What No One Really Wants to Talk About: The Real Hang-up about Health Care Reform

            The anger over the proposed reform of the nation’s health care system has exceeded everyone’s expectations.  At first, much of it, especially the histrionics that exploded onto the scene at the many town hall meetings held earlier this month, seemed orchestrated, if not by Republican opponents of President Obama, then by the insurance lobby that figures to take the biggest hit in any real reform measure that gets signed into law.

            The evidence of such an orchestration has been reported.  (That evidence included a memo from one lobbyist to ad hoc groups like “Americans for Prosperity” and “FreedomWorks” that outlined tactics to be used to disrupt the town halls.)  But beyond any dirty tricks, the sentiment that has settled over large segments of the grass-roots population is less about politics and much more about the great unspoken fear: death.

            Death is at the heart of the opposition to health care reform.  It isn’t rational, logical or even intellectually coherent, but that single-word subject is what has put President Obama’s health care reform agenda at great risk.  And, as might be expected, his opponents have made the most of the fear that surrounds the subject by falsely claiming that the bills establish “death panels,” and, this week, by alleging the existence of a “death book” that is somehow tied to the current proposals.  (The “book,” such as it is, is nothing more than a 52-page pamphlet, developed during the Bush administration to counsel veterans on end-of-life options and decisions.)

            But let’s get past the rhetoric and deal directly with the fear; let’s talk about the subject itself.

            Death is real.  It’s that part of life that all of us will experience, albeit we will never know we have when we do.

            Let me try that last sentence again, slightly rephrased to make my point.  Death is that part of life that everyone will one day experience, even though no one will actually know they have experienced it when they do.

            What am I saying?  Simply that we are all going to die, but once we do, we won’t know that we have, because death is, so far as we can determine, the end of consciousness, and, notwithstanding Hamlet’s trepidations to the contrary, the end of unconsciousness (i.e. dreams) as well.

            Thus, to die is to cease to know of life, even to know of our own demise.  We can know (or at least sense) that we are dying, but we can’t know that we have died.

            So, what then is the fear?  In part it is the fear of the unknown, and in part it is a fear of the known.  The unknown is the subject of much religious dogma, centered on the idea of some kind of after-life, a life after death that is available to the righteous in some religions and to everyone (albeit the quality may differ drastically) in others.  Since the unknown is implicitly unknowable, it is the proper purview of religions, dealing as they do in the unknowable, even as they pretend to know, even down to the finest details, the precise nature of it.

            But I digress.  It’s the known aspect of death that is at the heart of much of the opposition to health care reform.  And what we know is that death ends life as we know it.  In other words, to die is to cease living in the present world to which we’ve grown accustomed.  And, inherent in this cessation is the end of our identity as a living person.  Once dead, we lose our selfness, our ego, if you will.

             Ego is a powerful force.  It motivates our actions, it corrupts our ideals, it colors our perceptions, and it creates our will to survive. 

            And so do we fight death, even knowing of its inevitability.  We seek life-everlasting, immortality, mastery of our destiny.

            And that last point is the cause of the resistance to health care reform.  It springs from the wish to live forever, or, failing that, to die on our own terms, if not by something like a DNR (Do Not Resuscitate) directive, then at least by virtue of natural fate (or God’s will, if you prefer).

            But the health care reform proposals threaten that wish, or at least they introduce that possibility.  They do so by implicitly acknowledging that health care costs cannot be sustained unless some procedures are made unavailable.  No system, whether run by private enterprise or by the government or by some combination of both, can afford absolute coverage of all possible life-sustaining measures for everyone.  At some point, potential recipients of such measures must be denied.

            Of course those decisions have always been made.  In the past doctors themselves refrained from “high-risk/low-likelihood-of-success” procedures.  And currently HMOs deny coverage for the same type of procedures.  In both instances, the decisions have been hidden for the most part.  But health care reform would bring those decisions to the surface, with a government-run bureaucracy potentially taking on the position of the HMOs (themselves no less bureaucratic).

            Rationing is a harsh word, but it is also a very real one in contemplating health care reform. It isn’t an Orwellian solution; it’s a practical and essential one, driven solely by reality. 

We can’t afford to give the terminally ill the high cost surgeries that will, at most, extend life by months.  And we can’t afford to provide the severely disabled with high cost procedures that will, at best, only marginally improve the quality of life while posing the risk of even greater suffering.

            These decisions are hard and cold realities.  They are currently being made by private insurance companies whose primary goal is to make money for their shareholders.  In the health care reform measures currently contemplated in Congress, they would be made by teams of doctors paid by the government.

            Either way, death remains the reality.  Under the current system, we are going bankrupt and we still die.  Under the reform proposals, we can achieve financial stability, and we will die no more quickly and no less willingly.