By Robert J. Zieve, M.D.
Issue: Spring 2006, Spirit & Economics in Health Care; Issue #43
As the United States undergoes rapid changes on many levels in the early twenty-first century, let us look at health care through the prism of original American values. The Declaration of Independence begins: “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” We may first look at the word “equal.” We know this term perhaps best in phrases such as “equal protection” or “equal rights” under the law. So equality refers to the sphere of our lives in which laws and rights are active. This is our political life. In health care, this legal realm of life, especially over the past 150 years, has essentially become an instrument for the economic realm of life to become predominant in society. Through laws today, many people are denied equal access to quality health care. Laws now deny seniors coverage for non-drug therapies that work. Laws also restrict employees from seeking what they feel are appropriate therapies when these are not covered by their insurance plan. These laws prop up excessive, insensitive corporate health care, and often deny access to people with low incomes.
Then we have liberty. In the realm of culture, which includes religion, the arts, education, and health care, the key word is liberty, or freedom. What then is meant by freedom in the context of health care? In the United States today, we have put freedom on a pedestal and put responsibility in the gutter. Freedom has come to be equated with license. We think we are free because we can go to a movie or another city anytime we want, or we can eat anything we want and have the burger made the way we want. But these are material freedoms. Though material freedom is not to be taken for granted, as it is restricted in many countries, the way we practice it is freedom taken to its extreme because it lacks boundaries. These boundaries are what we would call responsibility. We want the freedom to eat whatever we want, to do whatever we want, and then have someone else pay for the consequences. This is freedom without responsibility. What we have today is a false and misleading sense of freedom, and entrenched self-centeredness.
A system of healthy medicine is characterized both by freedom of choice in health care practitioner and by all parties involved taking responsibility for the consequences of living in unhealthy ways. For the individual, this means accepting the responsibility for taking care of him or herself. For health care practitioners and suppliers, this responsibility means having transparent finances and making service and support of healing, rather than shareholder profit, their principle reason for existence in the health care field.
The Great Law of Peace in the Iroquois Confederation uses the phrase “autonomous responsibility.” This meant that each person judged only him or herself, viewed the others as masters of themselves and their own actions, and let others conduct themselves as they wish. This is what we need again in health care and in the United Sates in general.
This quality of freedom or liberty is most fully expressed in the cultural realm of life. There is freedom of speech, freedom of religion, freedom of expression. And there is freedom to choose one’s own doctor. It is in the cultural sphere of our lives, as opposed to the political or economic arenas, that we most deeply connect with our inner spiritual and human creative needs. When we sit quietly and alone in prayer or meditation, or in reading a book, in eating our food, or in taking our medicines, we live in this realm of life. The true home of health care is in this cultural sphere of our lives, not in the political and economic arenas. It is important that we see this. When we are truly free, we choose the health care practitioner with whom we wish to work, which is really no different from choosing a priest for confession, or a teacher or a book through which to learn and grow. All three of these examples are sacred to our most deeply human qualities. It is the work of healing that we undertake when we exercise the right to choose our own practitioner.
But this right must be exercised. Too often today we think healing means making symptoms go away, or eliminating organs surgically. This is not healing, but rather is fixing. If we demand to be fixed, then we will continue to get what we deserve: a sickness care system that will drive us into bankruptcy and in which we feel passively helpless. As earlier generations of great Americans have said, liberty must be fought for – not on the streets or in overt battles with opposing forces as in the past, but in our own individual lives and local communities. And it is Lady Liberty, who sits in the harbor of our greatest financial center, who is the national symbol for this quality of Freedom. We must bring this Liberty/Freedom into our financial and economic lives, including health care.
A further ideal of the American spirit can be found in the song America the Beautiful: “And crown thy good with brotherhood from sea to shining sea.” Fraternity, or brotherhood, is the part of the trinity of Liberty/Equality/Fraternity that is often forgotten. We have become a land of individuals seeking our own profit and protection. The common good is rarely thought of today. And the pursuit of happiness is more often than not a selfish, me-first phenomenon that damages local culture and economy.
A key part of a new and successful health care system, based on the sound principles of healthy medicine, is to support the growth of fraternity in the form of local communities and local economy. Without what author Christopher Budd calls an “enlarged egoism” that is inclusive of others, in which we recognize that our own happiness cannot be gained at the expense of others, we will continue to live in fear of scarcity, poverty, and illness, and lose sight of the abundance that is present all around us. This abundance that we equate with happiness is present when we are guided by the spirit of service and inclusiveness, or what is known as a win-win situation.
To be clear, a medical model based in comprehensive medicine recognizes health care as a spiritual cultural endeavor. Through the work of healing, we raise the human spirit and give birth to dormant creativity in every person. This has to be our goal in health care. For this to work effectively, we must establish clear and healthy boundaries between this cultural realm (the true realm of health care), the political realm of laws, and the economic realm of products and services. Healthy Medicine Associations, guided by comprehensive medicine practices and environmental sustainability, are an effort to begin this process.
If we can again establish these healthy boundaries, then, instead of rampant and destructive free-market forces, we can strive to create the conditions whereby life, liberty, and the pursuit of happiness are within reach of all Americans.
Robert J. Zieve, M.D., is a practicing physcian in Prescott, Arizona. Board-Certified specialist in Emergency Medicine for over 20 years, he is the author of Healthy Medicine (www.steinerbooks.org). His forthcoming book is called Beyond the Medical Meltdown:Working Together for Sustainable Health Care.
The Emerson Center for Healthy Medicine (www.healthymedicine.org) The Center is a growing collaboration of health care practitioners, economists, community educators, legal professionals, business people, artists, and many patients and families. The purposes of the Emerson Center for Healthy Medicine are to develop creative ideas about how to change health care, to offer educational support to individuals and groups who seek to improve our health care by making it more effective and affordable, and to support the implementation of these efforts in local communities and businesses.