17 February 2007

Looking at limitations

The Catholics teach that it's a moral good to embrace a philosophy of abundance. Meaning that God will provide, and that there are no limitations in faith. That fits right in with the American ideal of the frontier and the "American dream" — where there are also no limitations. There's always more land to develop and each one of us has the personal potential to become a millionaire, if only via the lottery. We don't think about the world's absolute finiteness, and we certainly don't want to hear about restrictions.

This paradigm's tragic results have been an ongoing theme for Colorado's former Gov. Richard Lamm. He served three terms, despite his proclivity to consider public policy in philosophical terms, a decidedly European quality for an American politician. Lamm talked about hard choices in healthcare long before most people were willing to admit that Americans already ration it by income. "Public policy must find a way to prioritize what benefits are covered instead of which citizen is covered," he writes.

Lamm is now a professor at the University of Denver's Institute of Public Policy Studies, where he's also co-director. He's also executive director of the Center for Public Policy & Contemporary Issues. There's still philosophy in the mix, perhaps a la Peter Singer, who also infuriates people by the fact that what he says is so easily taken out of context and seen as dangerous relativism.

And in fact, the common good can be perversely used to foster injustice. The film Damaged Care was the true story of how Humana and other HMOs got it wrong by rationalizing not providing expensive care supposedly so that they could provide more care to other patients. Laura Dern plays a physician who denies coverage to a man on his way to a heart transplant that would have cost $500,000. As she leaves Humana's headquarters, she passes by an extravagant new fountain. Its pricetag: $450,000.

We don't hear about problems with limitations on care in other industrialized nations, which all guarantee healthcare to all their citizens. There were stories for a while from Great Britain, but that was under Maggie Thatcher, who was trying to drown their national health system in a bathtub (a tub now owned by Grover Norquist).

The question of understanding how to use rapidly advancing technology ethically will remain with us as long as we continue to advance technologically. But I'd posit that abuses are more likely to arise when the profit motive becomes involved.

Healthcare, and the conundrums that arise in relation to it because of our American philosophy of abundance, are the subjects of two books by Lamm. He wrote The Brave New World of Health Care in 2003, and a new book is due out this June, Condition Critical: A New Moral Vision for Health Care.

Lamm wrote an article with a similar title for the World Future Society, in which he made several good points, including:
Public policy should concern itself more with extending the health care floor than raising the research ceiling. Public policy makers must care about the health of the total society as passionately as health providers care about an individual's health.
That has largely been missing in the United States — something that public health folks write about over at the American Journal of Public Health.

The healthcare mess is not unlike our crazy system of development — which is also something that Gov. Lamm has thought a lot about. He's the guy, remember, who said "If we don't build it, they won't come" — and said no to a Winter Olympics coming to Colorado.

Denver sprawled anyway, but I remember that at the time, I was pretty enthusiastic about our iconoclastic governor just saying no.

The point is that our philosophy of abundance — that no one should ever say no to advances in heroic medicine, for instance; or that no one should ever say no to another sprawling development — exists without regard to the fact that we live in a finite world.

It leaves us with gross misallocations of healthcare, with the wealthy getting MRIs just because they're insured and their doctor will make an easy $500 if he orders it, and the poor and middle class going without basic primary care.

It also leaves us with eye-watering sprawl that most people don't even seem to see. Its meanness no doubt affects everyone who drives through: Do we really all have to read Jane Jacobs or James Howard Kunstler to actually see?

We're wrong to think that acknowledging limitations will make us less. It's like editing. One of the reasons blogs can go on and on is because there's no editor involved. Really. Someone saying that's too many words — or eating up too much land or resources — can actually make a system better, not worse.

1 comment:

Unknown said...

Thanks for these cross-disciplinary thoughts about the need to recognize limits. A minor theological critique, though. There's a great difference between the moral principle of abundance, and the American fixation on affluence. Abundance can open the possibility of finding enough, of sufficiency, within the constraints of what we have. Affluence always seeks more.

Rev. Peter Sawtell
Eco-Justice Ministries