BEHAVIORAL HEALTHCARE
| Issue Date: Online Exclusive May 10, 2011 Online Exclusive Shaping the visions that will define our society |
Like the turbulence that occurs when cold and warm air masses collide, we are in the beginning phases of an epic struggle for control of the vision and the tools that will define our own future as a society. On one hand, Rep. Paul Ryan’s (R-Wis.) budget proposal for Fiscal Year 2012 embodies a vision in which less would go to the poor, the elderly, and the disabled, and more would go to the wealthy and to business. By contrast, President Obama envisions exactly the opposite. Both seek to reduce the large and growing Federal debt. For us, the imperative is to become engaged in this struggle. First, some additional analysis is required. On the right, we have a vision of the future that favors less governmental involvement in health, education, and our general welfare; on the left, a vision that promotes more effective and cost-efficient governmental intervention in our major institutional sectors. Those on the right would address our deficit by shrinking government and its role in community life; those on the left, by increasing taxes on big business and the wealthy.
The rapidly growing urgency of our deficit will increase the pressure on both the right and left to engage in this epic struggle. Probably at no time since President Franklin Roosevelt sought to overcome the Depression have we had such radically different views of our future as Americans.
Although I know that most who read this piece already strongly favor President Obama’s vision, it will be important not only to hold a position in the coming epic struggle, but also to be able to defend that position in our own discourse and writing. Here, I hope to present some key elements of that defense. View of peopleFirst, and foremost, what is our view of people? Do we follow the value enshrined in our Declaration of Independence that “all…are created equal”? If so, we actually are more likely to value all people equally, and to believe that health, education, and work are basic human rights for all. If not, we are more likely to believe that those who are brighter, more calculating, or more risk-taking are entitled to accumulate great wealth and to leave the less fortunate behind. Thus, put most baldly, we will either promote or deny the dictum of social justice and equity.
If one does not favor social justice, then a critical dilemma arises. In order to be competitive in the world, the U.S. economy must be comprised of a healthy, educated, and vibrant workforce. Without equity in health and education, that population simply will not be available in the workforce of the future. The net effect would be that the United States will become progressively less competitive in the world economy. View of governmental actionNext, what is our view of governmental action? Do we think that government must be capable of acting for the good of all? If so, we will favor government intervention in the community—in health, in education, in community welfare—to promote greater equity and overall well-being. If not, we will seek to minimize the size of government and its effects on our personal lives and on our communities. Put most directly, we will favor either the social good or the personal good.
If one favors only the personal good, then we must ask whether government will be available when a crisis occurs. It may be an obvious crisis, such as pandemic avian influenza or a Katrina-type incident. But it may also be much more subtle. For example, what is the role of government in bending the health cost curve? Or, put another way, can the health cost curve be bent without government intervention? I think that the obvious answer is no. View of valuesFinally, what values do we hold? Do we think that an important measure of a society is how it treats its children, its elderly, and its disabled? Or do we think that we should focus principally on self—the kind of individualism that predominated on the American frontier more than a century ago? Sociologists call this difference a communitarian versus self orientation.
If one has a strong self-orientation, then it is legitimate to question what one can expect from society when one becomes disabled or elderly, or both. Clearly, the answer is little or nothing. Our society needs a strong government to protect the life and well-being of its weakest citizens. The epic struggle will be engaged quickly by the right and the left. Hence, we also need to be prepared to advocate quickly. I know that we will. Franklin Roosevelt will be proud.
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