American Values

“Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tossed to me,
I lift my lamp beside the golden door!”
- The New Colossus, Emma Lazarus, 1883

On health care reform, David Brooks gets to the heart of the matter in The Values Question. The health care debate is not a policy argument. The devil’s not in the details. It’s a debate about the values of a nation.

During the first many decades of this nation’s existence, the United States was a wide-open, dynamic country with a rapidly expanding economy. It was also a country that tolerated a large amount of cruelty and pain — poor people living in misery, workers suffering from exploitation.

Over the years, Americans decided they wanted a little more safety and security. This is what happens as nations grow wealthier; they use money to buy civilization.

One one side of the debate are those most concerned about America’s economic vitality and competitiveness – those who can accept the hardship, suffering, sickness and even death of the unlucky in a free-market economy. These people value the initiative and luck of the individual and would like to see the nation thrive.

On the other side are those most concerned about the economic, physical and social health of the people who make up that nation. They see the fitness of the nation in the baseline well being of its citizens, and in the inherent decency and compassion of the nation’s policies. They want to live in an ethical and compassionate society at the possible expense of America’s economic supremacy.

No policy issue better reflects these opposing sides than health care reform.

The bottom line is that we face a brutal choice.

Reform would make us a more decent society, but also a less vibrant one. It would ease the anxiety of millions at the cost of future growth. It would heal a wound in the social fabric while piling another expensive and untouchable promise on top of the many such promises we’ve already made. America would be a less youthful, ragged and unforgiving nation, and a more middle-aged, civilized and sedate one.

We all have to decide what we want at this moment in history, vitality or security. We can debate this or that provision, but where we come down will depend on that moral preference. Don’t get stupefied by technical details. This debate is about values.

Brooks is a conservative – an astute, insightful, and perceptive one – who frequently betrays in his columns a fundamental preoccupation with human cognition, drives and behavior. He’s right about the true nature of this debate. He’s wrong, however, in assuming that making the compassionate and ethical choice requires a considerable sacrifice of American economic power.

I’m not an economist and neither is Brooks, and even the nation’s most respected economists can’t agree on what’s in the best economic interest of the country. So I won’t bicker about which government actions would yield the best economic outcome. I do argue however, that the best economic outcome can’t be measured purely in dollars and cents, and can’t be fully appreciated in the short term.

Every other Western industrialized nation has universal health care in some incarnation, and most manage to remain both economically competitive and socially equitable. Australia is one of the shining lights at the moment. This nation largely escaped the economic recession. Its citizens have enjoyed government-funded universal health care for the past 30 years and receive an average salary of $50+K per year.  University education rivals that of the United States and thanks to government subsidy, costs 1/5th of the cost.

The billions the Australian government pours into health care, education and various welfare programs for its people aren’t economic sacrifices that compromise its power and standing in the world. They’re investments in the long-term economic, social and political sustainability of this country. And they’re paying off. The greatest natural resource any country has, isn’t manufacturing, water, oil or minerals. It’s people. Healthy, educated, employed people leading productive lives in an equitable society.

Nurture them, and the nation wins.

From an email I just received from the First Lady of the United States:

Tomorrow, many of us will gather around the table with family and friends to give thanks over a feast of turkey, mashed potatoes and gravy — and let’s not forget pumpkin pie!

But for some in this country, the feast will not be as bountiful.  In fact, it won’t be much of a feast at all.  Hunger is on the rise in America — hitting its highest levels in nearly 15 years.  A recent report released by the USDA reveals that in 2008 an estimated 1.1 million children were living in households that experienced hunger multiple times over the past year.

Is this what it means to be a superpower? Is this the standard of living in a first-world country? Is this who we are? Is this who we want to be?

Does this reflect your values?

Deep in the Hate of Texas

On the eve of the anniversary of JFK’s assassination, Mark Warren considers “the paranoid strain in the American polity [that] has reasserted itself — that strain which ascribes the worst possible motives to one’s political opponents, and where lies abound and violence becomes possible”. The article’s poignance is found in the words of a Texan woman who, following Kennedy’s assassination, wrote a letter to President Lyndon B. Johnson about the pervasive racism and necrotizing hate of the people in her district of Texas.

