appears to favor more government, and consequently (perhaps) more social reform. Hence, President Obama’s platform on health care reform is arguably the most important piece of social legislation since the passing of Medicare.

With the exception of Medicare and a federal system of insurance for our military and veterans (the VA), people have long held the belief that their health care is a personal decision that is not to be tampered with by the government on any level whatsoever. Given that as a nation we have adopted other “socialist” tenets (social security, postal system, education, garbage collection, clean water, sewage systems, and highways) the observation regarding our reluctance to offer national health care is quite perplexing to say the least. We must ask ourselves why, for people should have access to affordable health care, just as much as they should have access to affordable education, clean water and all the essentials to maintain a life. Furthermore, an educated and healthy nation will prosper. A nation that offers its citizens these basic, fundamental needs is indeed a civilization.

Although we can contest the definition of civilization at length, in this context, civilization means a world where social justice prevails and where there is a social fabric (taxes, if you will) connecting the financing of health care and education (among other important civilized concepts). Insurance, managed care, or health care organizations which provide care to individuals certainly can remain in this space, and they should continue to be allowed to compete for market share based upon their innovative products and services, whether they are a health care or educational system, or otherwise. People should have the right to these products and services just as much as they should have the right to a clean glass of tap water.

The “problem” is our original and current history of capitalism, personal accountability, profit margin, free thinking, and a country where free market trade competition breeds innovation. Reconsider the frontier for a moment. For some reason, when it comes to a health-care-for-all-people equation, our prevailing capitalistic mindset enters the stage and complicates matters. On the innovation front, although costly, is an important principle in health care. People desire more treatments and more expensive technology to diagnose a particular malady more accurately and to sustain quality of life. Even as people evaluate their own desire to live longer free of disease, they have difficulty fully comprehending that the current financial model of health care in the United States creates highly fragmented and expensive care. No one really wants to consider this latter issue, but they must.

 

Part III: Accountability

Unfortunately, health care consumers want their symptoms treated irrespective of how they have lived their lives up to the point of illness. Barring genetic predisposition to a particular malady, many people actually fuel the end result by treating their bodies and minds poorly. For many years the idea of preventive medicine has been anathema to the general public and even today most people are unaware of how to make the right choices in diet, exercise and fitness to enhance their chances of living a healthier life both physically and spiritually.

Americans today are, by and large, extremely sedentary and due to the hectic pace of their lives they do not exercise enough and often eat foods that are low in nutrition, are calorie dense, and filled with unhealthy fat that contribute to chronic health conditions. Aging compromises all of our physiologic systems (e.g., circulatory, respiratory, digestive) so that even more diligence is required in terms of physical activity and nutrition. Much of these chronic diseases can be forestalled by making the right dietary choices as well as keeping a rigorous exercise routine which is generally defined by at least 30 minutes of exercise five times per week, raising the heart rate up to approximately 75% of max VO2.

Here is a big dilemma: If our foundation is personal accountability, why should we support a health care system if the majority of the citizens don’t take care of their personal health? This question is really about social justice, and when we talk about this kind of justice, we must agree to continue to educate all citizens even if they may not pay property taxes (renters, for instance). For many reasons, health care is more personal than education. Free education is what people expect, and so it is provided. For many people health care is a privilege that must be earned here in America. Why?

Recently during the economic downturn many people have lost their health insurance because they lost their employment. This further complicates the equation. Many folks who have diligently watched their health, made wise lifestyle choices and done all that was expected of them have found themselves in perilous states if they contract one serious illness or sustain injuries through accidents. The significant numbers cannot be ignored as the unemployment rate grows.

In a sense when one considers the status quo in the populace's view of health care they still want to surround their homes with fences, as if perils of the frontier are still there. Presently 20% of the insured population is responsible for 80% of health care claim liability simply because those 20% are the ones with most chronic disease (co-morbid). Few people use substantial health care resources, and yet most of these 20% fight tooth and nail any level of health care reform.

Health care claims are largely the result of major chronic conditions such as depression, diabetes and heart-related illnesses. It is important to note that through a proactive approach to one's health, such as exercise, eating healthy foods and avoiding known risks such as excessive alcohol and tobacco, individuals can go a long way in ensuring that they are maximizing their potential for a more healthy outcome to their lives and subsequently cut down their need of medical care in acute situations, thereby reducing health care costs for everyone.

When chronic disease is diagnosed, it becomes a lifelong battle, one involving multiple drugs and other therapies as well as appointments with medical specialists. Often when a patient has a chronic disease it is the result of two breakdowns in her/his initial care: a) Independent of genetic predisposition to certain maladies, the patient has shown a careless disregard for making healthy life choices in respect to eating and exercising and b) the health care system of which the patient was a member did not intervene quickly enough to mentor the patient properly. Ultimately, the goal is to marry these two disparate issues.

For some reason, perhaps up until now, the insurance industry has not been effective in making this marriage work in a sustained fashion. It is clear the insurance industry must aggressively create a meaningful wellness campaign to help improve the lives of our citizens. To help this message, employers must begin to recognize the advantages of such plans so that they must promote wellness at the workplace as a means to reduce overall costs to the individual and the company.

Among the many issues with the health care system in the United States is the lack of a healthy subsidy of premium. Young people by nature are a somewhat healthier subset of all Americans and are for the most part uninsured. They are not contributing to the risk pool. If all of us, including the younger individuals among us contribute as I suggested above, it will help to offset the liability that those who have chronic, costly conditions. The loss ratio, in other words, will improve, and consequently premiums for all will stabilize; they will moderate. We will all benefit from a positive, proactive approach to our health care and which starts with seeing a physician at regular intervals as opposes to seeing any physician for the first time in an emergency room. Beginning this healthier approach from an early age, along with sufficient information in our nation’s schools regarding nutrition and the benefits of physical fitness and wise lifestyle choices, will help to limit the possibility of making unhealthy choices later in life as people will be cognizant of it earlier and be more likely to see real benefits from their choices.

 

IV - Conclusion

If the traditional insurance model remains intact, rather than degrees of restructuring, such as on the one end with national health care (where government owns and operates health care facilities and provides constant financing), to less “invasive” forms of reform, serious consideration must be given to a level of national care that creates a mandate for the uninsured to join the risk pool, as well as a mandate that insurance organizations offer all applicants a policy regardless of pre-existing conditions, and mandatory wellness programs. These mandated policies must offer robust, preventive care based benefits so as to foster prevention rather than catastrophic coverage, even though there will likely always be the few who will cost the system a great deal of money and damage the efforts undertaken.

The goal is to reduce that damage. I believe we all should contribute to these discussions, about mandated care and coverage, as well as national reform. Of course, from a financial perspective we must draw from a variety of taxable sources because it will benefit the entire population in the long term, both financially and socially.

My interest in social reform and social justice and one of its iterations, health care reform, creates a natural curious consideration of how to reconcile the problem. On a social level I believe every society must have proper education and health care services essentially free of charge. Capitalism will prevail in this country, and so will the free-market enterprise system that many people enjoy. Applying deeper levels of social justice will not erode the principles upon which this young country was founded. Rather, it will help us build a sense of nationalism that far exceeds the current definition. It will create culture, folklore, age-old traditions set in stone.

When contemplating fundamental components, such as education and health care for a vibrant successful society we must discover ways to ensure success for all of us. Both in education and health care I believe we need to fuel a sense of community, creating a culture, folklore and tradition, simply because our young history has not created the nation state ethic that permeates central Europe, for instance. This is an ethic lacking in today's America and which hinders our ability to move forward together as a unified, cohesive nation.