Why is it so hard to reform health care? Rugged individualism

Excellent op-ed piece on health care reform in the Sunday Times. It’s by Roger Cohen, who recently returned from a trip to Germany. Europeans readily acknowledge universal health coverage as a basic right in a civilized society. Americans have great difficulty with this concept.

The current health care debate in the US isn’t about health. It’s about money. Legislation is written to accommodate the financial interests of money-driven medicine, especially the insurance industry.

Is there something in our fabled “ruggedness” that perpetuates financial inequality? At some level of the American psyche lies the belief that those who fail financially deserve to suffer, while those who succeed shouldn’t have to share. Does this strain of thought color the health care debate?

[S]omething is rotten in American medicine. It should be fixed. But fixing it requires the acknowledgment that, when it comes to health, we’re all in this together. Pooling the risk between everybody is the most efficient way to forge a healthier society.
Europeans have no problem with this moral commitment. But Americans hear “pooled risk” and think, “Hey, somebody’s freeloading on my hard work.”

A reader, John Dowd, sent me this comment: “In Europe generally the populace in the various countries feels enough sense of social connectedness to enforce a social contract that benefits all, albeit at a fairly high cost. In America it is not like that. There is endless worry that one’s neighbor may be getting more than his or her “fair” share.”
Post-heroic European societies, having paid in blood for violent political movements born of inequality and class struggle, see greater risk in unfettered individualism than in social solidarity. Americans, born in revolt against Europe and so ever defining themselves against the old Continent’s models, mythologize their rugged (always rugged) individualism as the bulwark against initiative-sapping entitlements. We’re not talking about health here. We’re talking about national narratives and mythologies — as well as money. These are things not much susceptible to logic. But in matters of life and death, mythology must cede to reality, profit to wellbeing.

I can see the conservative argument that welfare undermines the work ethic and dampens moral fiber. Provide sufficient unemployment benefits and people will opt to chill rather than labor. But it’s preposterous to extend this argument to health care. Guaranteeing health coverage doesn’t incentivize anybody to get meningitis. …

Medicare did not make America less American. Individualism is more “rugged” when housed in a healthy body.

Sources:

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Roger Cohen, The Public Imperative, The New York Times, October 4, 2009