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The American Health Care Myth A culture is largely defined by its myths. We use the term “myth” here not in its vernacular form (i.e., not to imply lies or untruths), but in its classic form. A myth is a story that describes how a people came to be, and why things are as they are. So, while myths are simply stories, they carry extraordinary power. Myths largely determine how a culture interprets the world around it, and provide a set of guiding principles by which that culture behaves, shapes itself, and responds to events. Myths impart vitality. Cultures that forget their myths, or allow them to become sterile, themselves become barren, impotent, and doomed. Throughout history, the greatest leaders have been those who have understood the power of myths. Such individuals often arise in times of great change, chaos, or turmoil – times when the old myths are losing their relevance – and offer a new interpretation. Here is what is happening, and why, they say. Here is who we are, and here is what we must do. One thinks of Jefferson, Lincoln, both Roosevelts, and Churchill. Essentially, great leaders are great storytellers. They offer new and compelling stories that explain things, that give order to chaos, impart a sense of purpose, and redefine and redirect a culture. With such myths great leaders can galvanize a people, and compel them to act in concert to achieve great things.
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Myths can be extremely beneficial. The ultimate American myth, laid out succinctly by Jefferson in the Declaration of Independence, celebrates the autonomy of the individual – all of us are created equal, and we all have the self-evident rights to life, liberty and the pursuit of happiness. The power of this myth is manifest in many ways. Consider that at the time of the Declaration and for decades afterwards, slavery was legal in America; Jefferson himself was a notorious slaveholder. Some have claimed from this fact that the founding fathers, and the myth they promulgated, were cruelly hypocritical. Yet, the power of this American myth - reconfirmed in the Gettysburg Address - ultimately helped bring about the abolition of slavery. While largely untrue at the time it was first stated, the cardinal American myth to a great extent was responsible for shaping subsequent events. Ultimately, the reality of American culture came more nearly to resemble its myth.
Myths can also be extremely destructive. Adolph Hitler rose from obscurity by telling a story about the German people that, in that time of great national turmoil, had resonance. The subsequent atrocities committed by the Germans were horribly logical in the context of that myth. Recently, it has been argued that the holocaust could not have happened without at least the complicity of the majority of the German people, and that therefore, perhaps the German culture is essentially flawed in some way. The problem with this facile synthesis is that similar atrocities have been committed innumerable times throughout history by many different peoples – the atrocities inflicted upon Native Americans by white Americans is just one example. In virtually every case, the culture committing these atrocities felt it was acting on the side of justice, righting a terrible wrong. In every case these cultures were behaving in concert with a powerful cultural myth. It is likely that the actions of the German people in World War II also stemmed from the myth to which they subscribed, and that therefore their actions are less reflective of a specific truth about a specific culture than they are of a general truth about the power of myths to influence the behavior of any culture.
To a large extent, how we think about health care in America is defined by a myth. This myth is a recent one, having taken shape during the last half of the twentieth century, coincident with the rise of modern high-tech health care, and with the soaring optimism that came with America’s emergence as the world’s greatest power. The myth goes something like this: In America we have and will continue to have the best health care in the world, the best doctors, the best hospitals, the best technology. Every American citizen deserves – indeed, has a right to – access to that best medical care. Since one cannot place a price on human life, everything that can be done for a sick person must be done, as long as there is some small hope of a beneficial outcome. Finally, every disease is potentially curable, and as a matter of policy we will strive to learn how to cure every disease.
The myth of American health care can be summarized thusly: where health care is concerned, there are no limits.
This health care myth is entirely consistent with the cardinal American myth as articulated by Jefferson, specifically the self-evident right to “life”. What better way is there of guaranteeing such a right than to insist on superb health care? (And, since the rights to liberty and the pursuit of happiness are also given, self-indulgence that results in disease does not abrogate one’s right to the very best health care.)
For the most part this myth has been an extraordinarily useful one. The essential optimism of our health care myth, and the single-minded efforts it has engendered, have led to amazing advances in the treatment of many formerly devastating diseases. Hospitals in almost every major American city are on a par with the world’s best, our physicians are the best trained in the world, and our biomedical industry is the envy of every other country. While no one can argue that all Americans receive the very best care, on the whole all but our most disadvantaged citizens have access to some of the best medical care in the world.
While the effect of this myth has been largely salutary so far, a new question now arises: how can you square the need to ration health care with such a myth?
And there’s the problem. You can’t. The need to ration health care is simply incompatible with a myth whose basic notion is that there are no limits.
The cold fear of going up against that myth is what freezes politicians and other policymakers in their tracks at the very thought of rationing. Rationing becomes unthinkable. Our health care myth leaves us no choice but to do that rationing covertly.
Next - Making rationing compatible with our Health Care Myth
Surviving the Health Care System is adapted with permission from YourDoctorintheFamily.com
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