In times of crisis (like these), all options should be on the table.

Ah, Saturday. Lazy, glorious Saturday, full of free time. The unplanned ones are often the best...the most relaxing, anyway. Feels like the perfect time to sit down and finally write my long-brewing piece about health care in the good ol' U.S. of A.!

This issue feels so personal to me in so many ways that you would think it had actually touched my life much more deeply than it has (yet). Until perhaps six or seven years ago, I never really thought that the American health care system was broken. In fact, to be honest, I just never really thought that much about it at all. I didn't have to. See, I was--always have been--one of the lucky ones, one of those who didn't get the short end of the stick in our system. I was blessed on two counts: one, to have always had near-perfect health, no terminal or serious recurrent conditions, not particularly prone to getting sick, in short, no real health problems; and two, to have been born into, and raised in, an upper-middle-class family that always had good insurance, and enough money to pay the copays and prescriptions on those rare occasions when they were needed. I never had to think twice about going to the doctor, though I hardly ever went--I hardly ever needed to; but if I did need to, I was taken, and there was never any concern about paying for it. Furthermore, what I always heard from my parents at home (and kids tend to take what their parents say for granted up until a certain age; some do forever) was that if you were really poor, the government paid for your insurance anyway, and if the government didn't then you could afford health care, if your job didn't provide it for you (and I was under the impression that most jobs did).

So my personal experience with what could happen without health insurance was limited to that of a couple of friends, whose families were not as well-off as mine and who were not covered. One night my best friend spent the night at my house, and I was up with her in the middle of the night as she moaned and sobbed hysterically in pain from a toothache, so much so that I had to wake up my mother and ask for some prescription painkillers to help her out. The simple response to the situation was, "She needs to go to the dentist tomorrow." The problem was, she didn't have insurance (of any kind, much less dental) and going to the dentist for a toothache like that would likely cost hundreds of dollars that she, at 16 or 17, did not have, and that her parents, working hard every day to pay the rent and bills, did not have either. I still remember that incident as a first glimpse of the reality of not having insurance for some people who were less fortunate than myself. It began to dawn on me that the system didn't treat everyone equally. Yet it did not become something that preoccupied my mind all that much. For one thing, I was in high school, and had more important things to worry about, like boys, going out, parties, what everyone else thought of me, trying to circumvent my parents' rules and not get caught. And for another, while we can certainly experience empathy as children or adolescents, or even as adults, if the experience is not one happening directly to us, we tend to shelve it pretty fast.

Several years later, after college, I spent about eight months in Lille, France. I was twenty-one, still pretty much self-absorbed but beginning at long last to take some baby steps toward maturity; that year was by and large an awakening to the fact that my own experience in the world was not everyone else's, brought home by being alone in a foreign country, living, working and socializing among people from another culture with another worldview. I spoke the language, having majored in French in college, and thought I knew something about French culture when I arrived, but I was very much aware of my "otherness" there, and it gave me a self-consciousness that was entirely different from the one I'd lived with my entire life. Before, I was always very concerned with what the people around me thought of me personally--I wanted them to like me, admire me, respect me, find me attractive, find me amusing and entertaining, all of those things that add up to personal popularity, a quality that was very elusive to me throughout my childhood and adolescence, up until my early to mid-twenties. Now, in France, I became increasingly conscious of my cultural identity--and I struggled with it. Part of me was desperate to defend everything American--the culture of conspicuous consumption, the arrogant foreign policies, the isolation from the rest of the world, the overwhelming sense of cultural superiority that comes from being totally ignorant of other cultures. At the same time, I became more and more aware of those very traits that I felt some need to defend, and wanted to distance myself from them, show these people that even though I came from there and could speak up for those things, I was not of them; I was not like that; that was not me.

