Universal Health Care, Individualism, and Social Responsibility

When I was a child, I spoke as a child, I understood as a child, I thought as a child; but when I became a man, I put away childish things.  (1 Corinthians 13:11)

To get The Stand published, Stephen King had to cut it down from about 1150 pages to 750; still quite long for a novel.  I know the feeling.  My original manuscript of The Case for Universal Health Care is about twice as long as the published work.  One part that had to be deleted was an examination of why people tend to view the world primarily through a liberal or conservative lens.  Here, I am using liberal and conservative to describe the values and attributes that influence and shape an individual’s behaviors.  For example, those with a liberal orientation tend to be open to new ideas, opinions, and experiences whereas those with a conservative orientation tend to hold traditional attitudes, values, and beliefs.  An important caveat to this definition is that this is not a dichotomous or bipolar scale; people don’t tend to be completely one or another.  Rather, it is a continuum and the behaviors and decisions people make based on their orientation may be situational.

All people have beliefs, attitudes, and expectations about the variables of individualism and self-reliance.  I found that the more conservative someone’s orientation, the more they believed in the importance of these attributes.  Conversely, the more liberal someone’s orientation, the more likely they believed in shared responsibility.  For a liberal the phrase “a rising tide lifts all boats” conveys the sense that we share responsibility for the welfare of one another.  For a conservative the phrase is fraught with the fear that in helping others there will be freeloaders who will take advantage of our generosity. 

This is not to say that someone with a strong liberal perspective does not value individualism and self-reliance.  However, it is the weight we put on these variables and how we put them into practice that creates differences.  This is important to understand because it colors and influences how many conservatives think about universal health care.  In fact, just the word “universal” may create a feeling of unease.  While the moral and ethical case for universal health care is based upon societal responsibility, for those who view health care through the conservative lens, providing health care is a personal obligation; for example, father works and earns his health insurance.  Father does not expect anyone else to help him get health care for his dependents and he is not responsible for the health care of others.  The above phrase from Corinthians resonates with conservatives because self-reliance is expected of mature adults. 

Conversely, those with a liberal orientation are guided by the concept of the common good, which means that all members of society benefit from certain actions, rather than just individuals or sections of society.  The common good is based in part on the concept of reciprocity; i.e. I do something for you, and you do something for me and we both benefit from this win-win situation.  The alternative is a society based on individual interests where everyone is left to their own devices, there are winners and losers, and no one has responsibility for those who can’t keep up or are left behind.  Sadly, this is the current state of our health care system where over 25 million Americans do not have health insurance.  In this case, being a loser can mean losing your life.

Self-reliance and individualism are important attributes guiding our lives, however, depending on the situation, other variables may have a more powerful influence.  Imagine that one of Donald Trump’s staffers reads my book and thinks Trump should endorse the idea.  He explains the book to Trump (we know Trump would never read it) and at a rally Trump announces this is his big breakthrough idea:

“Ah, health care.  Who knew it could be so complex?  I did, which is why I wasn’t surprised that the Republicans couldn’t get legislation passed.  Big failure on their part.  Big, big failure.  And the Democrats.  They just want socialized medicine which will ruin our country.  They don’t love our country, do they?  No sir, you can’t trust the socialist Democrat Party.  But I have something that will work.  Everyone will have health care.  And it will be a lot cheaper than you’re paying now.  A lot, lot cheaper and a lot, lot better.  I promise you that everyone will have really good health care.  The Republicans couldn’t do it.  The socialist Democrats, who don’t care about you, won’t do it.  But I’ll do it.”

Of course, Trump wouldn’t explain that universal health care is funded by a number of new taxes, albeit that it will be cheaper than the combined costs of health care premiums and out-of-pocket expenses.  He’d bask in the adulation and to the surprise of liberals, his followers would now support universal health care based on the moral foundation of the common good.  So what happened to individualism and self-reliance?

Social psychologist Jonathan Haidt and his associates have identified six traits that help create a foundation for moral behavior.[1]  Two of those traits involve loyalty and respect for authority.  In the case of Trump supporters, they are both extremely loyal and believe he is very intelligent and thus an authority on the issues he speaks to; Trump himself has acknowledged that he is “really smart and a very stable genius.”  Additionally, Trump’s most loyal supporters identify as a threatened outgroup, even though they function as an ingroup with shared values. Thus, if Democratic Senator and presidential candidate Kamala Harris gave the same exact speech, it would be rejected outright.

Liberals, in both the general and political sense, are often confounded when conservatives reject the concept of universal health care, after all it benefits them as well as others.  That’s why it is important to understand how people make sense of the world and their beliefs.  These world views are not entirely unamenable and common ground can be found for many issues.  But for those of us who support universal health care, we need to appreciate that conservatives look at the issue quite differently and will not readily understand our position, especially if we believe we hold the moral high ground.

[1] Haidt, Jonathan (2012). The Righteous Mind. Pantheon Books. New York, N.Y.

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