Reading veritas curat's diary, "Justice and Population Biology," reminded me of an interview I heard on NPR recently with Lionel Shriver about her new book, So Much for That. A NYT article about the book is here: it provides a decent plot summary. The point of the NPR interview that I remembered while reading the diary was Shriver's comment that we (American society) don't confront the hardest question ignored by the health care/insurance reform debate: How do we put a monetary value on human life?
This question already haunts insurers and their patients/clients. It would continue to do so even with public option or single payer reform. Shriver discussed N.I.C.E., the regulating board of the UK's National Health Service that determines how to allocate medical resources to patients. They've calculated a monthly value, let's say, for each person, and if, for example, the pill prescribed costs more than that monthly value, it's not dispensed. Shriver reported that more and more countries with universal health care systems are looking at that kind of mechanism to control costs. How much should we expect our society to pay to keep us and our loved ones alive?
As things turn out, that's the wrong question to ask. Shriver noted that most of us have an altruistic streak enabling us to say, "Don't worry about me. Spend the million dollars elsewhere," but that we can't say the same of our spouse, our child, our parent, anyone we love even though doing so would be charitable to a society beset by limited health care resources. Since everybody's somebody's beloved, we don't stand a chance of voluntarily controlling health care costs. Our consuming attachments to our loved ones will bankrupt any health care system operating while our population continues growing. The system, any system, will have to force cost controls on us, which in their crude way is what the private, for-profit health insurers have already been doing.
The truly objectionable feature of these insurers' behavior, as most here agree, is that their employees and executives profit from the misery of others, their customers: one form of the emiseration that is monopoly capitalism. However, we need to admit that even with single payer, there would be resource limits that would always create misery for someone and that, as a result, the rest of us who receive services would be the beneficiaries of that misery. Can we acknowledge that our lives and our loved ones' lives always depend, in one way or other, on the charity of strangers?
We live at the expense of others now and in the future. Veritas curat's nitrogen fertilizer example provides scientific evidence of this fact. There can be guilty feelings attached to this situation: call it "survivor's guilt." Perhaps all our other decisions about saving fetuses, starving children in Africa, whales, dolphins, abandoned pooties, and all else have at their core the desire to do something that assuages our "why am I alive?" malaise. I now understand the Christian concept of "original sin" as a metaphor for this survivor's guilt, a way of communicating before psychology that lots of people can feel worthless once they confront their lives as an escape from or forestalling of death. The religious answer, believe in a God that loves you and reserves for you a place in heaven, couldn't have been all that satisfactory given the eruption and global expansion of our consumer economy and its successful targeting of every human insecurity.
The diary's concluding reference to Small Is Beautiful and the Buddhist approach to maximizing well-being pinpoints resources we could use to improve our lives and, perhaps, our politics. While Buddhism acknowledges grief, its teachings of acceptance can inform any future discussions of health care reform by giving space to the question of how we value human life, the people we know and, more importantly, the people we don't. Perhaps by accepting the natural consequence that is death and by admitting that no system can sustain giving to everyone every medical procedure desired or needed to sustain life we, as individuals and a community, can learn to cherish and make useful what time on earth we do have.