An excerpt:

Mr. President, the easy thing and what is desperately trying to be done [is] to convince a stunned nation and world that Mr. Kennedy’s murder was the work of some deranged crackpot, and while the trigger was pulled by such a one, perhaps the atmosphere that made it inevitable was the hatred of the people (I don’t mean every one of them but a big majority) who wanted Mr. Kennedy and any one connected with him out of the White House. A week ago this might have sounded ridiculous but subsequent events lend it credence, I believe. There is a virus of disrespect and hate spreading here very rapidly. And unless one lives right here with it, day in and day out, it is unbelievable how quickly and subtly it infects reasonably intelligent persons. This is not too hard to understand only if one recognizes the unremitting, deep, bitter religious and racial prejudice existing today in this section of our land — I don’t know if any of them are similarly infected in other sections, but I know personally of what I speak as regards East Texas.

I find it equal parts depressing and confounding that just when many in the world have come to like America again for love of Obama, many in our country have come to fear for America in their hatred of him.

That hate is threatening to paralyze Congress and emasculate the President. And it’s now so admixed with legitimate grievances about the economy and unemployment, that the hateful feel justified in their rabid obstructionism, paranoid propaganda, and vengeful campaigns to delegitimize the President in a time of national crisis. We’ve had a dot com bubble and a housing bubble. Well now we’ve got a hate bubble. And if we don’t deflate this bubble fast, we’ll be begging for the good ol’ days of ’63.

The overweight scapegoat

In our indefatigable quest for enemies, Americans have now targeted the obese.

Even though I’m living in Australia, I can get the 6:30pm CBS News from America live at 11:30am the following day. And even though I’ll have read all the major news online, I like to watch the meagre 20 minutes of heavily scripted network news. It keeps me culturally and psychologically connected to home.

The format of network news is predictable: one political news item, one item on America’s health, and one fluff piece on an inspiring American, followed by a few quick words on the real domestic and international news to close the show. The meat is in the rear, and if you’re actually interested in news, you’ll sit through the formulaic bit and 10 minutes of commercials.

One of the health items last week was disturbing. In our debilitating but understandable anxiety about the economy, we’ve been frantically looking for the right donkey on which to pin the tail of guilt. We’ve been blaming Wall Street and Congress for a year now (and rightly so), but that hasn’t satisfied us, because the impact of the recession has only worsened. Now that healthcare reform is the item du jour, the current healthcare system has been targeted as one cause of our economic woes (and rightly so).  But now this begs the question, “How”?

Republicans and Democrats will never agree on who’s to blame within the system – insurance companies, drug companies, doctors, hospitals, or government bureaucrats. That leaves consensus on only one group to blame: patients.

CBS News and everyone else it seems, has now determined that the blame for our economic collapse and dysfunctional healthcare system can be confidently placed at the feet of America’s obese.

Shameful.

Prevalence of Obesity in America (CDC)

As a medical student, I’m fully aware of the health consequences of overweight and obesity. I’m just as aware of the health consequences of smoking, alcohol consumption, physical inactivity and poor eating habits among the skinny. I don’t deny that being obese places you at higher risk of a host of chronic diseases; but I do deny that obesity is the exclusive fault of the patients who suffer from the condition. And I further deny that the obese are principally responsible for the crippling expense of providing healthcare in America.

The reasons for the exorbitant cost of healthcare in America are multi-factorial. The reasons for obesity in America have as much if not more to do with the actions of government and industry than they do with the actions of people. Without any serious reflection on the subject – indeed, just considering America on my last trip home, a host of factors are implicated in the obesity epidemic.

City Planning: Good luck finding a sidewalk on any of the major roads in my family’s town. If you want to walk anywhere, be ready to get flattened by an SUV. And good luck finding any place to go within walking distance. Wal-Marts and supermarkets are built on giant lots at considerable distance from residential areas to accommodate their monolithic parking lots. And no, there are no bike lanes. Virginia ain’t San Francisco people. This is the fault of local government.

Work/Life Balance: You get the kids ready for school between 6 and 7; you’re on the road to work from 8 to 9; you’re sitting in a chair at work until 4 or 5; you’re on the road home from 5 to 6; you’re cooking dinner from 6 to 7; you’re socializing with the kids from 7 to 8; you’re getting the kids bathed and in bed from 8 to 9; and then you’ve got an hour to yourself in the evening to decompress. Then the weekends are spent driving your kids the considerable distance to football and soccer practice, karate class and birthday parties. When are you supposed to exercise? This is the fault of city planning and employer demands.

