Friday, June 29, 2012

Let Them Eat Broccoli

You may have heard: Big day yesterday in the legal world and in U.S. politics. Constitutionality of the healthcare insurance mandate affirmed so long as we call it a tax; Chief Justice rises above default assumptions about his entrenched partisanship.

What better time to turn briefly to King Lear? That greatest of Will’s tragedies begins with Lear doing a really stupid thing: disinheriting the only daughter who really loves his irascible old self and giving everything—all of his wealth, all of his governing authority—to the two daughters who hate his guts. After a bit of time passes, the king decides to pay one of the daughters a visit. He finds one of his servants in the stocks. He is given the brush off when he asks for an audience with the heads of the house. He starts to fly into a rage and then checks, himself, thinking that his hosts might not be well:

Infirmity doth still neglect all office
Whereto our health is bound; we are not ourselves
When nature, being oppressed, commands the mind
To suffer with the body.

Translation: When we feel like crap, we do not act like our regular selves; our minds start to reflect the suffering that our bodies feel. In the play, this observation is a rationalization. It does not explain why Lear has been treated rudely by his daughter and her husband. They have other reasons than the fake explanation that they are feeling indisposed. But, generally, Lear’s idea—that when the body is out of sorts, so is the mind—is quite true. I’m sure we’ve all been there.

Likewise, when we have to worry about what might happen—to our finances, our family, our plans for the future—should we get really sick, that also “commands the mind to suffer.”

In Shakespeare’s England, people probably didn’t worry too much about the consequences of getting sick because the average life expectancy was only about 30. There were no prescription drugs, just aromatherapy and apothecaries who could dole out herbal remedies and arsenic. “Surgeons” doubled as barbers. Neither the insurance nor hospital industries existed. And leeches were your best bet for countering infections. Bathing itself was suspect—removing all of your clothes and immersing yourself in water was, after all, merely an invitation to the devil.

In today’s England, they have a national healthcare system that is the “third rail” of their politics. No politician dare suggest messing with it or, heaven forbid, privatizing it, so beloved is it by ordinary citizens who can all get whatever medications they need and who do not have to devote a big chunk of their paychecks to insurance premiums. Nor do doctors who work in that system have to incur a lifetime of debt in order to get through medical school so in turn they are not consumed with the idea of pursuing wealth as they commence their practices. Of course, folks on the radio in this country will swear you have to wait in line for a month to get an aspirin. But they, like Lear’s daughters Regan and Goneril, have other motives for saying the things they say, which are frequently divorced from fact.   

Our healthcare system, for many, is kind of like that depicted in Lear. It depends heavily on the largess of family members and, if you are old enough or extremely impoverished, the floor of Medicare or Medicaid. That is because we are the only functioning democracy with the following anomalies in our system:

  • Most of us rely on private insurance plans to help us cover healthcare costs when they arise.
  • Most of us get access to these insurance plans through our employers.
  • If extreme accidents happen, we have to sue people to try to get them to cover our medical costs (except in places like Texas where they have essentially outlawed malpractice suits).
  • We have the very best medical schools and teaching hospitals but charge would-be doctors enormous amounts for this training.
  • Years ago, doctors gave over responsibility for valuating their services to bureaucrats who created a mind-boggling coding system that makes doctors even less interested in participating in a solution to the financial side of their profession.
  • Pharmaceutical companies are hugely profitable and influence public policy in multiple spheres.
  • We don’t believe much in preventative care—certainly not free or cheap access to prevention or discussions about what we could eat to avoid obesity. So the uninsured and unwealthy wait for crises and then go to emergency rooms where they cannot in principle be turned away but where the costs are most exorbitant and are passed on to those paying for insurance.
Lots of these anomalies are intertwined and self-perpetuating. These anomalies also explain why, as Claudio says in Measure for Measure, “The miserable hath no other medicine but only hope.” (III.1).

No comments:

Post a Comment