Down on the Ground with Personal Responsibility and Health Care

by George Sibley

I have a friend here in the Upper Gunnison with whom I argue politics a lot, mostly electronically. We are always sending each other e-mails with editorials, news stories, and essays attached, mostly focused on aspects of the political economy – which should be distinguished from the real economy, the miraculous helter-skelter whereby most of us manage to find enough food, energy, shelter, and other necessaries to stay alive and fairly healthy. A political economy, on the other hand, is the paste-up of philosophies, ideas, ideologies, and religion we each hold about how the real economy ought to work. A political economy always seems to fit some aspect of the real economy well enough (if beaten into shape with a bigger hammer) so that we can continue to believe in it.

My friend’s view of the political economy tends to find expression in the Wall Street Journal; mine tends to come from the New York Times or Alternet, which might lead you to understand where we each are on the political spectrum. Actually, we are both closer to the center than that might indicate. We both voted for Obama last year, but we are both somewhere between frustration and disappointment in Obama’s performance to this point. We begin to diverge when we try to get down to specifics about why we are disappointed.

Some slightly testy exchanges on the topic of health care (or health insurance or whatever it is we’ve been trying to resolve) led my friend to explain his perspective more basically:

A great concern of mine is the slackening of personal responsibility in our country. My views on government health care are incidental to that greater concern. Does government health care move us generally toward a society that practices more personal responsibility or less?

His examples were provisions in a health care bill (which bill, I don’t know) that didn’t allow insurers to charge more for obese people and smokers. He mentioned the “helplessness” of under-educated people who are in their second or third generation of welfare. If those people won’t take care of themselves, why should the rest of us support a government plan that takes care of them?

I think the “personal responsibility” issue is a good one. At first glance at least, the question he raises could be a good litmus test for public policies. Does a policy move us toward more practice of personal responsibility or less? But the question that immediately pops into my mind is – “Personal responsibility for what? To what?” Is he beating the drum for the old cult of the “rugged American individualist”? He has elements of that about him – maybe not to the extent of central Colorado’s Slim Wolfe (Come back, Slim! Come back!) – but he built his own house, which is heated entirely by the sun and wood he gathers himself. He sent me a picture of his 15-cord woodpile.

But he also drives a modern car, depends on a computer for both business and the pleasure of arguing with me, flies on airplanes for business dealings, et cetera, and he’s in about the same boat as I am there. When something goes wrong with car or computer now, I am helpless; I have to call on someone else to fix it for me. I used to do a lot of my own car maintenance when cars were mechanical, but the electronic knowledge and equipment necessary to do that today are beyond my budget or, frankly, my ambitions. And the computer? Forget it.

So in my refusal to master all these systems and devices on which I depend, am I abdicating “personal responsibility”? I can argue that I’m not, because I have both the cultural skills and the cash to be able to find a specialist to deal with my specialized problems for me. And having the cash (from pushing my own specializations) is the critical ingredient here. It enables me to not have to be a rugged American individualist doing it all myself to be “personally responsible.” I can just be a participating member of an interdependent society, woven together by cash; in cash we trust.

But you don’t have to read very deeply today in the newspaper (or online newsscreen) to learn that there are a lot of Americans who don’t have the cash today. Something like 17 percent of the work force is either unemployed or under-employed, and many still working are in “service jobs” that essentially waste their education and experience. Most of them weren’t “fired” for malfeasance; they were downsized, offshored or otherwise let go in efforts to cut costs. And most of these cost-cutting trends are industry-wide – maybe even “economy-wide.” What does an industrial society do when it has sent most of its basic industries to places where labor and life are cheaper? It has to become something else, but our masters of the universe are a little slow in coming up with what that something else will, or could, be.

So where does “personal responsibility” lie in this situation? We tend to be a pretty callous society when it comes to such things. We are very willing to believe that there is no significant difference between the overweight chronically unemployed couch potato and the 45-year-old who gets downsized after 15-20 years of holding up his end of the social contract. That the family that maxes out its credit taking care of a child with some rare disease is not categorically different from shopaholics who spend themselves into a similar hole. We want – almost religiously – to believe that anyone who is unemployed or uninsured or in serious debt is that way because they have not exercised personal responsibility. Then, as the old cowboy song goes, it’s their misfortune and none of my own. And when it happens to me – and I have been there, and am close to others who are there now – it is all too easy to accept that cultural judgment. I didn’t get downsized because some bean-counting sonofabitch who doesn’t even know how good I am, decided I represented an unnecessary cost and he could find an Indian to do what I do more cheaply. No, we tend to accept the cultural judgment that, if we got fired, it must be because we were personally deficient.

I share my friend’s conviction that people should take a large measure of personal responsibility for their own lives. But the very nature of our society seems to require a broadening of the concept beyond “look out for number one.” And there are areas of modern life where I think we need to go beyond the kind of interdependency I mentioned above, to a kind of “mutual dependency” on each other.

Health care is one of these areas. While we do cause a lot of our own health problems, everyone is vulnerable to health-related disasters over which we have no personal control. The old coal miners I was lucky enough to drink beer with in Crested Butte knew this. They were all treated by the company as independent contractors, totally on their own for everything including health care. If you got hurt in the mine, it was deemed to be your own fault (never mind the inadequate materials for shoring the tunnels, the lousy equipment, the cheap powder), and you dealt with it. So the miners – almost all immigrants – formed ethnic “fraternal unions,” usually based around a bar, and they all paid some small sum into a fund every payday, to help out the family of a member who got hurt or killed. And it covered the lazy as well as the industrious, the obese, the smokers, the incompetents, all the brethren and their families.

That’s my model for good health care. Everybody puts into the pot because everybody sooner or later needs to draw something out. And the bigger the number putting into the pot, the easier it is on everyone – especially if 20 percent of the pot doesn’t have to go for stockholder dividends. That is part of my definition of “personal responsibility” — to personally see the need, in a random and indifferent world, to accept certain responsibilities for each other’s misfortunes because there, but for the luck of the draw, go I.

Where it seems to fall apart is when we forget that the government is the vehicle whereby we accept that measure of personal responsibility for each other. Sometimes the government seems to forget that too. I would not mind paying the amount of taxes I pay if all of it actually went toward Americans accepting responsibility for those things listed in the Constitution’s preamble. These things include establishing justice, ensuring domestic tranquility, providing for the common defense (not the global offense), promoting the general welfare, and securing the blessings of liberty. But the fact that a lot of my taxes get diverted to imperial adventuring and corporate welfare doesn’t make me want to throw the baby out with the bathwater. And putting those tax dollars in a big national pot, like the Medicare I now enjoy but for everyone, is exactly where I think they should be going. Personally, I think that would be responsible.