By Prudence L. Gourguechon on 9/11/2009 11:05 AM
I feel like in my life I’ve moved, geographically, through the value conflicts that underlie our current health care debate.
I grew up in post New Deal suburban Washington DC, where the idea of government solving problems was a positive thing, much believed in. In fact just about everyone’s dad was part of the federal bureaucracy, trying to solve problems from the very mundane (creating forms for grant applications (my Dad, Labor Department)) to the very exotic—meeting with Emperor Haile Selassie of Ethiopia to settle some problem or other (my friend Paula’s Dad, State Department). There was truly a belief that everyone’s best interest was served by spending tax dollars on good things that helped everyone—public education, public health, Medicare, social security. Back home in Bethesda, no one complained about taxes. Nobody made much money either. There were all sorts of cooperative activities around—a coop nursery school, a coop swimming pool, an early cooperative group health plan, and a neighborhood Halloween party.
In early adulthood I moved to the Midwest, and have stayed there since. It was somewhat strange to me. No one worked for the government, or had a relative who did. People complained about taxes, saw them as intrusions rather than collecting group resources to do necessary things. People seemed to make more money, have more, travel more. Most people weren’t very interested in what went on in Washington. The group that was the focus of affiliation seemed to be smaller—family, neighborhood, church, town. Government was seen as more or less irrelevant and annoying, though not treated with much rancor.
Then there is a third value stance, often associated with a Western ideology these days, and also prevalent in much of the South. Rugged individualism, “patriotism:’ that seems to wrangle the group together mainly in order to exclude feared outsiders, a call for a non intrusive government that lets the markets and people free to profit and “make their own choices” about “how to spend their own money”. This ideology seems to contend that people can do better exercising individuality and freedom rather than entering into collective agreements for the common good. From this viewpoint, the government is seen as an intruder that will only take away and control, diminish individual choice, bring in the feared Other, and substitute its authority for that of the family.
Comparing the value set with which I grew up with the middle distance position of the Midwest and the individualistic extreme of the Western/Southern view, I am struck by the seemingly irreconcilable differences. Yet, for the country to come up with an effective health care plan, some resolution of this conflict has to be achieved, or one group has to override the other by sheer political power. This is unlikely as, per usual, each of the two more extreme positions needs a good portion of the middle ground in order to prevail.
Psychoanalysts spend much of their time with patients working with internal conflict. I wonder if we can help our country deal with its paralyzing conflict. When we help patients deal with conflict, the first task is to bring it out and elucidate the forces involved as clearly as possible. The second task is to see how the conflict has been, and might be resolved—compromise? A better compromise? Negotiation? Letting go of one side or the other?
It seems pretty clear to me that the presence of a highly charged conflict, in embedded in two conflicting value systems, is the greatest source of difficulty in coming up with national health care reform.
Here are some of the conflicting premises
- The only safety is in individual freedom/vs. the only safety is in large group action
- Government is a benign force essential to solving social problems/vs. government is a dangerous force that causes social problems
- Outsiders are feared/vs. outsiders are welcome/needed
- Someone we don’t know is dangerous/vs. someone we don’t know is probably similar to us
- I know best/vs. experts know best
In his speech this week on health care, President Obama referred to our “national character” and to some extent indicated that confronting and finding some resolutions to this American conflict—rugged individualism versus “I am my brother’s keeper” is essential to success.
I noticed, as did other observers, that the one issue that seemed to lie outside the conflict, that seemed to garner unanimous public support, related to pre-existing conditions. No one, from any ideological standpoint, seems to like the practice that people can’t get insurance if they have a pre-existing condition. I wonder if we can build on this small bit of unanimity to better understand the potential resolution of the underlying conflict. I think just about everyone might say it isn’t fair, and just about everyone can resonate with the hopelessness and helplessness an individual with a pre-existing condition feels when he or she can’t get affordable health care, AND just about everyone knows someone in that situation.
Perhaps these feeling states—searching for fairness, avoiding hopelessness and helplessness, could form the basis of a beginning resolution of the conflict. Measures that meet that benchmark for our citizens might start to bring us together. |