The following are the President’s Messages from Health Planning Today, 3rd and 4th Quarter 2006 issues. Reprinted with permission.
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John Steen |
My temperament is that of an idealist, and my education prepared me to teach moral philosophy, so it shows in how I now write on health policy. It leads me to want to address the categorical shortcomings I always find in the otherwise growing body of serious writing on universal health care and the health care system this nation deserves, and to do so the way I used to teach philosophy in graduate school.
To teach is to show others how to think clearly, and that can’t begin unless we have questions in mind. So what I’m asking is, “What questions should guide us in determining how to describe the health care system that would provide optimal benefits for the American people?” To answer that we must have a context in which we see the whole picture: Our nation, its people, and our values.
With what tools do we proceed? Clear thinking requires that logic governs thinking driven by moral values, for we must begin with the insight that we are raising major moral questions. And beginning with a vision, we must proceed from the general to the particular, from our goals for our society to the means for reaching them – the health care system we would design. It will save time if we list our questions simply as, “who, what, why, and how,” though logic requires that we address them in a somewhat different order. The context for our thinking will be developed in considering how to answer them:
- What: Good health. What are the conditions that produce good health in a society?
- Why: Because health is fundamental to enjoyment of the “life, liberty, and the pursuit of happiness” that we hold to be our birthright. Compassion for our fellow man and concern for our communities as places supportive of the flourishing of those qualities implies that health is to be seen as an important national goal. This imperative can be expressed by promoting health as a human right.
- How: By maximizing the ability of individuals, families, and communities to define and realize their own well-being.
- Who: It will require the participation of everyone to realize these benefits.
These are questions that can be addressed by national health planning, the sort of questions that were raised by the World Health Organization in producing its World Health Report 2000. The ultimate questions for a discipline must be answered by principles from another, more fundamental one. Commentators usually refer to the roles played by competition and regulation, business and government, but these are political and economic policy questions that need to be addressed in the same way as our questions about what kind of a healthcare system we ought to have. Because
ours are moral questions, they must be answered by each and every one of us, and to do so effectively, we need education in clear thinking.
We Americans need to relearn responsibility for our own development and the role of education in empowering that process. With better education comes more personal discipline and greater participation in public life. Only then can the universal aims of public health be realized through a society that holds education and government in high esteem. There are many excellent articles on improving health in our society in our most informative newspapers, magazines, and journals, not to mention books, but these are all written by and for those well-educated individuals we’ve come to see as an elite. The distances between people need to be reduced by closing the economic, social, and political divides that we’ve allowed to develop through a deficiency of caring.
Of paramount importance is how these values are perceived. The business sector fully understands W. I. Thomas’s principle that “if men define situations as real, they are real in their consequences,” and they spend enormous sums ensuring that we see their products in the best light, and remain blind to their faults. To counter this, we must all teach each other to see more clearly what we’ve been missing – the big picture. For a society as for an individual, its ultimate expression is the face it puts on itself.
More than any other nation, throughout our history we have revered the freedom and the initiative to maximize profits, and we have celebrated those who succeed. But having succeeded, the best of them acknowledged their debt to the nation that offered such opportunities. Rather than setting them apart, wealth opened their eyes to their connectedness to all those who helped to earn it for them. In this, they saw themselves as trustees for the interests of the communities that truly owned the resources they had tapped and expanded. They still knew how to ask, “If I am only for myself, then what am I?”
Education is key to this because these are the ultimate questions for all of us: What is the healthy life? So it all leads back to Socrates/Plato and Aristotle. Are you surprised? And from them we get some fundamental clarifications for our thinking. One is that nothing requires us to adopt a moral perspective for our vision. It has to be our own bent as a person to see these questions within a moral context, and to use a moral compass in deciding them. How else to see compassion and reverence for life as the greatest human qualities, and good government’s fostering of egalitarian principles of human rights and social justice through public health as the right health care system? For it is universal health caring that we most lack in our country now, and the effort to revive it should have what William James called “the moral equivalent of war.”
Winston Churchill’s prosecution of World War II solidified his small nation through such an approach, and at the time he stated that “Americans always try to do the right thing – after they've tried everything else.” Haven’t we done that by now? And, if not now, when?
In Part 2, to be published in the spring/summer issue, John Steen will continue the discussion in the context of the U.S. health system performance.
by John Steen
Consultant in Health Planning, Health Regulation, and Public Health
jwsteen@expedient.net