The US House of Representatives has passed a bill that should extend health care coverage to most Americans, and the US Senate is about to debate its own version. If the Senate bill passes and if reconciled with the House version, America will have given itself the document by which to join the civilized world. Like their counterparts in the advanced nations, most Americans will at last be covered with a blanket of security. And this will happen not because there is an incentive to looking after one’s own people but because it is the right thing to do. However, despite the fact that this much is at stake, the battle in the Senate will not be an easy one because this is not a chamber of Saints but a chamber of Jekylls and of Hydes. What transpired during the debates that unfolded, first in the country at large then in the House of Representatives, says that we are in for quite a show.
If you followed those debates you could not have missed the arguments that were made by prominent people such as the multitude of current legislators, the handful of former officials and the swarm of talking heads that staked out some truly astonishing positions. In general, these people were not the least bit shy to say it suits them fine to let 15% of the population go without health coverage so that the money saved may be spent on research and development to make health care better for the remaining 85% who now enjoy what they said was the best health care system in the world. These people and their talking heads deliberately avoided saying that America has the best coverage because they knew this was demonstrably false, so they said America has the best system because they could point to a handful of medical centers of excellence that are among the best in the world. What the talking heads failed to mention, however, was that such centers are not the exclusive domain of America but that they exist everywhere in the developed world as well as in some emerging nations where Americans increasingly go to get treatment.
Be that as it may, the question to ask at this stage is this: Have some people in America decided there are a trade-off and a choice to be made here? If so, have they chosen what amounts to a Robin Hood in reverse? When pressed to answer these questions, the people who previously staked out astonishing positions now go round and round unable to say anything that makes sense. And when you dig deep into what came out their pen and out the generator of their sound bites, you find them to be saying that because the centers of excellence cater to the rich, a coverage that is universal will take away this privilege from the poor fellows. Someone will then ask in utter puzzlement: what poor fellows? And the brazen answer will come back: the poor rich fellows, you see. Amazed and flabbergasted, you will dig deeper into the matter only to discover that the brouhaha was instigated by the insurance companies because they stand to loose business by losing not a captive audience given that very few listen to them, but a captive population because the one thing from which no one can escape is an illness, especially a catastrophic one afflicting you or a member of your family. You are in the grip of the insurance companies and they want you there without a public option to set you free or give you the least bit of hope because they feed on your misery and that of your loved ones.
In essence then, what these people use as an excuse to further the interests of the insurance companies is the argument that the centers of medical excellence are financed with the money that would go to cover the people now living without coverage. And should the coverage be extended to everyone via something like a public option, money will be diverted away from the centers, an idea they oppose because it runs contrary to the dogma to which they adhere. This is the dogma that says some people must make do with less or do with nothing at all so that a handful of people may have more, and more of the best. This is the essence of the capitalist ideal as they see it, one that the rest of the world sees as peculiar only to America, one that was derided as being Cowboy Capitalism.
To an outside observer like myself living in Canada and truly enjoying one of the best universal coverage on the planet, I look at these arguments with amazement and wonder what happened to these Americans. Over the past half century, I saw America go into spasms of every kind but they all meant to separate the issues so as to look at each one of them in isolation and come to understand it better. But what seems to happen now is that every issue is melded into a nebulous master narrative that says: If you are against this or against that, you are against the whole. And since we are whole and nobody else is, if you are not with us half-heartedly you are against us wholeheartedly. Not only that, you are also at war against us which puts us at war against you. But if you want to switch sides and be with us, be advised that your marching order for the day is to oppose universal coverage and to fight it tooth and nail.
To me, this means America has gone back to the business of eating from the cake of its own Benign Neglect. But this time the country is doing it with a twist that is different from anything I have seen before and so I ask: What are these people up to now? To answer the question I first observe that benign neglect is not new to America. The term was borrowed from British history by the late Senator Patrick Moynihan who suggested to then President Richard Nixon that America adopt a policy of benign neglect toward the African American segment of the population. But after all these years, it became increasingly clear to me that the word benign was injected in the term for the sole purpose of making the neglect look like a misunderstanding. I make this judgment based on my assessment of Moynihan’s conduct and I conclude that the real intent of benign neglect was more malicious than it was innocent.
