"Rugged individualism" gone awry

By Heraclitus

Amanda at Pandagon has an interesting post on Mexico's health care successes (a story Ezra Klein discussed earlier here). I just want to use these discussions as a spring board to say something about the underlying cultural or societal attitudes towards such things in the US. I'm not completely opposed to capitalism. I think it can be defended as the least brutal or most humane form of social control on offer at present. I think you can even make a slightly more positive defense of it, stressing the personal freedoms and whatnot. But then I think it's only fair to talk about the constraints the market places on all areas of people's lives, those who are ground up in the machinery of capitalism, economic rationalization, etc. But I think two cheers for capitalism, or for liberalism, is a perfectly respectable position.

I do not, however, have much sympathy for people who want to celebrate capitalism, those who usually call themselves "libertarians" (sounds better than money-grubbingtarians). I'm not going to engage in any extended criticism or airing of my differences with them, in part because I'm pressed for time, but I just want to parry them with a look at how health care debates are often framed in this country. First, the extreme moralization is noteworthy. There's a view that people should have to pay for their own health-care, because that will make them more likely to try to prevent illness and injury (George Will, for instance, has repeatedly made this argument). That's certainly true to a point, but it's odd how preventing the eventual on-set of, say, diabetes, should be someone's top priority in their life. All of us are predisposed towards some infirmity or other (or just outright fatality), but few of us making warding it off our chief concern in life. And for that, apparently, we deserve to pay through the nose when we do get sick, or sprain an ankle on an uneven sidewalk (you should have been paying closer attention).

Of course, one has to ask, if our health care system is all about prevention, why isn't it working? Why do we have such high rates of obesity, cancer, heart disease, etc.? Could it be because our health care system isn't really about prevention, it's about profitting from expensive cures--or, better yet, treatments (on which see Chris Rock)--for diseases?

But even if you're willing to buy that our health care system, as a whole, does aim at prevention, or that certain justifications of it aim at prevention, compare the attitude behind this to that in Mexico or Cuba. There the emphasis is on prevention, mainly because the countries cannot afford expensive treatment regimens. But note, above all else, that their attitude is not that those who cannot afford treatment should simply be left out in the cold. Their view is rather that the goal of a public health service should be, well, to keep the public healthy. They therefore focus on keeping everybody as healthy as possible. And it works (on Mexico, see the links above. And if you haven't heard about the successes of Cuba's health care system, you need to live a little and go hang out with someone to the left of Ted Kennedy).

But the real divide between America and other countries on health care is, of course, on the question of universal health care. But I think this is just another symptom of the "rugged individualism" gone awry I mention in the title. There's already a "let them eat cake" attitude, intentional or otherwise, in the focus on expensive medications and treatments rather than prevention. That attitude is much more explicit in the rejection of universal health care. Again, the argument is usually something like, "If they're poor, they're irresponsible. Not having health care will teach them to be responsible." A more upbeat version of the argument is, "People make choices. Who am I, or the government, to impose my choices or priorities on other people in the form of taxes. If they want to spend their money on something other than health care, that's their choice." The idea that some people may not have health care because they just can't afford it (that they "choose" food and shelter instead), and that there may be structural forces keeping them in poverty, is almost never mentioned. If it is, those structural forces are identified as government regulation, and nothing else.

But, again, look at the presuppositions of this view. Society is a (very) loose collection or aggregation of individuals. There is no common good, and certainly no common obligations. Compare this to the view that the government, and other powerful entities like the medical profession (where this is not under government control or supervision) have a duty to the society as a whole. I know, I know, it's collectivist and scary, but in this case, a little investment in public health care is good for everyone because, well, fulfilling your social obligations is better than being an atomized money-grubbing philistine.

Finally, this same phenomenon is on display in much of the immigration debate. Leaving aside the overt and rampant racism usually attending such discussions, let's concentrate on the argument that illegal immigrants somehow take from public investments in things like schools without giving anything back. Again, this argument, in a breathtakingly dishonest fashion, ignores the contributions illegal immigrants make to the US economy, and more specifically the fact that several major industries in the US simply could not exist in their present form without using illegal labor. (The fact that violating the immigration laws of one country is considered, implicitly or otherwise, worse than the exploitative treatment these workers receive is a whole other problem.) This argument about the horrors of illegal immigration also ignores that the children of the immigrants, who are themselves often US citizens, will one day use their schooling to contribute wealth and other things to American society. This is where the greed and myopic individualism I've been trying to highlight in this post spirals completely out of control. The anger at having to invest in a public good like education (this anger stems from something that used to be known as vulgarity) blinds people to the fact that this investment is, in the not-so-very long term, in fact in their own interests. You don't have to be a true-believing, flag-saluting communist, or even a disaffected, sardonic one (like me), to see how this is a problem.