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Health care - what Republicans don't understand
David Emmet Cockrum, an Air Force brat brought up on a succession of air bases on a diet of superhero comics, is one of the four or five men who have the best claim to have created the most successful superhero franchise after Superman. Cockrum is the man who designed the X-men. Stan Lee and Jack Kirby designed the original team; of the two, for reasons I set out elsewhere, I think that Kirby must have been the leading spirit. Len Wein created the new members of the team - including Wolverine, Nightcrawler, Storm and Colossus; and the wayward and ultimately self-destructive talent of Chris Claremont, his successor, gave them form and shape and character. But David Cockrum was responsible for their look and design, and it was that look and design that went around the world on billions of keyrings, lunchboxes and baseball caps.
Well, never mind that. Never mind that he is party responsible for profits worth, at a conservative estimate, several hundred million dollars. Never mind that he is the part builder of a mythology that will outlive all its creators (Nightcrawler was especially his creation, and he dedicated many excellent pages to this character); never mind that he was an able and successful artist whose work has given pleasure to millions. Never mind all that, and let us come to just this: this man worked all his life, earned an honest living - much less than he deserved, but honestly earned from beginning to end, and that his wife worked together with him through their whole careers (she was his colourist). What I am saying is this: that when this good, hard-working American, of military stock, whose life had given a positive contribution to his country and the world, was struck down by a murderous combination of diabetes and pneumonia, he had to spend his last days begging in public for money. It was his good luck that he had many friends and admirers, especially in comics, who quickly got together $40,000 for desperately needed medicines and care (plus an unspecified contribution from Marvel Comics for his part in creating the X-Men). It was his good luck. But then, it was his bad luck, from that point of view, to have been born American.
I only just read of his death (which took place two years ago), and I made up my mind that, whatever happened, this time I could not keep my views to myself. First, of course, there is the personal and artistic feeling. That a man like Cockrum - admittedly, not the top artist in his generation, but a seriously good one nevertheless, and one whose legacy will live - should suffer this sort of indignity in his dying days, just makes me sick. In my country, such a man would probably have received an official pension under the so-called Bacchelli law, a specifically Italian provision (named after the famous writer for whom it was first written) to honour and support people who had honoured the country but had fallen on hard times. This comes from a specifically Italian feeling that our country owes as much to her artists, her scientists, her intellectuals and her philosophers as to any politician, industrialist or military leader; although I like to think that every nation honours her artists, if they are aware of them.
But this, after all, is more than personal. It is not even about an artist it is about a citizen reduced in his last days - without any evidence of improvidence or vice - to begging for money, begging for his life in public. Nothing about David Cockrum's hard-working life suggests that he had done anything to deserve this. And apart from him, how often does this happen? How many thousands, tens of thousands, hundreds of thousands, perhaps, of begging websites are there on the net, begging for someone from America who has worked, paid tax and contributed to private health care schemes for decades - only to be thrown off them just when they need them most, when some lingering and expensive disease is eating them alive from within, and it has become simply too expensive for a private health business to pay for their care? I know that such things happen, because even I, poor as I am, have put in my penny in some such funds.
Americans brag of the multitudinousness of their private charity. They claim that American individuals and American corporations give much more than European individuals and charities. But then we do not expect our old and our sick to be desperate for help just as they are least able to help themselves; to have to go and beg in public just when they most need their dignity and their respect. These things have long been banished from our lands. And the height of demonic irony is that the very people who are working to keep from America the evils of "socialized medicine" always quote the very moments in which the British Health Service turns out to be most like their own - letting unhappy old and sick citizens to die in the cold, or forcing them to beg for money for their cure - as if this somehow condemned the principle of national health care and proved anything in their own favour! Truly, as the poet said, there is no wonder in the world so strange as Man.
In fact, this is part of a much deeper American misunderstanding about Europe. Europeans, for instance, are routinely appalled at the low amount of Americans who turn up to vote. In most European countries, the vote is regarded as a public duty, as much as paying tax. And mention of paying tax rouses another echo: while Americans are more law-abiding than most Europeans (even staid Germany had some incredible revelations recently from banks in Liechtenstein), they have a lot less respect for taxation as an institution. They never pay a penny without grumbling about "the State taking my money" - as if that money were, somehow, their own creation, to which nobody but themselves had any legitimate claim. And the same population treats the vote not as a citizen's duty, but as a kind of favour they do to politicians, and which they can give or withhold at their will. Is this not the same difference? Does it not make a structure? The American does not regard either his vote or his taxation as due, owed, part of his citizenship, his belonging to a unit. Until recently, you could have pointed to a third element: the draft, a founding element in all continental European states, but intrusive and barely tolerated in America, and for that matter in Britain.
