I came across James Meek’s excellent Where will we live?: The Housing Disaster in the London Review of Books, a piece of long-form journalism as incisive and poignant as the situation it covers is infuriating. It’s a worthy read about the human costs of ill-considered privatization, and the tragedy isn’t just that people—hard-working people who’ve done nothing to deserve it—are losing their homes, but that the idea of what housing can be, of what it is they’re losing, had already been killed by the thousand paper cuts of bureaucracy. At the end of his life, public housing architect Berthold Lubetkin lamented:
the public themselves became more and more disillusioned with any idea that art or architecture could lift them up or foreshadow a brighter future. Instead of looking at architecture as the backdrop for a great drama—the struggle towards a better tomorrow—they began to see only the regulations, housing lists, points systems, et cetera, and so expect only ‘accommodation’…
One of the great sins of bureaucracy is that it diminishes life from a story to a mere set of things you have to do, forms to fill out, boxes to check off. And once something is diminished like this, once a right is turned into a chore, of course it’s less readily defended. Just look at healthcare in America.
Like other safety nets, the promise of decent healthcare—which in the U.S. means having good health insurance—has the potential to do so much for us. It can allow us to take risks and pursue our dreams—buy a house, have a child—without fear of random illness or injury bankrupting us and our loved ones. When tragedy does happen, it can lift at least the financial burden from our shoulders. And yet, if you have health insurance in America, this probably sounds comically idealistic. For me, having health insurance means losing a sizable chunk of my paycheck to a corporation I did not choose because ballooning costs leave many aspects of medical care otherwise unaffordable. It means that the stress of many doctors’ visits and surgeries is multiplied by having to obtain pre-certification beforehand, fill out paperwork during, submit claims forms afterward, and to appeal if the insurance company1 decides to deny coverage anyway. It means waiting on hold, being responsible for my insurance company’s clerical errors, and rarely enjoying the peace-of-mind that’s supposed to be the whole point or insurance. And I consider myself lucky even to have these problems.
The sorry state of our health insurance system is put in stark relief by this piece by American Anya Schiffrin in Reuters about her father’s final days with cancer in the French healthcare system.
The final days were harrowing. The grief was overwhelming. Not speaking French did make everything more difficult. But one good thing was that French healthcare was not just first rate — it was humane. We didn’t have to worry about navigating a complicated maze of insurance and co-payments and doing battle with billing departments.
Every time I sit on hold now with the billing department of my New York doctors and insurance company, I think back to all the things French healthcare got right. The simplicity of that system meant that all our energy could be spent on one thing: caring for my father.
That time was priceless.
This is what healthcare can be. For Schiffrin, it didn’t make losing her father any less painful, but it did allow her to make the most of her last days with him. And Schiffrin’s father wasn’t a special case; he received the same government-subsidized healthcare that everyone in France does (and France spends less than half as much as the United States for it2).
Corey Robin sums up these ideas well in a provocatively-titled essay about healthcare.gov, Socialism: Converting Hysterical Misery into Ordinary Unhappiness for a Hundred Years. His point is that while no political system can claim to eliminate the pain and grief from human life, socialism does try to make them more bearable by not abandoning citizens to manage it all on their own. His political vision echoes exactly what it was that the French healthcare system offered Anya Schiffrin and her family:
We want to give people the chance to do something else with their lives, something besides merely tending to it, without having to take a 30-year detour on Wall Street to get there. The way to do that is not to immerse people even more in the ways and means of the market, but to give them time and space to get out of it. That’s what a good welfare state, real social democracy, does: rather than being consumed by life, it allows you to make your life. Freely. One less bell to answer, not one more.
In some ways, the Affordable Care Act of 2010 was a step forward, moderately reforming a deeply broken system and bringing 30 million of the previously uninsured within its sphere. But while the right to choose from among crummy options is vastly better than no such right, we should keep our political imaginations open to the possibility, and the kind of life it might enable, of not having to choose.