Recently, while perusing poster presentations at a medical conference, I came across an ingenious little study examining Americans’ attitudes toward Obamacare. The researchers had undertaken a cross-country bicycle tour, purposely traveling on smaller highways and stopping at coffee shops and town halls along the way, wearing bibs that read: “Ask Me About Obamacare.” At each of their stops, the researchers conducted and recorded conversations with local citizens, striving to understand their perceptions of the Affordable Care Act. In these predominantly rural areas, the attitudes were largely negative. The study offered a unique insight into the mind of the everyday citizen regarding the government’s efforts to impact their health.
But the study was not the most valuable piece of knowledge I gained that day at the conference. As I read, another physician approached and stood at my elbow, appraising the poster. After a few moments, he gave a short snort and said, “Unbelievable. Those people are crazy!” He glanced at my raised eyebrows and continued, “I mean, I’m from Canada. If these people have a heart attack and don’t have insurance, they’re through!” He walked away, shaking his head.
I’ve never been adept at snappy comebacks; about five minutes later I came up with this zinger: “Yeah, but we rejected the empire 200 years ago!”
This exchange opened up a vein of thought that has given me new perspective on the ever-oscillating battle to insure our citizens and improve their health. Put simply, our system, largely based upon capitalistic ideals, provides healthcare for those who can afford it. It rewards innovation, sometimes at great expense to those who might benefit from new treatments. It allows the formation of large hospitals and insurance companies capable of treating a vast number of people while turning a profit.
Conversely, it also provides opportunities for altruistic individuals to supply healthcare to those less fortunate. Our system appears to run counter to how many other countries approach doctoring; while we have the best healthcare money can buy, the rest of the world provides the best care it can afford. Why do so many in our country support the American system when we might be able to do better for cheaper with a little more government oversight?
The answer might lie in our cultural DNA. The motivations for our approach to healthcare may not be dependent upon a person being rich or poor, urban or rural, Republican or Democrat, conservative or liberal. Rather, it may depend upon an ancestor who chose Yankee over Tory.
When our country was born, citizens dumped tea into the ocean, tarred and feathered tax collectors, shouldered their muskets and marched barefoot into battle over the matter of taxation without representation. If we could not have a say in how we were governed, and more specifically, how our money was spent, we would not be governed any longer. So, we declared our independence and set up a government of the people, by the people, and for the people—clashing with the most powerful empire (at the time) in the world. And we won.
Although our country has undoubtedly adapted through the years, the right of an American to pursue life, liberty, and happiness remains a beacon to people of all races who endure great hardship to come to this country. So it should not surprise anyone that we give up our freedoms (and our money through taxation) very grudgingly, if at all. When we say we oppose government involvement in healthcare, or the resist a requirement to purchase insurance, what we are actually saying is WE WOULD RATHER DIE than have someone tell us how to spend our money. We will gladly have a heart attack if it means we get to be free from unnecessary government oversight. It also means we are willing to let our parents, children, and friends die in exchange for those same freedoms. Two hundred years ago, we fought a war for our freedoms, and we have a legacy to uphold.
Is this the right way to think about one’s own health and the health of a nation? There may not be a “right way” and a “wrong way”—currently, what we have is the American way, and each country addresses this conundrum individually.
My exchange with my colleague at the conference shows that this question is complex and that our approach to healthcare is rooted in our societal DNA. As such, altering our healthcare system via debate is not going to be easy. I hope it does not take another war. Recent legal decisions have questioned the constitutionality of the Affordable Care Act, and as the legislation hangs in the balance, it will be very intriguing to see how we reconcile the future of healthcare with our American past.
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