It will come as a surprise to no one that the health care system in the United States is vastly different from the health care systems in other countries around the globe. Both sides of the reform debate make reference to this fact. Those in favor of reform suggest that we might learn valuable lessons on how to improve things here at home by looking abroad. Those opposed to reform suggest that the terrible evils of socialism await us, and that if we’re not careful, we’ll find ourselves devolving into Canada or England. Neither side, however, is asking the most important question of all: Why are we so different from everyone else?
Before we tackle the issue of whether or not our differences are a good thing, I think we must examine the underlying cause of our differences. It is simply too naïve to think that we have always had the health care system that we know today. In fact, modern health care as we know it is a development of the last century give or take about 50 years. This is not the forum for an exploration of that historical development. The interested reader who hasn’t yet done so, should pick up a copy of Paul Starr’s Pulitzer Prize-winning book The Social Transformation of American Medicine for the most thorough account of how our health care system came to be.
Here’s my answer to why we’re different, and it comes from our unique history: We are a land of immigrants unlike any of the other modern industrialized nations. People came to this country, first, fleeing from the oppression of a despotic monarchy, then much later, to pursue the “American Dream.” From these foundations we have become a nation distrustful of government and ruggedly individualistic—not altogether unconcerned about the welfare of our neighbor, but predominantly motivated by our singular self-interest. The antonym of “America” might well be solidarity. Often it seems that we are a united states in name only.
That lack of solidarity, I believe, is what permits entrenched interests, ruled by money, to dominate the health care debate. We may not like what the insurance companies are doing to us, but as Americans we can understand the hungry pursuit of the dollar more readily than we can sympathize with those less fortunate among us. But I think that can change and I look to the civil rights movement in this country for proof of that hope.
In 1964, Congress passed the Civil Rights Act with a large majority, paving the way for racial equality in this country. Among the nay votes, however, was Sen. Barry Goldwater of Arizona, who argued that “You can’t legislate morality.” Perhaps he was in some way right. No law can change the way someone feels deep in their heart. Or can it? With the passage of civil rights legislation, segregation was outlawed. Certainly the implementation of the new laws was anything but smooth, but it was the beginning of a process—a long, arduous process—that continues today with the election of the first black President of the United States. Did the Civil Rights Act of 1964 abolish racism from the people? No. That isn’t something a law can do. But did it diminish racism and its effects? Absolutely.
And so, with health care, my hope is similar. We are not a nation that values solidarity. In fact, we have a long history of valuing individualism. But, if the right structures are put in place through health reform, I believe that we will begin to see the benefits of providing health security to the American people. I don’t think that the transition will be painless, and I don’t think that it will necessarily be swift, but I do believe that it is incumbent upon government to take the first step—even if it is considered unpopular by a vocal portion of the population—that leads us to becoming a better and stronger nation.
I see it as no small coincidence that the man—the leader of the free world—who has become a symbol of the success of civil rights, now stands in front of us, prepared to lead the charge on health reform. If we had always been a nation of civil rights and solidarity, we would never have known the dark days of slavery or segregation, and we would already have the best health care system in the world. Instead, we have had to evolve, slowly and painfully into a nation that works to become just a little bit better today than it was yesterday, and which sees in that the promise of tomorrow. We can and we will.