The American citizen does not feel that he has anything fundamental that he shares with all the citizens of his country. He does not feel that he is, in the philosopher's words, a tribal animal - zoon politikon - naturally and inevitably a part of a community. He does not feel that the community has certain and inevitable claims upon him; much less that, as the wisest of the Greeks used to say, the nation has a more radical and unanswerable claim on us than our own parents. The vote is something he can give or withhold; the taxation, something he does under protest; fighting in the army has to be volunteer (and I argued elsewhere that this is actually contrary to the letter and spirit of the Constitution). Generations of Americans were taught Perikles' great speech in Thucydides, without understading the force of that remark: "Among us democratic Athenians, and among us alone, a man who does not take an interest in public matters is regarded, not as a harmless fellow, but as good for nothing". We understand it. Among us, to be concerned with public matters, to have an opinion on politics, to vote on it when called upon, is a fundamental duty of citizenship. In Europe, an 80% turn-out for an election is considered disastrously low. In America, the system nearly broke down under the pressure of a 60% in 2004.
That being the case, the difference is obvious. We do not give as much in private benefactions, because we do not need to. We have long made up our mind that such things as health are public concerns, not private ones. And we frankly do not understand the selfish sophistry that argues that the State is entitled to protect the citizen's life from foreign invaders (armed forces) and domestic banditry (police, judiciary, prisons), but not from the equally damaging and murderous physical counterparts, disease, plague, contagion. We understand that such things cost; and on that ground, we accept the inevitability of taxation. But we accept it on a deeper level: for to pay for our collective organization, as to take part in its management with our vote, and to be responsible for its defence in our conscript armies, is simply a part of our citizenship. All these things have been weakened in various ways of late, which I do not find a good development, but the principle still holds. The State and the citizen are bound by mutual obligations of service, and also - as long as the citizen is a free man - by the citizen's duty to criticize and work to correct evetything they see as wrong in the State, indeed in the community. And from that viewpoint, if a European sees a law-abiding, hard-working citizen reduced to penury and beggary by failures in our healthcare system, we will know that it is not just our desire but our duty to work to make sure that such a thing does not happen again.
The arguments for a national health care system are infinite, and here I only set out one that particularly angered me. The arguments against it can be summed out in one burst of outdated, and indeed fairly ridiculous, Victorian rhetoric: "I am the master of my fate, I am the Captain of my soul". No you are not. Your fate does not belong to you; and as for your soul, no Christian with the slightest bit of sense ever conceived anything so wholly ridiculous. The posture of the man who owes nothing to anyone but himself is something that three seconds of unblinkered thought would blow to smithereens; yet policy is still made from it. And on the pretence of being the masters of one's fate and the captains of one's soul, sick and dying citizens are made to go out and beg for their lives at the point in time where they could hope some return for everything they had contributed to the community down their lives.
Well, never mind that. Never mind that he is party responsible for profits worth, at a conservative estimate, several hundred million dollars. Never mind that he is the part builder of a mythology that will outlive all its creators (Nightcrawler was especially his creation, and he dedicated many excellent pages to this character); never mind that he was an able and successful artist whose work has given pleasure to millions. Never mind all that, and let us come to just this: this man worked all his life, earned an honest living - much less than he deserved, but honestly earned from beginning to end, and that his wife worked together with him through their whole careers (she was his colourist). What I am saying is this: that when this good, hard-working American, of military stock, whose life had given a positive contribution to his country and the world, was struck down by a murderous combination of diabetes and pneumonia, he had to spend his last days begging in public for money. It was his good luck that he had many friends and admirers, especially in comics, who quickly got together $40,000 for desperately needed medicines and care (plus an unspecified contribution from Marvel Comics for his part in creating the X-Men). It was his good luck. But then, it was his bad luck, from that point of view, to have been born American.
I only just read of his death (which took place two years ago), and I made up my mind that, whatever happened, this time I could not keep my views to myself. First, of course, there is the personal and artistic feeling. That a man like Cockrum - admittedly, not the top artist in his generation, but a seriously good one nevertheless, and one whose legacy will live - should suffer this sort of indignity in his dying days, just makes me sick. In my country, such a man would probably have received an official pension under the so-called Bacchelli law, a specifically Italian provision (named after the famous writer for whom it was first written) to honour and support people who had honoured the country but had fallen on hard times. This comes from a specifically Italian feeling that our country owes as much to her artists, her scientists, her intellectuals and her philosophers as to any politician, industrialist or military leader; although I like to think that every nation honours her artists, if they are aware of them.
