03 ottobre 2009

Helth care, rights and liberties in America

La mia amica Linda Eklund ha letto su questo blog un articolo che avevo scritto sul "manifesto" sulla riferoma sanitaria in USA e mi ha mandato questa sua traduzione - di cui la ringrazio tantissimo!
My6 friend Linda Eklund read on this blog an article I had done for "il manifesto" on health care in the US and sent me this translation. Many many thanks, Linda!


I’ve got a couple of images in my head. The first is a photograph I took in Washington in September of 1982, the last time American unions called workers to the capital. They were there to demonstrate against Reagan’s economic policies, and there was an old man walking alone holding a sign that read “health insurance is an American right”. The other is recent and you can see it on TV and on line. A woman shows up at a meeting on healthcare reform with a sign that says «Health insurance is not a right.» Twice now, with Clinton and Obama, the United States has elected presidents who promised healthcare reform, an indication that the voters want it or at least that they don’t reject it. And twice this program has run into obstacles not only from the battle-hardened corporate interests, but from the not-negligible encouragement and active support they give citizens. Clearly uninformed and politicized, they are nonetheless carriers of a logic that we might understand a little better if we explore the territory these two apparently opposite placards actually share: a concept of the state, of “America”, and a concept of “rights” which are rooted in the very foundation of the country. Let’s start with the first, healthcare as an “American” right. I had to work hard to resist the temptation to tell that old man that healthcare is a right in every industrialized country - Germany, Italy, England, Spain - everywhere but “America”. And in fact infinite examples come to mind of Americans who are surprised to discover that the entire world has what they are missing. A young woman in Cumberland, Harlan County, Kentucky told me: “The other day I was watching on the Discovery Channel and - I can't remember what country it is—but everyone has health care. And it's not a rich country. See, that just boggles my mind.”An article by Sara Paretsky (the brilliant Chicago feminist detective writer), making an ironic observation about the anti-Obama propaganda using the presumed bureaucratic excesses in foreign government-run healthcare, said that when her husband got sick in France they had to navigate all kinds of cantankerous hospital bureaucracy. But when they asked for the bill, they found that the visit, the specialist, the x-rays and everything else cost next to nothing. “I’m ready to suffer a lot of bureaucracy for that kind of healthcare!” she said.
Now, her surprise and the ingenuous claim of that man in Washington derive from an a priori never seriously placed in discussion: that the United States has the best everything in the world and doesn’t have to go looking for examples anywhere else. So and thus, the meaning of the first placard is that if you have a right, you don’t have it because you are a person but because you are “born in the USA” and therefore special. An “American right” means a privilege in comparison to the rest of humanity.Internally, this means that other things that we consider rights are also not attributable to citizenship but are instead a consequence of a specific and not universal social location. Let’s remember that almost three-quarters of the American population already has some form of support or insurance; but besides the large limitations on coverage and costs (and bureaucracy: the insurance companies and the hospitals spend a disproportionate share of their budgets on administration and operations. But they are private so this is not “bureaucracy”!), the thing that characterizes them is that it isn't a question of the rights of citizenship, whose basis is collective, but of contractual clauses deriving from a private employment relationship or a union contract. You have coverage not because you are a citizen but because you work at General Motors or somewhere else. (In 1962-63 there was a miners’ revolt in Kentucky complete with gunfire, bridges blown up, and dynamite when the union rescinded the workers’ hospital cards which were financed by a royalty in the coal extracted. The miners had it in for the corrupt union and the companies who weren't paying, but it never crossed their minds to claim coverage that might not derive from their contract, the union bureaucracy, or the energy market, and that wasn't applicable to them alone).In this sense, then, the second woman is right: healthcare is not a right but a privilege. a «frringe benefit» as the jargon has it: a collateral advantage available to some and not to others. Thus, if 40 million Americans do not have a right to health care, this is not a scandal for the others and, who knows, maybe for some of them, too.So let's ask ourselves: how come carrying guns is a right (absolute and not subject to regulation), and being treated isn't? Simple. The right to bear arms is written down in an amendment to the Constitution; the right to good health is not found in any constitutional document. There is a conservative judicial fundamentalism in the United States which propounds a reading of the Constitution no less literal than the religious fundamentalism related to the Bible. The form of the state and the rights of citizens are carved once and for all in a venerable Constitution written two centuries ago, and every idea of evolution in the form of the state and extending the sphere of rights is considered not as an enlargement of the sphere of freedom, but as an invasion by the leviathan state.The concept of liberty is inscribed in the bedrock of the state, born in a peripheral rebellion against colonial state, and oriented more to a defense of personal rights against the state than to the idea of the state as a surce and guarantor of the rights. Life, liberty, and the pursuit of happiness are born with the individual and are exercisable individually (rather than other rights like equality and fraternity, which are only thinkable in relation to others).It is envisioned, therefore, that the state will protect individual rights, but it is simply anathema to think that the state might assume a social obligation. The right wing comes up with paranoid fibs like the «death committees» that would be set up under a public option to decide who should live and who should die (as if private insurers don't do this every day). These become credible if you imagine that every government assumption of social functions is a step toward a «totalitarianism» in which the state becomes the master of life and death.This helps us reason through another paradox: a rejection or a pushback against any program which in the end serves to guarantee exactly the first of the rights affirmed by the Declaration of Independence, and that is life itself. Let's compare it, one more time, to the right to carry guns, which is also claimed as the protection of one's own life. With healthcare coverage, the state defends everyone's life via institutional means; with armed self-defense, the individual protects a single life against others with his or her private means (the only institutional protection which constitutional fundamentalism accords the state is a military one: thus, wartime expenses never elicit the same frenzy as the predicted outlays for healthcare in a country that spends more than any other on healthcare but ends up with worse care than many).Healthcare coverage is a right that demands a social structure of institutions and relationships, an idea of solidarity in which a citizen has a right because everyone has it and it cannot be exercised alone. This is very hard to grasp after centuries during which the established rights have been those that everyone could exercise on his or her own behalf. Public health, in the last analysis, contradicts the tremendous liberal dogma by which «my liberty ends where that of others begins». In this case, my freedom begins where everyone else's begins. And this is valid for every one of the «new» rights that aren't found in the 18th-century Constitution, and which in fact the United States sweats to acknowledge: the right to livable climate, the right to water, the right to education - which no one can exercise unless everyone else does.Now fortunately, the United States cannot be reduced entirely to liberal-constitutional fundamentalism and to anti-“socialist” paranoia. After all, this is the nation that invented the New Deal, the country where even a president we rightly considered an enemy, like Lyndon Johnson, committed the state to the «War on Poverty» (another of America's un-won wars). And in his speech the other day, Obama repeatedly used what is perhaps the key word in all of his poetics and in all of his politics: «we». Obama's «we» is no mere rhetorical call to national unity; rather, it implies the reconstruction of a pact between citizens and the state and of a pact among citizens themselves. which in an age stained by egotism reintroduces a minimum of shared consciousness of the fact that the destiny of each individual is interwoven with the destiny of all. I don't expect much from the latest goings-on. But if, beyond the specific content of whatever reform happens, Obama could begin to (re)introduce even an embryo of an idea of common social rights, he might open a passage to a different future, a more decent one. For us, too.