For instance:
It’s enough to know that most people strongly associate health and weight. So when disingenuous sexists start to bellyache about the dangers of letting fat women out in public, they get traction, because it’s becoming increasingly acceptable to suggest that not being perfectly healthy is a moral failing that should be punished with social disapproval, shaming, ostracism, and lowered access to society. Of course, we double down on fat people, and triple down on fat women, because of plain old prejudice, but this isn’t happening in a vacuum. Smokers, people who don’t eat right, and other people with poor health habits are also considered morally inadequate, if harder to judge because they’re harder to spot.
What is troubling about this is how it shapes policy: healthcare coverage is only for the deservedly healthy--if you have a poor outcome it's probably due to your irresponsibility and therefore you don't deserve help.
There is also an important discussion on the tactics of shaming in order to eliminate or modify people's behaviors:
People who see sex as a fraught, moral issue aren’t often in a good place to make healthy changes to their sexual habits. People who don’t view the status of your genitals as a judgment on your moral character are often in a lot better position to take care of themselves. For instance, if you get an STD and you think this means that you’re being punished for sin, you’re much more likely to be in denial, not get treatment, and pass it on. If you think it’s got no more moral implications than getting a cold, then you’re much more likely to get treatment.
I guess we need to make a choice, and sooner than later: do we really, truly care about helping people and having a healthier society full stop or do we care more about the smug, self-satisfied superiority we get from being moral scolds who other and punish?
4 comments:
I totally laughed at that last paragraph, because I read it while internally hearing the cadence of how you'd say it at the same time.
So yeah, health care is all about triage, right? Insurance or anything else is about how to define the rules of that triage. In the USA, having good insurance means having access, i.e. the better your insurance, the better your access. It's actually the same in Germany, although they won't admit that: they have public heatlth care (in which anyone can get any care, just as long as you show up early enough to get in line and can stand the multi-hour wait), and private care (in which you pay for what you need and get it right away, but you REALLY PAY).
So that's what's being lost in this overall discussion, I think. Someone has to lose. We don't have the resources to take care of everyone. I waited in line for THREE DAYS in germany, getting up every day very early, to get a rash diagnosed. In the US, if I had the money, I could have that diagnosis in an hour and a prescription in hand in an hour after that, but of course I'm privileged.
Meh. So what's the answer? My grandmother died because of government health care. I have none, so I could die tomorrow -- or be bankrupted.
All these things being said, I still think it's wrong that people are denied good care based upon their material worth. So how are we to effectively triage?
We can start by moving from a disease management model of providing care to one based on prevention and wellness. A few states (I believe Colorado is one) have put forth proposals for a sort of "merit pay" structure for docs who get/keep people healthy, but that makes me uneasy for the same reason as merit pay for teachers, e.g. it's not always fair how classes are assigned or how resources to teach are doled out, etc. While a doc is within his/her rights to refuse to treat a patient before treatment begins (unless the patient is emergent, and then that's a whole nuther thing) that's not really practical. Who will want the chronic/difficult cases then? Plus it sets up for more moralizing.
Then again, the system does NOT reward docs for providing preventive care, as any underpaid GP or pediatrician can tell you. No one is picking those specialties and there are huge shortages already.
Kind of OT from what you wrote, but I'll bring it around: preventive care and wellness is a shitload more cost-effective. If you can marry that with food and other kinds of public policy that support it, there might just be a way to make it work.
And if you want to talk about moral vs. immoral, how about the concept of health insurance for profit? It's a mortal sin against free market fundamentalism, but just ewww.
Howard Zinn once remarked that we would never know true peace and democracy as long as we privileged profits and greed over people. I'm inclined to agree.
Stupid html. Anyway--here is what I meant to post: found this over at Alternet this morning. It pretty much touches on everything we've talked about.
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