How malicious was that? Well, things get a bit complicated here because I can only explain a deliberate misunderstanding by discussing another misunderstanding that was not deliberate but were, in fact, innocent. Like I said, it is going to get complicated so please bear with me. Most people believe that the phrase “Let them eat cake” means “Let them go to hell” when in reality it was meant to convey the opposite. This is how the story goes: Long ago, France ran out of food, and famine was beginning to set in. When told that the people had no bread, the Princess in charge uttered what comes naturally to someone living in a palace. Normally, the discourse would go something like this: We’ll just have to eat cake till the servants are done baking the bread. And this was the spirit in which the Princess said “Let them eat cake”. Legend has it that Marie Antoinette was the Princess who uttered the phrase and if anything, that woman lived up to her reputation in that she demonstrated how little she understood the difficult times through which her country was passing.
Marie Antoinette did not commit a deliberate act of malice but was the victim of an innocent misunderstanding created by her inability to grasp the complexity of the situation. However, given her stature and her privilege, this is not how the utterance sounded at the time or how it survived to this day. In fact, the utterance is now taken to mean “Let them go to hell” which is exactly what Benign Neglect was meant to convey by the late Senator and by those who wore his mantle after his passing. But whether we have here a case of let them eat cake or a case of benign neglect, most people see it as a case of the mask dropping to reveal an aspect of American reality no one thought existed. Hence, let it be known that we are witnessing the unfolding of a twist in American history that is gradually revealing the uniqueness of our time. It is that the neglect is no longer directed against the African American segment of the population or against any one ethnic group but is directed against anyone that may be unfortunate enough to fall between the cracks of this imperfect system.
Beyond all of this, there is an aspect of culture and society that needs to be clarified. What is puzzling is that a situation such as the one described above should be associated with the American people who are thought to be among the most generous in the world. These people donate as much as a quarter of a trillion dollars every year to various causes in societies near and far yet they fight ferociously to deny life saving medical coverage to a good chunk of their own society. They say with a straight face that they lead this fight because it will cost too much to cover everyone when the reality is that the money required to cover the uninsured will amount to less than what they donate. So why are these people the way they are? Is it because charity is tax deductible while health coverage is not? Is this the only reason?
This may be one reason. After all, incentives dispersed by the government greatly influence the decisions that people make every day. But there could be another reason too. It could be that the Americans are ruled by the power of the same old dogma which also says it is a sin for government to distribute the wealth of a nation. As hard as it is to understand this self-contradictory argument, it gets harder still when we assess the oddity of a situation where the people who adhere to a dogma that is this harsh can also be this charitable.
When someone exhibits this kind of split personality, the stereotype that comes to mind is that of Robert Stevenson’s novel Dr. Jekyll and Mr. Hyde. This is the story of a medicine man who produces a substance which allows him to switch back and forth from being a helpful doctor to being a hurtful drifter. The story serves as a metaphor reflecting an America that is a kind of Dr. Jekyll without borders who heals people around the globe. But the story also reflects an America that is a kind of Mr. Hyde who deliberately abandons his people to benign neglect as they hunger for a medical coverage they can depend on. What a modern horror story this is!
The double image of America does not reassure the nations of the world as to the trustworthiness of that country. Consequently, this image must be changed, and the US Senate has the opportunity to do just that. In fact, the Senate can bring back the image of an America that the world used to love and respect. It can do that by morphing the current image into that of a Dr. Jekyll minus the associated shadow of Mr. Hyde. While I have no illusions about a Senate that is made of individual Jekylls and individual Hydes, I am convinced that the upcoming debate on health care will tell the world whether the Senate as a whole is closer to being a Dr. Jekyll or a Mr. Hyde. And the way in which the world will come to view the Senate will be the way in which the world will eventually come to see America as a nation.
So go ahead, Senators, do your thing and show the world what you are made of -- what America is made of. Say yes to your people and the world will believe in your generosity. Say no to your people and the world will see you as the incestuous father who will do anything to look saintly in the eyes of his neighbors but then rapes his own children when no one is there to witness the horror.