“Then a journeying Samaritan came to wounded man and, having seen, ἐσπλαγχνίσθη” – literally was moved in his guts, esplagchnisthe. (This is my translation, with the help of cross-textual resource.)
We know the rest of the story. The Good Samaritan took action to mobilize healthcare for the wounded man.
What will move us in our guts to take action to re-mobilize and reform our healthcare system? Just good ideas? Just a new idealistm? Or is the empathy of the Good Samaritan needed, too?
In this post, we will walk through Fixing U.S. Healthcare’s quest for answers to these questions, and will pose a new one.
Fixing’s Good Idea
Fixing U.S. Healthcare originally proposed that a good idea would suffice to spur us to action. To know the good would be to do the good, as Plato taught. This blog explained that the problem in healthcare was that citizens didn’t know that the system was spending too much – way beyond the “flat” of the marginal benefit curve, where more dollars don’t give better results. Americans needed only to emulate Oregon. In 1994 Oregon elected a doctor as governor who showed citizens that cost-benefit analysis could cut through empty rhetoric and political pettiness. Oregon adopted his Health Plan, and, lo and behold, access expanded, costs were contained, and more fairly-paid doctors joined the public system.
So, Fixing asked, why don’t we just scale up the Oregon Health Plan? But the U.S. never did.
So much for Plato’s philosopher-kings doing the good! Various commentators – notably Steven Brill – have identified perverse forces that have grown up since 1994 to block reform – corruption, greed, cronyism. Originally-well-meaning doctors and health leaders began using their genius not just for the common good but for “moats” that protected their own turf. Money flowed in, and attracted not just the altruistic but also the greedy. This new breed then slowly entrenched themselves into crony networks of special interest through lobbying, politics, and institutional structures – social, financial, commercial, academic.
So, Fixing asked, how do we overcome these entrenched forces? And, what must each of us do, since we all collude unwittingly in the system?
Call out the corruption, greed, and cronyism! That should spur all to action! Fixing called for a new idealism of shared sacrifice, a can-do spirit that would bring Americans together, put aside petty differences, and leverage our Yankee ingenuity. True, some would need to sacrifice their disproportionate advantages, but surely they would be satisfied with their still-generous and fair remuneration.
Then came the reckoning in the wake of George Floyd’s murder in March 2020. The video witness revealed what could no longer be denied. Half of the country then saw that all of our society – including healthcare – was permeated with vestiges of ugly “plantation law-and-order.” But another half of the country looked away, unwilling, or perhaps unable, to countenance the sight.
Americans of 2021 didn’t create this. We have “no racist bone in our bodies.” The worst most of us have is “unconscious bias.” We may rationalize, against the evidence, that America gives equal opportunity to those who will grasp it. We may debate — in good faith — whether healthcare is a right or a privilege, or whether a commodity or a public good.
Beyond the Rhetoric
But doctors see every day in our clinics the clear effects of social disparities borne of the same structures that thwart reform. We also see that overruns in healthcare spending incur an opportunity cost across our nation in neglected infrastructure, education, environmental stewardship, research, and more. Some in 2021 would deny these public goods to all rather than share them with “the undeserving,” as argued by McGhee.
At the individual level, we see that healthcare costs ensnare workers in unproductive jobs for fear of losing health insurance coverage. High healthcare costs harmfully “pollute” their opportunity to buy other goods and services of more immediate value to them. Or, worse, costs can bankrupt the sick with out-of-pocket surprise expenses. The healthcare system ignores others altogether, leaving twelve percent of American adults uninsured and some dead before their time.
So, beyond all the rhetoric are, indeed, human lives. Those paying attention to these human lives can be derided as “bleeding hearts.” At the risk of such derision, this blog now claims that philosophy, public policy, politics need a large dose of empathy to motivate reform. Good ideas, idealism, and rhetoric alone have not been enough to propel reform.
Empathy does not mean, as some argue ad absurdum, “giving away the farm” (or, some might say, the plantation). But it does mean looking into the eyes of real neighbors. Only then will we stare down some of the subtle and not-so-subtle ugly disparities in access and quality that need fixing and bring spending to heel. Empathy will ask, What if this happened to me – medical bankruptcy or no access to care? Can it be okay if this is happening to others who, though different, are like me?
Dialogue Across Differences
One model to promote empathy is “dialogue across differences.” This started as a controlled field experiment conducted in 2013 by three social scientists in college settings. By setting up dialogue among students from diverse backgrounds, this technique resulted in measurable increases in thoughtfulness about the structural underpinnings of inequality, in motivation to bridge differences, and in intergroup empathy.
There have been a number of other approaches shown to promote empathy. For example, a 2018 study among medical trainees correlated exposure to music, theater, and other arts with empathy. Reading literary fiction increases empathy. In the aftermath of George Floyd, corporations, newsrooms, Hollywood have taken steps to bring in and empower previously excluded voices. This blog has cited other civic initiatives such as America in One Room and Civic Saturday.
Will Empathy Be Enough?
Arming citizens with knowledge, measurements, and analysis like cost-benefit is necessary to know what to do. Adding empathy will provide them the motivation to do it. But will even ideas, idealism, and empathy be enough to accomplish healthcare reform?
Ideas and empathy are necessary. But this blog suspects that even they are not sufficient. Power may be the missing element. And, ironically, power tends to corrupt empathy absolutely.
Now, take action.
Title: Good Samaritan (18th century Russian icon, Rybinsk Museum)
By: Anonimus [sic]