Food: Only in America are entire aisles each devoted to sugary cereals, sodas, potato chips, candy, and frozen dinners. The variety of preservative-filled junk is staggering. The amount of saturated fat, trans-fat, sugar and salt in each item sold in an American grocery store is nauseating.  It would take a mother a full weekend to read the nutrition labels on the backs of boxed and bagged foods in order to find enough healthy choices to fill a grocery cart. And it would take an upper middle class family to afford to limit their purchases to fresh fruit, vegetables and meats. This is the work of the food industry playing on the financial insecurity of families who need to feed and please the palates of a household.

Healthcare: If the average American could afford regular visits to a family doctor, insidious weight gain and early signs of obesity-related disease could be caught early, and patients could be counseled about the urgent actions needed to prevent chronic disease. When patients have strong, reliable relationships with doctors who have an interest in their overall health, they become more aware of their health (or lack there of) and  more motivated to improve it. They’ve got an educator. They’ve got a coach. They’ve got a partner. But most Americans don’t have a family doctor they can trust and afford.  That’s the fault of the healthcare system.

At the end of the day, sure, we’re all responsible for what we put in our bodies and the amount of energy we expend. So individuals are also responsible for the obesity epidemic. But we’ve got enablers, promoters and accomplices aplenty. I’m not saying anything new here. We know this. So let’s not forget this in our quest to find a scapegoat.

Because the scapegoats come in all shapes and sizes.

♦    ♦    ♦    ♦    ♦    ♦

In other CBS News, by way of evidence, a recent study has found:

A medium popcorn and soda combo from Regal, the country’s biggest movie chain, is the equivalent of eating three McDonald’s Quarter Pounders with 12 pats of butter. That’s 1,160 calories and three days worth – 60 grams – of fat.

So ends my 30-year tradition of eating popcorn at the movies.

Most trusted source in news!

Enough about the Daily Show and Colbert Report. They’re not funny. They’re just cathartic for those of us who prefer to use our brain-bones – a transient antidote to watching 30 seconds of Fox & Friends.

And the Daily Show is not the most trusted source of news these days. That honor goes to The Onion. No other publication so consistently, accurately and humorously articulates American values, attitudes and proclivities.

In this week’s issue:

Area Man Passionate Defender of What He Imagines Constitution to Be

Classic. That pretty much sums up the Republican position in the political and cultural wars of our time.

Enemies of health care reform

Republican Senator Orrin G. Hatch (Utah)

“It’s going to be a holy war.” – Senator Orrin Hatch on the Republican fight against healthcare reform

Nicholas Kristof takes a short trip through the history of Republican opposition to social welfare programs. In The Wrong Side of History, he reminds us of the identical Republican arguments against Social Security and Medicare.

Understanding past Republican opposition to these indispensable programs is critical to understanding their present fight against insuring 30-odd million people, including 8 million children.

And critical to understanding the feasibility of reform is an appreciation of universal health care’s success stories worldwide. Contrary to Republican claims, the British National Health Service (NHS) is a success. The Brits will whinge about it, sure, but universal health care in Britain works and works well. The British have a longer life expectancy than we do, and a lower infant mortality rate. And those are but two measures of success of their superior approach to public health.

And then there’s Australia, which you never hear about in the healthcare debate. While my relatives in America are terrified of losing their jobs because they’ll lose their health insurance, I reap the benefits from Australia’s universal healthcare system, Medicare. I see a family doctor on average four times a year, and he’s referred me to various specialists in the past 12 months alone. I had a minor surgical procedure earlier this year and will have another next month. The cost?  A pittance. Or free. The most important thing I need in my wallet when I visit the doctor is my Medicare card.

No one has to worry about losing their health insurance in Australia. Provided by the government, it’s the privilege of residency or citizenship. It’s also a reflection of a civilized and compassionate society, and one with the intelligence and foresight to recognize that a healthy citizenry cures economic and social ills.

No – more than that. Universal healthcare is also the height of patriotism; for how can one claim to love America, if one cares so little for the people who inhabit it? What is a nation but a community of souls with a vested interest in the productivity of each for the benefit of all? No community can thrive where its people are left to die by the roadside – at least not without losing its soul.

“It’s going to be a holy war” says Orrin Hatch, a fierce opponent to government-funded universal healthcare. As a senator, Hatch enjoys government-provided health insurance, and as a senior citizen, is eligible for government-funded Medicare. Well, let him fight for his god.

I’ll fight for Americans.