But this, after all, is more than personal. It is not even about an artist it is about a citizen reduced in his last days - without any evidence of improvidence or vice - to begging for money, begging for his life in public. Nothing about David Cockrum's hard-working life suggests that he had done anything to deserve this. And apart from him, how often does this happen? How many thousands, tens of thousands, hundreds of thousands, perhaps, of begging websites are there on the net, begging for someone from America who has worked, paid tax and contributed to private health care schemes for decades - only to be thrown off them just when they need them most, when some lingering and expensive disease is eating them alive from within, and it has become simply too expensive for a private health business to pay for their care? I know that such things happen, because even I, poor as I am, have put in my penny in some such funds.
Americans brag of the multitudinousness of their private charity. They claim that American individuals and American corporations give much more than European individuals and charities. But then we do not expect our old and our sick to be desperate for help just as they are least able to help themselves; to have to go and beg in public just when they most need their dignity and their respect. These things have long been banished from our lands. And the height of demonic irony is that the very people who are working to keep from America the evils of "socialized medicine" always quote the very moments in which the British Health Service turns out to be most like their own - letting unhappy old and sick citizens to die in the cold, or forcing them to beg for money for their cure - as if this somehow condemned the principle of national health care and proved anything in their own favour! Truly, as the poet said, there is no wonder in the world so strange as Man.
In fact, this is part of a much deeper American misunderstanding about Europe. Europeans, for instance, are routinely appalled at the low amount of Americans who turn up to vote. In most European countries, the vote is regarded as a public duty, as much as paying tax. And mention of paying tax rouses another echo: while Americans are more law-abiding than most Europeans (even staid Germany had some incredible revelations recently from banks in Liechtenstein), they have a lot less respect for taxation as an institution. They never pay a penny without grumbling about "the State taking my money" - as if that money were, somehow, their own creation, to which nobody but themselves had any legitimate claim. And the same population treats the vote not as a citizen's duty, but as a kind of favour they do to politicians, and which they can give or withhold at their will. Is this not the same difference? Does it not make a structure? The American does not regard either his vote or his taxation as due, owed, part of his citizenship, his belonging to a unit. Until recently, you could have pointed to a third element: the draft, a founding element in all continental European states, but intrusive and barely tolerated in America, and for that matter in Britain.
The American citizen does not feel that he has anything fundamental that he shares with all the citizens of his country. He does not feel that he is, in the philosopher's words, a tribal animal - zoon politikon - naturally and inevitably a part of a community. He does not feel that the community has certain and inevitable claims upon him; much less that, as the wisest of the Greeks used to say, the nation has a more radical and unanswerable claim on us than our own parents. The vote is something he can give or withhold; the taxation, something he does under protest; fighting in the army has to be volunteer (and I argued elsewhere that this is actually contrary to the letter and spirit of the Constitution). Generations of Americans were taught Perikles' great speech in Thucydides, without understading the force of that remark: "Among us democratic Athenians, and among us alone, a man who does not take an interest in public matters is regarded, not as a harmless fellow, but as good for nothing". We understand it. Among us, to be concerned with public matters, to have an opinion on politics, to vote on it when called upon, is a fundamental duty of citizenship. In Europe, an 80% turn-out for an election is considered disastrously low. In America, the system nearly broke down under the pressure of a 60% in 2004.
That being the case, the difference is obvious. We do not give as much in private benefactions, because we do not need to. We have long made up our mind that such things as health are public concerns, not private ones. And we frankly do not understand the selfish sophistry that argues that the State is entitled to protect the citizen's life from foreign invaders (armed forces) and domestic banditry (police, judiciary, prisons), but not from the equally damaging and murderous physical counterparts, disease, plague, contagion. We understand that such things cost; and on that ground, we accept the inevitability of taxation. But we accept it on a deeper level: for to pay for our collective organization, as to take part in its management with our vote, and to be responsible for its defence in our conscript armies, is simply a part of our citizenship. All these things have been weakened in various ways of late, which I do not find a good development, but the principle still holds. The State and the citizen are bound by mutual obligations of service, and also - as long as the citizen is a free man - by the citizen's duty to criticize and work to correct evetything they see as wrong in the State, indeed in the community. And from that viewpoint, if a European sees a law-abiding, hard-working citizen reduced to penury and beggary by failures in our healthcare system, we will know that it is not just our desire but our duty to work to make sure that such a thing does not happen again.
