I’ve seen two types of reaction to Trump’s proposed replacement for ‘Obamacare’ this week. The first is a mixture of horror, anger, fear and disgust, and covered all the Americans in my completely unscientific sample, as well as many of the Brits. What made the British reaction slightly different was the confusion and the disbelief. I don’t claim to speak for an entire nation, but certainly prevalent within my echo chamber was the perpetual bafflement at how healthcare works in the US. We just don’t get it. And we’re not alone.
What is it about universal health care that makes it so unthinkable for so many Americans? Why was there such a vicious hatred of ‘Obamacare’? And how on earth can Republicans justify replacing it with something far worse, that many admitted they hadn’t even read? One way to get to those answers is via the question in my title: what is the value of a life?
To try and get my head round it, I’ve been pondering a few analogies. The cultural difference between the UK and the US is so huge when it comes to health care, that some of these analogies are a little bit ‘out there’. They might be a bit upsetting or offensive. Bear with me.
There are only a few times when British people need to think about the cost of health, if they don’t have (optional) private health insurance. Most of the time we pay nothing at all, other than our national insurance contributions of course. Dental treatment is heavily subsidised, as are prescriptions. We might weigh up the value of a life when we take out travel insurance, or life insurance. But probably the closest we get to seeing the American way is when we look at pet insurance.
If our pets become ill, we can choose which veterinarian surgery to take them to. We are given the costs in advance. If we are lucky, we can afford treatement, or we can claim it back via our insurance company. Premiums go up as the pets get older, and pre-existing conditions might not be covered. Long-term illnesses or conditions can become increasingly expensive. There may come a horrible time when treatment is no longer affordable- or when it is no longer cost-effective. There are some tough choices ahead when that happens. Is that where the similarities end? Perhaps. For now. But when health care is corporate, there will always be some treatments that are not seen as cost-effective. What do human patients do then? Do they suffer without the treatment they need? Are they gently ‘put down’ to avoid suffering? Are they abandoned to shelters, to become someone else’s problem?
If a pet dies, the value of their life is determined by how much you paid for them. Some pets are cheaper than others, of course. A pedigree animal would cost more than a mutt. Is a pedigree animal’s life worth more? If people die when covered by insurance policies, compensation might be paid. Does that amount represent what that person was worth? Or just how much they could pay for a premium? Does compensation measure the impact that person might have had on those around them? How much they are missed by their loved ones? What sort of role they played in their society?
Maybe our value is just the sum of our component parts. What is our scrap value, I wonder? If we took into account the going rates for organs and hair, factored in some creative butchering and tanning, we could probably arrive at a figure. Is that what we are? Is that how we value a life?
I suppose we could consider our value in terms of our contributions to society- either in terms of the service we provide in our job, or the tax that we pay from our income. The purpose of health care then becomes an investment in a healthy tax-paying workforce. Keep ’em healthy, keep ’em working. But what about those who don’t work yet, or who are currently unemployed, or who have retired? Are they no longer worthy of investment? Do they not contribute to society?
These are all pretty grotesque, right? Because the only acceptable answer to the question isn’t a number. Value isn’t accurately determined by the inherent qualities of an object; value is bestowed by others. The best indicator of our value is in how well we are loved. You cannot put a price on that, and you shouldn’t. What our wonderful, beautiful NHS was designed for is to only value human beings in this way. Health care is a cost, not an investment. It is not a capitalist opportunity. What is the value of a life, for a doctor or a nurse? It doesn’t matter. They will help you no matter who you are, no matter how wealthy you might be, no matter how you may have suffered in the past.
There are reforms that are needed in the NHS, but applying corporate notions of value to human life is disgusting. Human beings are not pets, they cannot be sold for scrap, and we should never determine the quality of someone’s care by their bank balance. What sort of person would do that? Oh, right.
Universal health care is expensive for governments, requires funding via taxation, and it is not perfect. But not having it at all speaks volumes about a nation. Just as the speed of the pack is determined by the speed of the slowest member, the values of a nation are shown in how they treat their most vulnerable. What ‘Trumpcare’ proposes to do is punish the most vulnerable in order to give a tax break for the super wealthy. How are Republicans valuing human life?
Something that really stings is the hypocrisy of this behaviour from those who claim to be Christians, selectively quoting from the Bible to justify their homophobia, or to claim power based on alleged moral superiority. But in the stories of Jesus healing people, he didn’t charge for the privilege. Nor did he decline to heal those with pre-existing conditions.
In the Beatitudes, Jesus said that the meek were blessed, and would inherit the earth. I am not a religious person, but I appreciate good ideas in stories, and this seems like a decent philosophy. But let’s expand it and turn it around. How leaders treat the meek shows whether they deserve to have power in this world.
Our NHS is under attack by those who want to privatise its services, and who look admiringly at the American model, thinking of the savings that could be made. This should be a wake up call for all Brits. If we want to save our beautiful NHS, we need to be prepared to defend its principles. Because we need only look across the Atlantic to see what the alternative could be.