Tuesday, 25 August 2009

Wealth, Virtue and American Mythology

In the late 80s/early 90s, I put some frequent flyer miles on the old broomstick and spent a great deal of time in the US. Not the real US – a cultural anomaly they call New York City. But I travelled a great deal and experienced other parts too. On a person by person basis, I’d say that the US has as friendly a citizenry as you could hope for anywhere and yes, that goes for New Yorkers too (although they’d kill me for saying so!)

Of course I always made sure that I had health insurance. In the event that I broke my arm and leg, I wouldn’t have wanted the afflicted body parts to be confiscated in lieu of doctor’s fees. American health care was, and is, so notoriously expensive that it strikes fear into the wallet of any well-informed traveller. If your policy ran out while there (you could get them to run ninety days at a time then) we Nouveau-Yorkers had elaborate plans to get the quickest flight out while bent over clutching at the chest/stemming gouting blood spurts around a stab wound/dying of the plague inconspicuously in the back row of the aircraft (they allowed smoking there in those days). Just DON’T GO TO THE HOSPITAL WITHOUT MONEY.

The insurance was a good buy. It turns out that a kidney infection can turn you from a youthful, grinning impression of a spring lamb on pogo sticks to a groaning, human pretzel sweating like a homeopath at a chemistry exam … all in about twelve hours. I grabbed my insurance certificate and got wheeled off to the nearest emergency room.

I won’t make any cheap shots and, in any case, one hair-raising anecdote does not a statistical analysis make. I spent a week in hospital, I’m alive, let’s leave it at that. It was expensive, but who cares? I didn’t pay - Messers. Readem & Ouipe, insurance underwriters did. It did not affect my medical outcome that my room-mate was a lady with an explosive farting condition and a fractious family. Security guards are probably regularly called in to separate sparring partners in London hospital wards too.

So what, dear reader, did I learn? Apart from ‘take your own charcoal gas mask to hospital’.

Just get insurance. Treatment is expensive as hell and they tend to over-treat because they’re scared of litigation. Also, they don’t appear to have time targets for treatment in the emergency room – bring a tent and your own pain relief. That may have since changed or been an anomaly, but it’s most likely down to the fact that ERs are the only kind of free care provided by law in the US, so they have a larger and more clinically desperate clientele than we do here.

But insurance is a different matter for US residents. For one thing, it’s a lot more expensive, pro-rata, than the kind of extended vacation coverage that I had. While I don’t have the time in my tea break to cite multiple statistics on the subject, I think it’s fair to generalise on the following points as they’re relatively uncontroversial:

  • More is spent on health, on a per capita basis, in the US than in any other country in the world
  • Despite the massive cost, the average satisfaction level of US healthcare is below that of many other wealthy, industrialised nations
  • The USA is perhaps the only wealthy, industrialised nation that does not ensure that all its citizens have some kind of health provision; around fifteen percent of Americans have no coverage at all
  • Medical debt is the principal cause of personal bankruptcy in the US, and this includes not just the feckless, but people who eventually find their insurance doesn’t cover all their costs

The US is able to provide wonderful outcomes on such conditions as prostate cancer, suffered by rich old men. It’s less able to provide good outcomes on infant mortality, suffered by babies who haven’t earned much yet.

Oh, we could go on for hours … and it truly is a complicated subject with reasoned points on both sides. It involves issues of tax breaks, effects of government interference on free markets, medical research funding and so much more.

But my focus here is on the attitude of many Americans to the idea of universal healthcare provision. Watching FOX news and other broadcast reactions to the subject must have left the rest of the world wondering just what on earth had been suggested: that China should be allowed tweak international human rights law? That Iran should be given a warhead or two for Christmas? That a black man should be president? There was more hyperventilation than at a ‘Twilight’ screening at a girl’s school. It’s also noticeable that healthcare debates in the US don’t get far before somebody hurls the ‘s’ word (‘socialised’ or ‘socialist’) like a piece of verbal dog poo at the would-be reformers. These ‘ad. verbum’ moments precipitate the kind of national shudder normally experienced when Mount St Helen’s clears her throat.

