American health care: the view from expatriate who came home
Posted by Roger J. Newell, guest opinion July 20, 2009
As the health care reform debate revs up, the vested interests in the status quo warn against any alterations that might damage "the world's best health care system." In the 1980s I was a temporary resident in Great Britain, first as a graduate student, later as a pastor.
I'll never forget feeling anxious about how I would survive the "socialized" medicine against which I had been repeatedly warned. What I discovered instead was an absence of the anxieties that American families continue to endure 20 years later: worries over losing coverage or being able to afford quality care when it's urgent.
These nagging dreads were simply nonexistent among the people with whom I was now living and serving. Of course they had concerns about health, but they were of an entirely different order.
What helps me explain the difference to Americans who have not lived in Europe is an analogy with the public school system. Setting aside for the moment the important debates about funding and the possibilities of private options, the fact remains that Americans simply assume their kids will attend school through high school as a universal entitlement of democracy. We can't imagine any child being denied an education because of a parent's misfortune in losing his or her job for whatever reason. The British (along with the rest of Europe) regard health care the way we regard education.
Gradually, however, I saw something deeper at work in a society where everyone had a right to health care. I witnessed how the privilege of universal health care had awakened a common sense of duty toward my neighbor and mutual respect for one another, causing a tangible awareness that everyone was treated with a fundamental equality, not as an abstract motto repeated on patriotic occasions but as practical as walking into the local doctor's office or hospital when you or a family member were ill. In other words, my personal self-worth was bound together with a respect for my neighbor's worth (and health) as well.
Of course, universal health care doesn't guarantee that British children (or parents) don't get sick, any more than universal education means all kids graduate at the top of their class. But since the devastation of World War II, the British (and the rest of Europe) became convinced that health care belonged alongside education as an intrinsic quality of life in a democratic society. It had become a fundamental obligation of any government that serves and protects its people, to be supported and protected along with education, law enforcement, fire departments and national defense. For all her admiration of Ronald Reagan, Conservative Prime Minister Margaret Thatcher never dreamed of eliminating this fundamental part of what it meant to be British. She would have been swept from office.
As a working pastor in that culture for eight years, it's hard for me to express to Americans how good it felt to know that everyone in my church (and in my city, for that matter) received quality health care, whether rich or poor, over-employed, underemployed or unemployed. It gave us a sense of mutual support that cut across class distinctions, economic levels and religious differences. In over a decade I never met anyone -- not a doctor, a nurse, a young person or someone elderly -- who envied the American system. It was quite the opposite. To them we seemed trapped in a system that was too full of self-interest, fatally constructed to profit from the sick rather than to serve them. In recent years as a college teacher I've taken many student groups to countries throughout Europe, and repeatedly the Europeans have expressed to me how strange our health care system appears to them as a contradiction of America's founding promise to provide a government of the people by the people and for the people.
"Your government has ignores that it pledges life as well as liberty. Doesn't that imply access to good health care," they would ask. "Surely health care is a basic prerequisite for any 'pursuit of happiness' worthy of your founding ideals."
It isn't only the British, with their single-payer scheme. From Spain to Germany to the Scandinavians (and back again to our neighbor Canada) maturing democracies have implemented a variety of strategies to cover the entire population. Again and again, this practice concretely demonstrates to fellow citizens how mutual respect in a maturing democracy has migrated from the ballot box once every couple of years to the family living space of each citizen every day of their lives.
Paradoxically, our current financial mismanagement and Wall Street-run health care inefficiencies may have brought us to a crisis that is our best opportunity to repair the black hole at the center of our social fabric, one into which 45 million of our fellow Americans have fallen and which swallows more every month. There are special interests who paper over this black hole with the label "freedom of choice." Together with the inertia of the discouraged they collude to deny for this country what every other advanced democracy in the world gratefully enjoys. But surely it is possible for Americans to weave together a health care system that exemplifies our historic "can-do" attitude and binds us together as citizens committed to ingenuity, respect and compassion.
As an American who has lived abroad, I believe the implementation of universal coverage is a quality-of-life issue whose time has come. But it hinges on whether we have evolved a critical mass with sufficient empathy to realize that my neighbor's health care, like my neighbor's education, profoundly affects my own; that it is in our mutual best interest to have a health care system that serves us all, especially the most vulnerable among us.
Roger J. Newell teaches in the Religion Department at George Fox University. For 12 years he lived with his family in Durham, England, and Aberdeen, Scotland.
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