The arguments for a national health care system are infinite, and here I only set out one that particularly angered me. The arguments against it can be summed out in one burst of outdated, and indeed fairly ridiculous, Victorian rhetoric: "I am the master of my fate, I am the Captain of my soul". No you are not. Your fate does not belong to you; and as for your soul, no Christian with the slightest bit of sense ever conceived anything so wholly ridiculous. The posture of the man who owes nothing to anyone but himself is something that three seconds of unblinkered thought would blow to smithereens; yet policy is still made from it. And on the pretence of being the masters of one's fate and the captains of one's soul, sick and dying citizens are made to go out and beg for their lives at the point in time where they could hope some return for everything they had contributed to the community down their lives.
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On the contrary: medicine would be paid for by the state, so more people would have access to it, so the companies would be able to sell more instead of limiting their market to people who can afford it with their own means.
Of course if a "social medicine system" meant control of the industry by the state, as in some form of communist economy, you would be right, but that's not what a national health system is about.
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I hope you are right, that Americans would be prepared to pay for a national health service that maintained profits to fund research, but i'm not sure that any leader proposing the necessary tax hikes could get himself elected.
I think the main issue for America is that under the present system the taxpayers can't, or won't, pay for universal health care but the structural changes to cut costs would be unacceptable as they would impact directly on the huge number of personal shareholders in medical insurance companies and other areas of the health industry. Even more difficult is the impact the structural change would have on some of the biggest shareholders, pension funds.
Hard choices will have to be made. And from the outside looking in I think they ought to be.
I suppose my basic political view is that "No one left behind" ought to be the motto of every nation when it comes to education, health and retirement.
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You either raise taxes to pay for universal health care under the existing private system, (too expensive to be viable) or you restructure the health system along the lines you mention. A measure which would be very unpopular due to the impact on the share prices of various health industries including Insurance and the equivalent of our hospital trusts.
The fact that Health is the one 'industry' in the US which is more or less recession proof makes it a favourite stock to hold, especially at the moment. It will be a brave politician who will risk the wrath of the small shareholder and those who are members of share-based pension plans.
This is made more serious by the fact that the people who miss out on health care are also those least likely to vote, while small shareholders seem to be very politically aware.
I'm not putting this forward to disagree with your comments on the american health situation, simply to offer an explanation as to why politicians are fearful to do anything about it.
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Nonetheless, change must come. The current situation in America is simply untenable, and, in spite of the enormousness of private health, state and federal public programs are still ballooning out of control. My guess is that it will take a future conservative president, becoming convinced by the facts - like Peel became convinced that the Corn Laws were untenable, or Nixon that the US could not afford to have no relations with Communist China - to drive real, substantial change. As it is, the United States of America are wasting a tremendous amount of money, sapping both public accounts and the welfare of individual families, for no good reason, and at the same time disgracefully encouraging that atmosphere of sneering incomprehension that drives Europe and the rest of the world away from them.
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As for the pros and cons of public research vs. private research, I think they're pretty much the same no matter the area of research: private means profit-driven means more money readily available and more incentive to find results quickly and so it is more effective in some areas. On the other hand, public research means that long-term projects with much potential but no immediate profit, and research on less profitable (but important for public health) products get attention as well.
Both are necessary, I think.
As for the fact the Americans don't welcome new taxes, that's obviously quite true: the whole conception of the State and its role and relation to individuals is at stake here, so I wouldn't await significant changes with bated breath. I really hope that the USA are going to make sure all its citizens get decent health insurance, but I'm not particularly optimistic.
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And I don't know the whole story about the comics artist, but if he were unemployed and homeless, I'd have thought Medicaid would have picked up the medical cost--I've always understood the truly poor and homeless are the ones served by Medicaid. (Medicare is for senior citizens.) The people in the US who fall through the gaps are the underemployed--fast food workers and the like, who don't make enough money to pay for insurance, but whose job doesn't include it either.
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Anyway, this is missing the forest for some of the smaller knots in the lower reaches of one tree. The point is that nobody outside America understand the reasoning whereby the State has the duty to protect the citizen against violence from people, but not against ill-health and accidents.
no subject