But I’m not a healthcare expert - I’m an observer of how mythology inspires human behaviour. And I believe that a bit of American mythology is instrumental in the emotional engine of this reaction The American mythology in question is that wealth equals virtue. That Puritan streak still possesses so much of the American subconscious, despite the passage of time and the influence of subsequent cultures.

I believe it’s true, for most people in industrialised nations, that prosperity is roughly proportional to work (especially if you add tactics, such as the use of delayed gratification). Life isn’t completely random. But life experience surely also shows us that it is possible for some to thrive without work, and others to work without thriving. In US mythology though, the thought that somebody else – especially a lazy person – should profit from your labours is anathema. In a nation where wealth equals virtue, the poor are immoral.

As I said in the opening paragraph, I truly believe that Americans as individuals are a lovely bunch, not abnormally callous or brutal. But the simple equation of money and virtue means that at a societal level, the level where generalisations and outgroups appear, that those ‘without’ can be written off as undeserving, maybe even of life.


  1. You'd think that on a purely pragmatic basis, people would see that universal healthcare is a good idea. Take dental insurance. Is it really a good idea to have many thousands (millions?)of people wandering around with a mouth full of pain and a gun in their pocket because they can't afford it?

    The American attitude is very 19th century British but they seem to have missed out the category of the 'deserving poor' - people who work hard but still struggle. And, given the cost of healthcare in the US, that would be the majority of the population.

    As an anecdote, I had insurance when I went to India, needed a doctor, got a load of tests and medication and was charged £7. I didn't bother claiming it back.

  2. My 4 year old son had an emergency appendectomy in Texas, resulting in a weeks stay in hospital.

    Thankfully, we took out insurance for £30 for the trip, and it saved us from the $23,000 dollar bill it totted up to.

    Now, the care was excellent with a private room in a childrens hospital which probably accounts for the bill. I don't know how much of that went to the surgeons and how much went on the amazing grounds, the games room or the fact there was an armed guard to protect us from the poor people outside who may have been silly enough to get sick whilst not winning the lottery.

    But boy-am I glad that we took out that insurance.

  3. Well speaking as someone who lived through that horrid affair with you ... it must have taught them a lesson. Lutheran Medical has become one of the best hospitals in the city, despite its proximity to the werehouse hell of the Sunset Park Industrial Park (note not Center to avoid the unfortunate acronym) in Bush Terminal (yes really). Said proximity may well account for your roommate and her squabbling kin.

    TK's comment about America being very 19th Century Britain is dead on balls accurate as we used to say in Brooklyn ... in many regards. it's become a culture of personal entitlement and little else. There are pockets of people who care and care deeply but the unfortunate fact is that the "what I have & what I've worked for means more than literally anything else" attitude prevails.

    I just hope we comport ourselves as well as you lot have since your empire fell now that ours is well past teetering.


  4. Hi Dennis,

    Glad to hear Lutheran is so well respected. Can't complain - it treated my illness and I'm here today; I think any issues I had were as a result of the US approach to medicine, rather than than any deficiencies of the institution itself.

    Ah, Sunset Park: needles in the gutter, discount sneaker shops, trans-sexual prostitutes, toasted bagels, feral dogs. They've closed it now, but I thought there was one of the best views of Manhattan & the Staue of Liberty you could get from a partially collapsed dock that went about a hundred feet into the Hudson. Happy Days!

    Jourdemayne x




  6. Previous posts seem to be blaming 19th Century Britain for poor healthhcare, when in fact we have 19th Century Britain to thank for the origins of awareness and beginnings of reforms where slavery, poverty and healthcare began to be seriously addressed for the first time.
    The only surprising thing with a new country starting from scratch like the USA and getting an awful lot of things right is that it's taken till now and President Obama's proposals to get the healthcare thing right. That said, I don't know the history of US health insurance, but maybe it worked for a while until medical care became so much more sophisticated and thus prohibitively expensive.
    Let't try and be positive. If Obama can pull this one off, he will go down as one of the great presidents, and in a tiny group of world leaders for having done something that affects people's lives significantly for the better on a huge scale.