Dynamic Yet Consistent

Many of our friends and family members have expressed concern about the quality of health care here in Swaziland, so I wanted to do a quick post to set their minds at ease.  Most people are aware that here on the mission we actually have two clinics: one specializing in HIV / TB and another that deals with general health issues / maternity / etc.  We have 8 nurses that live within a few hundred feet of us and a doctor who works with our clinic.  This is by far the closest we have ever been to basic medical care and assistance.

But, if that was not enough, we recently discovered a place within 20 minutes of that offers private surgery if we should ever need it:

With a facility this close and convenient, we might just have to undergo some elective surgery.  I am sure it is cheap and we could always use a good appendectomy or lobotomy!

NOTE: This is obviously written tongue in cheek… but in all honesty, we do have access to surgical services within an hour of us, and "first world medicine" is available just across the South African border.

In the past few months I have had several excellent conversations about the origin and inventory of human rights.  It seems most people agree with the idea that people are “endowed by their Creator with certain unalienable rights,” yet when it comes to specifics there is much disagreement.  For instance… does “Life, liberty and the pursuit of happiness” refer to freedom or opportunity (put another way, are these things something all people should have, or have the option of having — the difference is substantial).

This discussion began when I compared universal education with universal health care and asked if both should be considered human rights.  My friend Aaron pushed back saying that rights exist individually apart from anyone granting them to you.  (Therefore if the government is the purveyor of universal health care, it cannot exist beyond them and thus cannot be a right). Desmond Tutu takes a different approach by saying human rights exist because we are created in the image of God.  Without too many specifics, he argues this means we should extend respect and care to all people.

As nice as it is to say that rights are inherent and/or God-given, it seems the facts of history do not support this.  Most would agree the freedom (from slavery) is a God-given right.  However, in the hundreds of years across which the Bible was written, this “right” was never extended or even articulated.  Heck, even our constitution, which is still a relatively recent document, did not consider this to be a right.

At the end of the day, societies are the ones who give rights, and this usually comes in the form of the government.  Put another way, rights can not be rights until they are extended by the authority of a group of people (government).  Freedom of speech, which is actually a relatively old idea, was first extended under Greek empire.  Before the powers that be articulated and defended that right, it did not exist.  Likewise, freedom from ownership was not a right to be extended until governments listened to the Abolitionists and began protecting people from slavery.

Rights may in fact come from God, but at the end of the day, it is up to governments (or other authoritative communities) to identify and codify these rights.  One thing is clear… Rights are not static, but are evolving.  In the last 250 years, Americans have come to generally agree on a slew of individual rights: right to bear arms, right to vote, right to practice religion, right to private property, right to a fair trial, etc.  While people may consider these to be God-given, they are all actually given by our constitution.

It is my belief that we as a society are moving towards a more civilized existence.  I am glad our constitution protects so many rights and I am also glad our nation has risen up to extend more rights (like voting and abolishing slavery).  I believe we have reached the point where we understand what things should not be done to people and are starting to understand what things should.  It is my guess that in 100 years, everyone will consider education, healthcare, clean drinking water, adequate food and shelter to be basic human rights that should be extended to all.  We should not fear the government extending these rights anymore than we should have feared the government banning slavery.  Change happens, and when it comes to governments extending rights, history has consistently shown this to be a good thing.

I few weeks ago I wrote a post discussing health care as a right.  Since then I have had several good conversations with people from across the political spectrum on what constitutes a “human right” and what the implications are of such a delineation.  Last night I came across a 1996 article by Archbishop Desmond Tutu (a hero of mine) entitled Religious Human Rights and the Bible.  In just a few short pages he frames the question brilliantly by exploring how the Christian worldview calls us to understand the importance and dignity of each human being.

Archbishop Desmond Tutu

Tutu begins by acknowledging that religion (especially Christianity) has led to oppression and injustice.  Yet, he is quick to counter by pointing out the narrative of Scripture calls for a different view of things.  He bases his argument on the implications of the creation story where all humanity is uniquely created in the image of God.  He says:

The Bible claims for all human beings this exalted status that we are all, each one of us, created in the divine image, that it has nothing to do with this or that extraneous attribute which by the nature of the case, can be possessed by only some people… We must therefore have a deep reverence for the sanctity of human life… The life of every human person is inviolable a gift from God.

Being created in the image of God is not just about identity Tutu contends, it is also about calling and purpose.

The [Biblical Narrative] declares that the human being created in the image of God is meant to be God’s viceroy, God’s representative in having rule over the rest of creation on behalf of God.  To have dominion, not in an authoritarian and destructive manner, but to hold sway as God would hold sway–compassionately, gently, caringly, enabling each part of creation to come fully into its own and to realize its potential for the good of the whole, contributing to the harmony and unity which was God’s intention for the whole of creation.

When we understand ourselves and others in light of our connection with God, it requires a different response to questions about humanity and the rights of all persons.

