GELFAND’S WORLD--The newly elected Republican majority in Congress wants to be sure that America is protected against terrorist attacks. They're willing to do what it takes and spend what is required to ensure our security. Otherwise, hundreds or even thousands of us could die.
I suspect that most Americans are on board with this philosophy.
What we're talking about is the idea of collective security. It would be unreasonable to expect every coastal community from Maine to Georgia to raise its own navy. We do it as a nation, not as individuals or families. And when Pearl Harbor was attacked, we treated it as a national loss, not the responsibility of a few Hawaiians. Likewise, when major Hurricanes hit the Gulf coast and the Atlantic seaboard, the national government pitched in with the recovery. Taxes coming from California and Nevada went to those recovery efforts. Few Californians complained.
One reason for creating collective security is that there is an element of randomness in regard to who happens to be in the line of fire. We can't know that it is going to be ourselves or somebody else who gets blown up. And even if it was somebody else who was at the finish line of the Boston Marathon or in the Federal Building in Oklahoma City, we treat such events as attacks upon all of us.
We used collective efforts to deal with the problem, in this case the matter of catching the killers. When an airport terminal was attacked a few days ago, police agencies all over the country raised the alert level and federal agencies were involved.
Terrorism is definable not just by its underlying motives, but by the serious level of its effects. Petty theft isn't terrorism. Graffiti isn't terrorism. Terrorism involves direct threats to human life and, sadly enough, the loss of life or permanent injury.
So we have a pretty good reason to take precautions against terrorism. As a liberal, I share with conservative Americans the desire that we all be protected against terrorism. We have this, at least, to agree on.
I would like to suggest to both liberals and conservatives alike that there is a parallel when it comes to sickness. For a number of conditions, there is an unhappily random element to the whole thing. Childhood diabetes and childhood cancers are examples, as are broken bones and congenital heart defects. What these have in common is that they come as surprises to otherwise normal families and that they can cost a lot.
Considering that these conditions are fairly random and fairly rare, it doesn't make sense for people to consider them in advance as a normal element of their own lives. Young couples planning a family can be forgiven if they don't decide up front what they would do if their new baby has a heart defect requiring surgery. Should every young couple be advised to set aside a couple hundred thousand dollars in advance of having children?
At this level, it makes sense to consider randomly occurring birth defects and childhood cancers as physically and financially analogous to terrorist attacks. They are of course very different things, but each happens without warning and results in costly, painful effects.
In other words, we should consider at least some physical ailments as falling into the category of collective responsibility, in the same way we think about collective security against foreign invasion, because individuals and individual families shouldn't be expected to either anticipate them or (if they happen) to be able to afford them.
Beyond such near-catastrophic events are the severe but usually non-fatal chronic conditions such as asthma, scoliosis, and severe allergies, all of which are amenable to medical care following proper diagnosis.
Let's get to the crux of the argument. If we are to have the equivalent of collective security against serious congenital defects -- in other words, a national healthcare system, or Obama Care, or socialized medicine -- and if we want to extend it to appendicitis, pneumonia, and dangerous allergy attacks, then where exactly do we draw the line? Where do you define a set of symptoms that are guaranteed to be so non-dangerous that we deny access to the national healthcare system for them?
If this seems like a slippery slope argument, I assure you that this is exactly what it is. Nations that create a universal healthcare system for heart disease and cancer don't draw the line against treating the common cold or the flu. The public can't be expected to know in advance that a nagging cough is nothing to be concerned about.
Western industrial nations that create some kind of national healthcare system do draw lines. But they do it after the diagnosis, not before.
When we talk about childhood leukemia, it is easy to make a case, at least at the level of common decency, for some system of universal healthcare. Why then does the conservative political wing insist that healthcare should be provided through the free market?
I suspect that the clash lies in the imagined picture of real world healthcare. It is possible to think of routine medical checkups, teeth cleaning, and the like, as normal expenses of being alive. We shouldn't expect the government to cover the cost of getting your nails done, buying tires for your car, or painting your house. Why then, they might ask, should we put the tab for your yearly physical on the taxpayer?
The answer, I think, lies in the realization that the annual physical, the well-baby exam, and the emergency room are all parts of the same continuum in which mostly normal people are screened for dangerous conditions. What happens from there depends on the diagnosis.
I wonder why conservatives treat our collective fear of cancer as less important than our collective fear of terrorist attacks. Each is susceptible to treatment, but only one is accepted by conservatives as requiring collective spending.
(Bob Gelfand writes on science, culture, and politics for CityWatch. He can be reached at [email protected])