Another Opportunity for Hypocrisy?

by Howard Ross, Founder & Chief Learning Officer

Last week a divided panel from the U.S. Court of Appeals for the 11^th Circuit in Atlanta struck down the insurance mandate portion of the 2010 health care law, ruling that Congress overstepped its authority when it required all Americans to have health insurance.

To be clear, this ruling does not end the legal debate on the legislation, which will undoubtedly eventually be decided by the Supreme Court, but it is a frightening harbinger of what is likely to come. As much as I searched the newspapers and internet over the past few days, I was unable to find any hue and cry against this “radical judicial activism” from those who were so vociferous in that characterization when the courts ruled against voters or legislators decisions on marriage equality, affirmative action, or other such issues.

In all transparency I supported the healthcare bill.  Actually, that is not truly accurate because I had hoped it would have gone further.  But at least it was a start.  An acceptance of the general notion that quality healthcare should be a right for all citizens. 

Now I know that many people criticize and condemn that idea.  They see it as a move towards “socialized medicine.”  But I have a hard time understanding why it is fine for us to have state-sponsored education, state-sponsored traffic laws, state-sponsored postal service, and a state-sponsored military, but it is somehow repugnant or “socialist” to have some governmental process that ensures health access in a society that prides itself on the notion that the American people are endowed with “…certain inalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

Life, Liberty and the pursuit of Happiness.  It is hard in my mind to understand how life and happiness (and arguably liberty as well) are not related to health.  Life is obvious. But I know that I am never less happy than when one of my loved ones or I is sick or injured.  I would find it appalling if some Americans in general, regardless of race, economic status, gender, etc., had less access to quality healthcare and poorer health outcomes.  But how often that happens is not random in our society, it is directly related to race and socio-economic status.  Consider these Department of Health and Human Services statistics:

• African American men are over twice more likely to die from prostate cancer than White. While breast cancer is diagnosed 10% less frequently in African American women than White women, African American women are 36% more likely to die from the disease.
• African Americans are twice as likely to have diabetes as Whites. Hispanics are 1.5 times as likely to have diabetes as Whites. American Indians and Alaska Natives are twice as likely as non-Hispanic Whites of similar age to have diabetes.
• African American men are 30% more likely to die from heart disease than non-Hispanic white males, despite the fact that 6% of African Americans have heart disease.
• 32% of African Americans have hypertension compared to 23% of Whites.
• Non-Hispanic Blacks are 60% more likely to die from viral hepatitis, as compared to non-Hispanic Whites. American Indian/Alaska Natives were almost twice as likely to develop a case of Hepatitis C, as compared to the White population.  Hispanics are twice more likely to be diagnosed with Hepatitis A than non-Hispanic Whites.
• African Americans accounted for 52% of all HIV/AIDS cases diagnosed.
• African American mothers were 2.3 times as likely as non-Hispanic white mothers to begin prenatal care in the 3rd trimester. Or not receive prenatal care at all.
• American Indian/Alaska Natives have 1.6 times the infant mortality rate of non-Hispanic Whites.
• Puerto Rican infants were twice as likely to die from causes related to low birth weight, compared to non-Hispanic white infants.
• The infant mortality rate is 1.7 times greater for Native Hawaiians than for non-Hispanic Whites
• Mexican Americans, who make up the largest share of the U.S. Hispanic population, suffer in greater percentages than Whites from overweight and obesity, two of the leading risk factors for heart disease. Premature death was higher for Hispanics (23.5%) than non-Hispanics (16.5%).
• Oral health disparities are so dramatic in this country that Native American people have dental diseases 3-5 times as often as Whites.

I could go on with similar statistics that link income levels, sexual orientation, and gender to health performance. Data that link poor healthcare to education and job attainment, especially for poor children, is readily available. But the real issue is why so many of us feel comfortable ignoring the obviousness of this data.

“Liberty and justice for all?”  

“Life, Liberty and the pursuit of Happiness?”   

The “best healthcare system in the world?”

 According to the World Health Organization, the United States is:

• 31^st in the world in life expectancy (tied with Kuwait)

• 37^th in the world in infant mortality (an American child is 2 ½ times more likely to die before the age of five than a Singaporean child)
• 34^th in the world in maternal mortality (an American mother is 11 times more likely to die in childbirth than an Irish mother)

Who are we kidding?

I have heard the argument that the United States Constitution does not provide for healthcare for all.  But, of course Article 1, Section 2, Paragraph 3 of the United States Constitution also did not provide for African Americans to be counted as full human beings, and, of course, there was that sticky issue of a woman’s right to vote…

I have heard the argument that this service is best provided by the states, which was, of course, the same argument that Mississippi and Alabama used to resist the Civil Rights movement.

I have heard the argument that people should be able to decide for themselves whether they need health insurance. But there have been numerous times when we have decided as a society (education, child labor, child sexuality, seat belts, etc.) that the well-being of our citizenry requires that we sometimes be protected from our own poor decision-making. Not to mention the fact that we as a society pay for the lack of health insurance of our fellow citizens through the rising tide of healthcare costs.

And I have also heard the argument that private industry is better able to provide these services. I generally believe that there are many healthcare companies that combine a deep commitment to service with an ability to operate a consciously capitalist company. But we also have to admit that there are some who are simply out for profit and need to be carefully regulated.

Unfortunately what is just under the surface of the resistance to our intervening in the tragic inequity in healthcare in our society is a rising tide of Social Darwinism, a notion, originated in the 19^th Century, that some of us are just more “fit” for survival and it is simply the evolutionary forces of nature that sort out the ones who aren’t.  It slips out sometimes, as when Utah Senator Orrin Hatch recently said, “The poor need to share some of the responsibility in reducing America’s debt burden.”  It is a philosophy that was generally discredited after it contributed to the development of eugenics, scientific racism, imperialism, and fascism.

One of the overarching themes in my just-release new book, ReInventing Diversity: Transforming Organizational Community to Strengthen People, Purpose & Performance, is that we all need to work to overcome the deeply ingrained and polarizing dynamic of “us versus them.”

Personally I don't believe that poor people, black and Hispanic people, women, and gay people are getting poorer health results because they are “less fit to survive.” I believe we, as a society, have not joined virtually the entire developed world in understanding that it is the responsibility of the strong to assist the weak. And the rich to assist the poor. How? By providing the simplest, if not the easiest, of safety nets: universally available and affordable health insurance.

The notion that just because you are poor, black, Hispanic, gay, or a woman, doesn't mean that you should be doomed to be sick and die more than those who are rich, white, straight men.  And, if you don’t believe that we have a responsibility to help our neighbors than consider your own family’s self-interest:  when your neighbor’s children are sick because they can’t afford quality healthcare, they still play on the same playground as your children and grandchildren.

This fight is not over.  Please contact your elected representative today and tell them that we need to stand strong for a quality healthcare for all people in this country.  And if the Supreme Court overturns this bill, we intend to fight for another so that the United States can truly have liberty and justice for all.