[This understanding] imbues each one of us with profound dignity and worth… In the face of injustice and oppression it is to disobey God not to stand up in opposition to that injustice and that oppression  Any violation of the rights of God’s stand-in cries out to be condemned and to be redressed, and all people of good will must be engaged in upholding and persevering those rights as a religious duty.  Such a discussion as this one should therefore not be merely an academic exercise in the most pejorative sense.  It must be able to galvanize participants with a zeal to be active protectors of the rights of persons.

Even if we capture the depth and breadth of the implications of this understanding of God and his people, we are still faced with the fact that humanity was given the freedom to choose right or wrong, good or evil, obedience or rebellion.  We must not only understand who we are in light of our creator, we must also walk the delicate line of what it means to embody this reality.  Tutu explains:

We are created to exist in a delicate network of interdependence with fellow human beings and the rest of God’s creation.  All sorts of things go horribly wrong when we break this fundamental of our being.  Then we are no longer appalled as we should be that vast sums are spent on budgets of death and destruction, when a tiny fraction of those sums would ensure that God’s children everywhere would have a clean supply of water, adequate health care, proper housing and education, enough to eat and to war.

Tutu contends that it is only when we are willing to first understand ourselves and others in light of our relationship with God and our role as bearers-of-the-image-of-God, that we are truly able to to grasp the dignity, worth and inherent rights of all persons.  He concludes:

The biblical understanding of being human includes freedom from fear and insecurity, freedom from penury and want, freedom of association and movement, because we would live ideally in the kind of society that is characterized by these attributes.  It would be a caring and compassionate, a sharing and gentle society in which, like God, the strongest would be concerned about the welfare of the weakest, represented in ancient society by the widow, the alien, and the orphan.  It would be a society in which you reflected the holiness of God not by ritual purity and cultic correctness, but by the fact that when you gleaned your harvest, you left something behind for the poor, the unemployed, the marginalized ones–all a declaration of the unique worth of persons that does not hinge on their economic, social, or political status but simply on the fact that they are persons created in God’s image. That is what invests them with their preciousness and from this stems all kinds of rights.

Tutu’s analysis is poignant and thought provoking — especially for Christians.  It is not adequate to define human rights in terms of the constitution or any body of law.  Likewise, we cannot base our decisions on what is right on economic models or political ideologies.  Instead, we must ask a different sort of question. We must inquire as to how we can love and care for all people — all of whom are created in the image of God.

All marks of emphasis in quotations are mine. Religious Human Rights and the Bible was originally published in Volume 10 of the Emory International Law Review.  You can download the complete file here from The Center for the Study of Law and Religion at Emory University.

This health care debate is getting out of control.  We seem to have reached the point where no one is listening anyone and both sides consistently descend into the type of demonization where everyone who doesn’t agree with you is a Nazi.  Therefore, it is not my goal to convince anyone to change their view on the issue, but rather to present a different way of looking at it.

At the end of the day, there is one question under-girding this whole debate and no one seems to be approaching it directly.  Rather than arguing over the merits of a single payer system vs. co-opts, or arguing over how much government intervention is acceptable, we must first as this: Is healthcare a right? How you answer that question is going to determine how you approach every other question.

For the last century we have generally assumed that education is a right of every American.  Before the mid 1800’s the school systems were nearly all private and it was not until the Reconstructionist movement following the Civil War that nearly the entire country offered “universal education.”  We have reached the point where no one questions the appropriateness of using tax dollars to ensure every American the chance to graduate high school.  Of course reform is needed, there are inefficiencies that need to be addressed, and problems the system faces; but no one is arguing we should cut off access to education just because people can’t afford it.  Again, this is because we assume education is a right every citizen is entitled to.

So what about health care?  If we think it makes sense to extend education to everyone, why not basic medical care as well.  After all, our Declaration of Independance understood the presence of certain inalienable rights including “Life, Liberty and the Pursuit of Happiness.”  In my book, basic health care falls under the right to life.  And why wouldn’t it?  Do we really think the ability to be healthy should be a privileged only extended to the rich, those with good jobs, and those who are already healthy?  This is the debate we need to engage first before we get into the logistics.

Let’s jump back to the discussion of universal education because I think there are many parallels we can learn from.  First, both are expensive.  In America, according to the Education Department, we spend roughly 7% of the GDP on education — most of that comes in the form of tax dollars.  By comparison, health care consumes 14-17% of the GDP depending on which source you use.  Apples and oranges right?  Well not really.  If you look at countries with socialized medicine, their spending levels are dramatically lower.  Spain spends 7.6%, the UK spends 7.7% and Canada 9.6%.  [ASIDE: Did you know the average health insurance company spends 12% on administration, while Medicare/Medicaid only spend 2%]

