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General The American Paradox
2012.07.09 08:32
by Richard Horton  from the Lancet June 30-July 6, 2012  The Lancet was founded in 1823, a time of Romantic idealism, the broadening of democracy, and a concern with “the condition of England”. The great cause of these interlocking movements was something writers then called liberty, illuminated poetically by Shelley and philosophically by Mill. The liberty Shelley argued for was a kind of equality or egalitarianism, where the aristocratic divisions and privileges of 19th century English society were attacked in order to be erased. This was Thomas Wakley's objective when he founded The Lancet: to create an equality of knowledge, where every medical practitioner had access to the best available understanding of the medicine and medical science of the time. Liberty is rarely talked about in this way now. Liberty has been successfully appropriated to mean something quite different—freedom from interference with the way one chooses to live one's life. Is this notion of freedom a very American idea? It has a perfectly justifiable political heritage if so. Americans have good cause to be suspicious of those who, like their former colonial ruler, might wish to forget a history of repressive government. America's independence, its claim to freedom, was, in some ways, the purest expression of this very different idea of liberty. But the birth of a radically altered notion of political freedom—and the eventual rejection of the word liberty itself (a word that had initially inspired the American revolt against Britain)—has had profoundly adverse consequences. It has meant that those advocating any notion of equity or egalitarianism, even for an issue such as health (in which one might think we all share a common interest), are commonly viewed as threats to the very principle on which America was founded—freedom from interference. Here may lie the origins of the predicament that is now the Affordable Care Act.  Although this history provides understandable reasons why Americans might value freedom (from interference) over liberty (of equal opportunity), it could, if applied to foreign policy, inadvertently lead America to deny the progressive realisation of the right to health for many millions, even billions, of people. This concern is not merely theoretical. In 2011, the US Government gave $7·6 billion in bilateral development assistance for health (27% of total global spending on health). Their contribution dwarfs all other donors by far. The US invests more into global health than either the World Bank or the Global Fund. America's proportion of global health aid is rising as Europe's contracts. The philosophy underpinning how American donor aid is spent is therefore of urgent importance. The notion of universal health coverage—the international equivalent, in intention, of the Patient Protection and Affordable Care Act—is beginning to gain ground in global health. Will the US Government throw its weight behind an idea that has the overwhelming support of low-income nations? Based on the rancourous political debate about America's own efforts to implement universal coverage, these countries will probably have to reconcile a paradox: that America's own history of triumphant independence may turn out to shackle, even disable, the health (and so independence) of others. |
Comment 4
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이한중*65
2012.07.09 08:43
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운영자
2012.07.09 10:37
"Presidents Clinton and Obama, strenuous advocates for extending health coverage,
focused too much on the economics of healthcare.
Instead, they should have made health a moral issue,
a legitimate entitlement and expectation for the people of a wealthy country."First of all, I like to thank that he considers us a "wealthy country".
However, I just wonder if we are really wealthy.
So many people don't have any health insurance.
For middle or lower class families without medical insurance,
if they visit an emergency room or stay in the hospital for a day,
they risk getting bankrupt due to the medical bills.
Is that a wealthy country?
I would say it is a "wealthy medical enterprises" rather than being a wealthy country.
Who makes all the money from the exorbitant medical care bills?
Are they happened to be the Republicans and their clients,
the big corporations of insurance, pharmaceuticals, and healthcare outfits?If one is sick and can't find a proper medical care, does "Liberty or Freedom" mean anything to him?
For a sick person, liberty and freedom don't mean a damn thing.
Yes, availability of medical care to everyone is definitely a moral issue. -
이한중*65
2012.07.09 11:23
Another example of "American paradox," I believe,
would be the controversy surrounding gun control.
Other countries around the world other than USA don't have any issue
with gun control, but we do. -
방준재*70
2012.07.09 18:41
As a small fish in the big pond, I'll just swim in the system.
in understanding the complexity of the health care issue surrounding Obamacare.
One can see where Republican way of conservative stand comes from, i.e.
"Freedom over Liberty."
I thought this article helped me understand the complexity of the issue
in different, (very unique, the only American) historical perspective,
which I would like to share with friends
in case they haven't read it yet.