Satyagraha

Cultural Psychology

The Moral Wrongs of Obamacare. Part 1. Entrenching the Medical-Industrial Compex

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I believe it is important to set down, in as methodical and systematic way as possible, the ways in which Obamacare is not only risky or potentially harmful, but actually something morally wrong.  Several times I’ve begun to write an article that does this, and each time had to quit as the task became simply overwhelming in scope.  It is a big issue, a huge one.  We’re talking about something that may constitute, both in what it is and what it may lead to, a fundamental restructuring of the system of American government and the nature of our society.  Yet, as many times as I give up and put the project aside, I feel dissatisfied for having done so and return to it again.

In part, what I face is what every person faces when, in a debate, they encounter the big lie.  The big lie is the tactic by which a party presents a falsehood so enormous, so outrageous, so utterly beyond the realm of plausibility, that it literally overwhelms the ability of the other party to refute it.  The opponent is simply flummoxed, bewildered by the sheer audacity.  The big lie changes the ground rules of a debate, transforming what should be an earnest attempt by two agents of good-will to find the truth, into something of bad-will.  The big lie is a power play, a trick, which seeks to win  by deceit and  subterfuge.

The big lie tactic therefore, is not used, or should not be, by decent people, either in debates between two people, or between groups of individuals in a social or political context.  However in the present case we are not debating an individual, nor groups of individuals.  We are ‘debating’ – in a broad sense of that term – a vast system, something intrinsically amoral.  It is a system like or analogous to the military-industrial complex, but something much greater; a system that includes our government, our political parties, Wall Street, multinational corporations, and our news and entertainment media.  Moreover, each of us is, to varying extents, consciously or unconsciously, part of this system.  Anyone who has a mutual fund or retirement plan with dividends linked to Wall Street profits, is, to some extent, part of this system.  This system is our opponent.  That it resorts to the big lie to sway public opinion is the least of our problems.

One reason the big lie tactic is so effective is that an opponent faced with the prospect of refuting it envisions how hard a task it will be, and simply gives up before trying.  Much as I might like to do that, I simply don’t see it at as an option.  The only alternative, therefore, is to try to make this daunting task more manageable by breaking into several smaller ones.  The present, then, will be the first of several installments dedicated to this.

Preliminary Remarks

Some preliminary remarks are in order.  First I wish the reader to know that I am most certainly committed to the principle of social justice – both in general, and in the particular matter of health care.  I *am* a health professional, and I chose that profession not to make money, but because helping people with health and psychological problems is in my nature.  It is my vocation (or, at least, one of my vocations).  In fact, it is precisely *because* I care about people’s health that I am opposed to Obamacare, which I see as ultimately harmful to public health. I have major political and economic concerns, also; but, frankly, I would be willing to overlook these were it not for the disastrous effects on public health.

Second, I should make clear that it is not Obamacare in particular that I am concerned about, but rather any attempt to place the healthcare system further under the management and direction of the federal government.  If a plan of universal health care administered at the level of local or county governments could be developed, I would have much less reason to object.  In any case, it is certainly not because the new plan is associated with President Obama that I object.  For me that is simply a term.

Third, I wish to clarify what I mean by “moral wrong.”  I mean this in the strictly technical sense of moral philosophy.  That is by “moral wrong” I mean (1) what is opposite or opposed to moral good; and (2) that which we therefore have a moral responsibility to prevent, change, or oppose.

Finally, it should be pointed out that I am not writing this out of any need or wish on my part to merely complain or criticize.  There is already too much emotionalism, antagonism, and partisan strife in society today.  I know better than to be part of that.  I am writing because I should.  I have many years’ experience in diverse facets of the health field, an insider’s perspective (including positions at
Duke University, Wake Forest University, and the RAND Corporation) and, it could honestly be said, a uniquely informed one.  Much as I might like to evade it, I have a civic responsibility to write about this.

These clarifications made, let’s proceed to the analysis.

Reason 1.  Industrial Medicine

The first and greatest reason why I see Obamacare as morally wrong is that it will consolidate and entrench the paradigm of modern industrial medicine in our society.

By consolidate I mean it will strengthen and make more prominent the model of industrial medicine, and those organizations and institutions that promote it, and it will drive out competing, non-industrial health paradigms.  By entrench I mean that, once consolidated, it will be extremely hard, almost impossible, at least for many years, to change that paradigm.  We will watch in anger and disgust as public health and healthcare deteriorate, and be powerless to change it.

By modern industrial medicine I mean the prevailing system by which medicine is practiced today, which emphasizes (1) domination of healthcare and policy by large corporations, (2) treatment rather than prevention; and (3) expensive rather than moderately or low-priced alternatives.

The modern paradigm of industrial medicine is inextricably linked with profit motivation.  The innovations in healthcare, the new products that emerge, are those which deliver the most profit to corporations.  The nature of the system is that there is every incentive to develop expensive, invasive interventions, and virtually none to produce less expensive and less invasive treatments.  The paradoxical nature of “health for profit” can be illustrated with a hypothetical example: if we had the technology to develop a pill that cured the common cold that cost .1 cent per dose, we wouldn’t do so.  There’d be no profit in it.  But if the same pill could be sold for $10, companies would be fighting tooth and nail to develop and market it.

Similarly, it is well within our technological ability to wipe out a global scourge like malaria; but this receives comparatively little attention, because it isn’t seen as profitable.  I don’t know the actual statistics, but wouldn’t surprise me if more money is spent in the US developing new versions of Viagra and Cialis than goes into anti-malaria research.

Malaria doesn’t affect public health in the US, but obesity does.  So do the effects of alcohol and tobacco use.  The effects of this deadly trio alone probably account for at least half of all hospital admissions in the US.  We have virtually an unlimited ability to prevent these problems.  Anybody can stop smoking.  Most obesity can be prevented by intervening in childhood.  But, again, it’s much more profitable to treat the outcomes of these problems than to concentrate on prevention.

This problem affects the very foundation of medicine, the culture of it.  It affects how physicians, nurses, and medical researchers are trained.  It affects undergraduate education.  By the time someone gets an MD or a research PhD, they are fully indoctrinated in this model.  It becomes difficult to think of health in any other terms.

As long as the federal government stays out of healthcare there is some hope for change.  We always have the potential for new ideas and innovators to arise at the grass-roots level, to demonstrate new paradigms, which catch on and influence others.  But the danger of Obamacare is that, in centralizing healthcare delivery, planning, and policy to an unprecedented degree, and laying the foundation for still further centralization, we make it much harder for the grass-roots kind of innovation to occur.  Instead, will have a massively top-down model of dissemination of technology and practice.  Centralized boards will review and approve only certain medical procedures, and will pressure all players to use these methods.  Further, it is the large corporations who will have the most influence in choosing these methods and designing policies.  Naturally these policies will lean towards  practices and a basic philosophy of medicine that produces the most profits.

It is not just the actual dangers outlined above that concern me.  Beyond these is the fact that we will be placing literally our lives under the control of a vast, amoral, non-human system.  We have already seen, over the last 50 or 60 years, what happens when we place national defense in the hands of such a system: instead of peace, which is the natural desire of every human being, we have perpetual war.  Our collective policy becomes utterly dehumanized, and inimical to each individual.  I do not see how we can expect anything different when we hand over control of our health to the federal government and profit-driven corporate system.

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