Sunday, August 16, 2009

American Values and Health Reform (2): Liberty

As I noted in a post last week, The Hastings Center has published eleven short essays as a small booklet – “Connecting American Values with Health Reform.” The aim of the project was to consider what we want health reform to accomplish and what values our institutions and practices should be built upon, based on the belief that more clarity about underlying values would allow legislators and the public to handle reform more effectively. This post is the second of three I plan to do based on The Hastings Center project.

Bruce Jennings, senior consultant at The Hastings Center, wrote about "liberty." In the context of the orchestrated hooliganism that is disrupting town meetings and the stunningly confused public fear that government involvement means euthanasia, Jennings's comments are remarkably prescient:
Values so ubiquitous [like liberty] are often taken for granted and not sufficiently scrutinized. They therefore have great political power yet are vulnerable to cynical misuse and manipulation...The health reform conversation has to be reframed at the grass roots level so that a new way of seeing what liberty is and what it requires will grow out of that conversation. (emphasis added)
The reframing of liberty that Jennings wants to encourage is to see liberty as freedom to, not simply freedom from:
Health care is not simply about preserving you from the 'outside' interference of others or of disease; it is also about obtaining the active assistance of others so as to enhance the types of activities you can pursue and the kinds of relationships you can have. Thus, health care is as much about positive liberty as it is about negative liberty.
The fundamental American skepticism about claims made by government and other authorities has largely been a force for the good. But as Jennings suggested, our attachment to liberty from external control is vulnerable to "cynical misuse and manipulation." That's what we're seeing now, as in this statement by Newt Gingrich about the allegation by Sarah Palin and others that the House health reform bill promotes euthanasia:
I think people are very concerned, when you start talking about cost controls,'re asking us to trust the government. Now, I'm not talking about the Obama administration. I'm talking about the government...We know people who have said routinely, well, you're going to have to make decisions. You're going to have to decide. Communal standards historically is a very dangerous concept...You're asking us to trust turning power over to the government, when there clearly are people in America who believe in -- in establishing euthanasia, including selective standards.
The President has tried to mobilize a sense of crisis about health reform, but thus far the true danger that runaway health costs will euthanize American prosperity does not measure up to the false claim that health reform threatens the lives of our citizens. A subset of the population that appears to hold a monolithic commitment to negative liberty - freedom from -is prepared to believe the Republican lie that an administration led by a "foreigner" is covertly preparing to kill its citizens.

Words like "insane" and "paranoid" are being used too casually. While there probably are a few clinically paranoid people among the hooligan protesters, my guess is that most are folks who would (a) get a "D" in a college ethics class because (b) they are unable or unwilling to see complexity among values but who (c) unlike lazy students are (d) prepared to be mobilized into a fascist gang disrupting public meetings.

Jennings's essential argument is powerful:
One tenet of [health reform] should be that equity in access to health care, reduction in group disparities in health status, and greater attention to the social determinants of the health of populations and individuals are all policy goals through which liberty will be enhanced, not diminished...we must see that health reform involves equitable access to the social preconditions of health, as well as to health care...that when anyone lacks such access the liberty of all is compromised.
His vision, however, won't silence the hooligan disrupters, especially as their fears are stoked by cynical politicians of the Gingrich/Palin ilk. But his analysis, and others, may help legislators and members of the public understand the otherwise perplexing frenzy we are currently seeing and turn against it.

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