What’s in it for me?
That’s the way Americans debate health care, just as it is the way we debate everything these days. What will it cost me? What will be my options? What will be the effect on my taxes? This is not an entirely absurd or venal approach. Self-interest is an appropriate prism through which to evaluate public policy. But this narrowness and solipsism illustrates the way in which America has personalized, and thereby stunted, what used to be called the American Dream.
The American Dream represented the idea that the United States was a place where any person could accede to whatever life their talent, ambition, and diligence would allow. It was about universal, common opportunity. Today, it is about my opportunities. It is the notion that I can succeed, I can acquire; and it’s every dog for themselves.
The practical difference between these visions is subtle. Either way, success or failure is largely predicated on desire and drive, on the pointedly self-interested ambitions of the individuals who strive to better their lives. But from the moment the phrase was coined, in James Truslow Adams’s 1931 text, The Epic of America, the distinction between the voracity of individualistic materialism and a broader sense of social justice and collective empowerment has always been crucial. Here’s how Adams originally formulated it:
The American Dream is that dream of a land in which life should be better and richer and fuller for every man, with opportunity for each according to ability or achievement. It is a difficult dream for the European upper classes to interpret adequately, also too many of us ourselves have grown weary and mistrustful of it. It is not a dream of motor cars and high wages merely, but a dream of social order in which each man and each woman shall be able to attain to the fullest stature of which they are innately capable, and be recognized by others for what they are, regardless of the fortuitous circumstances of birth or position.
The American Dream that has lured tens of millions of all nations to our shores in the past century has not been a dream of material plenty, though that has doubtlessly counted heavily. It has been a dream of being able to grow to fullest development as a man and woman, unhampered by the barriers which had slowly been erected in the older civilizations, unrepressed by social orders which had developed for the benefit of classes rather than for the simple human being of any and every class.
The recasting of the national narrative as one of individual privilege and away from common, communitarian ideals is a radical shift, which undermines the opportunities on which both conceptions tacitly depend. As Bill Clinton admonished in the 1991 speech announcing his candidacy for the Presidency, “We need a new spirit of community, a sense that we are all in this together, or the American Dream will continue to wither. Our [personal] destiny is bound up with the destiny of every other American.” America has only moved further from this sense of shared fortune in the intervening years. The fact that we all desire more comfortable lives hardly makes that aspiration a collective experience.
Today, the question before America is whether to reform its atrociously dysfunctional health care system to ensure the availability of coverage for all Americans, including the 46 million who have no health insurance whatsoever. Those whose voices are raised most loudly, most angrily in this debate are those with health care insurance, who do not want a change in their present options (although this has never been a part of any proposed reform) and who do not wish “to pay for the health care of others.” Tax dollars (My tax dollars!) supporting a low-cost, government run insurance program is somehow an uglier form of socialism than, say, the corporate welfare and Wall Street bailouts to which Americans are all too accustomed.
The Obama administration has been tepid and confused in support of its own proposals, and unwisely ceded responsibility for drafting the legislation to Congress, one of the least effective legislative bodies in the history of representative democracy. Just as damagingly, it has also relinquished the terms of debate, allowing the focus to center on the financial consequences of reform rather than the moral imperatives. The issue of universal coverage is rarely cast in terms of economic justice; and the case is far too seldom made that a country where health care is available to all its citizens is exactly the kind of country we wish to call our own.
Were it not so pathetic, it would almost be funny that those who would kill health care reform in the U.S. point to the Canadian “single payer” system as a principal bogeyman. As someone who has shifted his residence to Canada in large part because of the availability of universal health care, I am dumbfounded this argument gets any traction whatsoever. The cherry-picked, anecdotal horror stories about Canadians who endured long waits for access to treatment utterly misrepresent the promptness of emergent and urgent care and the comprehensiveness of preventive, non-urgent, and elective medicine. Canadians and their government pay only 55% of what Americans pay on a per capita basis and have substantially lower morbidity and mortality rates than Americans, which should certainly recommend the system, even in innumerate, jingoistic America. The supreme irony of the American hullabaloo over Canadian health care, of course, is that adoption of a Canadian-like system is not even under consideration in the United States Congress.
Canada does, however, have something important to teach us about the vast reach of the social benefits of universal health care. The distinguished Canadian science fiction writer Robert Sawyer was recently asked why there are so many world-class writers hailing from Canada. “The answer,” he said, “is that all of us in the arts in Canada are blessed with this thing the Americans are terrified of right now, which is socialized medicine, universal healthcare. I’ve been a full-time professional since I was 23 years old; but so many of my colleagues south-of-the-border are shackled to pretty meaningless nine-to-five jobs, not doing what they want to do with their lives because, for that basic necessity of their health and well-being, they have to have a regular job. Set aside the Canada Arts Council and all the provincial arts councils; the number-one best thing Canada ever gave to the arts was our universal health care system.”
Americans must once-again imagine their country as a place where all can prosper and all can contribute to the richness of the national experience. Until then, America itself is but a superfluous, marginal aspect of the American Dream, nothing more than a fungible setting for fantasies of wealth accumulation.
The health care debate illustrates with nauseating clarity the epidemic narcissism that has infected and crippled the American Dream. Will this noble and globally celebrated ideal survive the small-mindedness of its present custodians? It is difficult not to despair. As George Carlin famously cracked, “They call it the ‘American Dream’ because you have to be asleep to believe it.”