Beyond just looking at cost, I think many of the charges leveled against universal health care can be dispelled by looking at our universal education system.  One of the most persistent questions concerning a “public option” has been how can fair competition exist a for-profit private company and a government entity.  The same question of competition could be asked of the education sector: How can any private education institution compete with public schools who offer free tuition?  If you ask me, private schools do just fine.  There are plenty of people willing to pay more for exclusive environments.  Just look at private colleges.  Even though they generally cost 2-3 times what a public university does, enrollment is still strong.  Why is that?  Because even when there is a free (or cheap) public option, people still want exclusivity and choice.  In a recent town forum discussion, a University of Colorado student asked Obama how private companies could be expected to compete with a government run plan.  That is a good question for sure, but the irony lies behind it.  This student is receiving a government subsidizes university education, and asking his question to a person with a degree from Harvard – the oldest private university in the nation, and coincidentally, the first corporation in our nation.  The costs are not even close.  UC tuition is 4-6K per semester while Harvard is 17K.  That is not fair competition is it?  Yet which school would you rather have a degree from?  When you offer a good product, there is always competition.

What about the rationing of care?  You would think that since the government is picking up the tab for everyone’s primary education, they would need to ration educational expenses — you know, get rid of the people that cost the most.  In practice, the opposite is true.  Special education students are given more resources and extra services despite the fact it is of increased cost.  Additionally, even though a public education option exists, parents have the option of seeking additional interventions on their own.  No one is kicking little Johnny to the street because he costs an additional $1,000 per year because he need speech therapy.

Our education system is not perfect.  There are blatant ineffeciencies and places where reform is clearly needed.  There are areas where we are not providing the services we should, and times where the government is overstepping its bounds.  But at the end of the day, people are not looking to throw out the whole system.  Why?  Because we think education is a right, and when we believe this we are willing to work with the system even if it is not perfect.

Considering health care a right is not some crazy liberal thought — it is widely held by the richest countries in the world.  The following countries have universal  health care: Afghanistan, Argentina, Austria, Australia, Belgium, Brazil, Canada, Chile, China, Cuba, Costa Rica, Cyprus, Denmark, Finland, France, Germany, Greece, Iraq, Iceland, Ireland, Israel, Italy, Japan, Luxembourg, the Netherlands, New Zealand, Oman, Portugal, Russia, Saudi Arabia, Spain, Sweden, South Korea, Sri Lanka, Ukraine and the United Kingdom.  We are not breaking new ground, we are simply exploring an understanding of human rights that is already commonly held in developed world.

When we argue against universal health care, we are arguing against the worth of another human being.  I am convinced in 100 years it will be as inconceivable to deny health care to people as it is today to deny education.

One of the top stories in the news this week has been the increased tension surrounding universal health care. (See for instance Health debate turns hostile at meetings.)  The plan being discussed in congress certainly has its problems, but unfortunately we have reached the point where meaningful discussion has transitioned into hyperbolic arguing with emphasis on scare tactics, skewed statistics and atypical anecdotal stories — and that is from both sides.

Sarah Palin

A prime example of this can be found in a statement by Sarah Palin which she posted on her facebook page.  Here is an exerpt:

The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

Health care by definition involves life and death decisions. Human rights and human dignity must be at the center of any health care discussion.

Discussion of health care does involve life and death decisions.  It also involves money.  In our current system money, not human rights and human dignity is the primary consideration.  It takes money to have health care.  The insurance companies are out to make money.  They make more money by charging people more and paying less.

Lets look at some of the charges against a universal plan, and see how they apply to the current system

• Health care will be rationed – People are worried about the government telling them what procedures they can get and where they can get it.  Guess what… that already happens.  Insurance companies dictate which doctors you can go to and which procedures are covered.  Plus, those without health insurance can’t get the procedures at all, so we are rationing for rich.  We may disagree whether health care is a right or a privileged, but I am not comfortable with the deciding factor on who lives and dies being wealthy.  Palin argues the elderly, sick and disabled will be the ones most affected.  The irony is that these groups are the ones who already have the hardest time getting coverage.  Even with a minor pre-existing condition, getting coverage  is very difficult if it is not employer provided.  Again, we see rationing already exists, but the only people who get it are the skilled.
• There will be a bureaucrat standing between you and your doctor – Guess what… there already is.  If you look at the chart designed by the GOP in order to scare people into thinking things are more complicated than they are, you will realize most of the boxes and lines already exist.  We already have government involvement in health care.  Universal health care would not add another layer, it would simply change who you are dealing with.  As it is, the insurance companies stand between you and your doctor and they are motivated to not provide you with service because doing so would cost additional money.



• America has the best health care in the world and that will be lost – This one is all about definitions.  What is undisputed is that America has the most expensive health care.  We pay on average more than double the average of every other developed nation in the world.  However, even after spending that much we still are 17th in the world in terms of life expectancy.  According to the World Health Organization, we are far from having the best system:

The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The United Kingdom, which spends just six percent of GDP on health services, ranks 18 th . Several small countries – San Marino, Andorra, Malta and Singapore are rated close behind second- placed Italy.

I think there is plenty of room for discussion around this topic, but we first must be honest with the system we have.  America is not plotting new ground here, instead we are following every other developed nation in the world who has chosen to go this path.