From the 4th Quarter 2007 issue of Health Planning TODAY.  To read the full article, click here.

It seems obvious that we have closed minds about American health care, a condition that has been ascribed to American education as well. Twenty years ago, Allan Bloom’s The Closing of the American Mind (Simon & Schuster, 1987) took a radically unorthodox view of American education much as the documentary Sicko is now doing for health care. His philosopher’s observation on an insidious political process at work in our society provides insight into the real barrier we face in policy reform, not just in health care: "The most successful tyranny is not the one that uses force to assure uniformity but the one that removes the awareness of other possibilities, that makes it seem inconceivable that other ways are viable, that removes the sense that there is an outside." (p.249)

Doublethink

On Sept. 24, 2007, John Goodman, National Center for Policy Analysis president, issued an e-mail "Health Alert" announcing that he was establishing "the Mondrian Award for Ineffectiveness in Health Policy." Interested, I read on only to learn that "the award will go to the program, agency or proposal that promises the least health outcome for the most dollars spent," and that he had given it the name "Mondrian" to signify the minimalist nature of the health policy thus selected. I was eager to find out which policies he had in mind, but he hadn’t yet selected one. Instead, he just wished to discuss the award’s potential to identify so much waste. Then I came across this:

If this doesn’t look to you like a distorted view of our social and political reality, nothing I could write will reveal it to you. I just wonder how much of the distortion is economic, how much is political, and how much is moral.

There is a moral blindness in our nation, evident in national politics ever since Ronald Reagan said in a speech in 1964: "We were told four years ago that 17 million people in America go to bed hungry every night…. Well, that was probably true. They were all on a diet." And now, due to our political blindness, the nation has been put on such a diet for the last seven years.

The President’s explanations about why he would veto the expansion of SCHIP proposed by Congress led him to assert that the uninsured "have access to health care in America. After all, you just go to an emergency room." This can have some credence only for those who have no concept of what a health care system is, nor any appreciation of the proper role of public health and prevention in it. If they did, they would see the need to use emergency rooms for any but true emergencies as failures that ought to be obviated by a health care system that places public health on top and values personal medicine for providing a medical home for health education and preventive care. And it is the lack of such care leading to the misuse of ERs that causes people to descend into bankruptcy and poverty. Here we see the promulgation of the same distortion "that removes the awareness of other possibilities," and through it, "removes the sense that there is an outside," in the fateful words of Allan Bloom. I hope the time has come for us to see what lies outside such a treasonable lack of governance.

The almost total ascendancy of libertarian values over communitarian ones – too much freedom – exacts a serious moral, social, and emotional price. The orthodoxy of neoclassical economic theory elevated to a sort of secular religion has managed to redefine "the cost of living" in terms of the alienation of those who follow it, alienation from our authentic self and from our obligations to each other. We manage to think we love our individualism without realizing how misguided our ways of expressing it have become. All these blind spots should be seen for what they are: symptoms of how we have come to live our everyday lives without a sense of the values implicit in living a mindful life intentionally. We no longer seem to see that the meaning of life consists of giving life meaning.

And so, Bloom’s insight is that the most successful tyranny is the blindness that results in our living out the sort of impoverished lives that match the conception of human nature contained in orthodox neoclassical economics. Health care is just one of the important social institutions needing to be reformed. The success of that will be determined by how well we are able to see through the smokescreen of societal myths far upstream from it. We must see that there is an outside and redeem our original values in that clearer light that restores a truer vision of the good life.