I should mention here that I did not feel "attacked" as an American. It has always irritated me to hear, over and over again like a broken record, that "the French hate Americans" and that I would be reviled in France. That was not my experience in the least. While yes, I did encounter a few rude Parisians here in there, generally in very touristic areas, my overall experience with the French was very positive. Maybe this was because I did speak the language, and was therefore able to communicate with people, make friends, and consequently explore not so "touristy" places where the attitude was different. My experiences in other parts of France, outside Paris, also tended to be better on the whole from the social standpoint; especially in Lille, and in smaller towns, what automatically qualified me as a "tourist" to be treated with vague disdain in Paris was simply fascinating. Those places are not on the tourist's path and they don't see many Americans; that seemed to lend me something of a movie-star allure, particularly among the teenagers in the high school where I worked in Lievin, a rather desolate little town in the poverty-stricken Pas de Calais region just south of Lille. Even adults were more often than not intrigued by that "otherness." Overwhelmingly, people were friendly, curious, not harsh or judgmental or snooty. Though this sidebar is not related to health care, I do feel the need to set that record straight: I never felt that "hatred for Americans" people here love to rant and rave about. I felt more than welcome there, for the most part, certainly just as (or more) welcome as any French person staying in the U.S. would feel.

Indeed, that need to defend those negative qualities of Americans stemmed not so much from a feeling of being attacked as an American as from a newfound awareness of their very existence. It is true that the French tend to talk politics much more readily than Americans do (on the whole), and they generally do not hesitate to criticize American policies, just as they criticize their own policies and those of other countries around the world: they tend to be outspoken about their political beliefs. On the rare occasion that I would start feeling particularly defensive in a political dialogue, I was quickly reminded: "There's no need to get defensive. We're not attacking you or even Americans. We're just saying we disagree with those policies." I had to take a step back, try to put things back into perspective, distance myself from the political criticisms, and start over.

All of this just to explain that my political sensibilities first started to come into focus during this time. I did not leave France with fully-developed political ideas when I came home in the summer of 2001, but I had definitely become aware that there were very real, very pressing problems within my own country that did have political solutions that were not being explored. I was not entirely ready to disown every idea I had been brought up to believe, but I was beginning to question many of them, and the wide array of answers to those questions often leading far away from what I had been told was right began to trouble me profoundly. My curiosity had blossomed.

The American media confines political debate to a very limited sphere, something I realized during my various stays in Europe and for which I am finding detailed explanations right now as I read Edward Herman and Noam Chomsky's masterpiece study Manufacturing Consent (highly recommended). Watching the TV news, reading newspapers and magazines and talking to people in European countries showed me complete other sides to familiar stories that I had been totally unaware even existed. The Israel/Palestine conflict is one example. I had never had an overwhelming curiosity about that region of the world, and therefore knew only what I had heard in the news in the U.S., all of which, even the most "liberal," has a striking pro-Israel bias. I truly believed that Israel was the underdog and that the Palestinians were terrorists. That's what the media had told me, and due to lack of fundamental curiosity for the subject, I had not bothered to explore it further. In Europe and in relationships with Europeans my views came to turn nearly 180 degrees, as I saw the other side of the story that had never been revealed to the masses in the U.S. Health care is another example. The propaganda against "socialized medicine" has been so consistenly strong in the American media that outside of highly educated and often academic circles, it is very rare to hear anyone speak in favor of it, at least until recently. In fact, systems such as those in France, Canada and Great Britain were held up as threats: do you really want us to end up like them? We were inundated with horror stories about interminable waits for operations and procedures, terrible bureaucracy and red tape, warned that such a system would all but turn us into a communist country. Mass media never showed us the other side of the coin, never explored the advantages of those systems, and certainly never showed any opinion polls of people living in those horrible, horrible socialist countries. Had I not spent 3 years (at different times) living in Europe and had I not developed relationships with many Europeans and Canadians, I might never have come to the realization that single-payer systems can work, are fair and equal, and are popular where they have been put in place.

The simple fact is that not one of my European or Canadian friends or acquaintances has expressed the slightest inkling of jealousy of the American health care system. On the contrary, they are generally astounded and horrified by it. How could such a rich country not provide basic medical care for all of its residents? It blows their minds. They do more for their citizens in poor countries than we do here, in the country with the most resources in the western world. I have been asked more times than I could count by my European friends: Why? Why don't Americans want to fix the system?

When you look at what we Americans are so accustomed to through the eyes of someone from a country where everyone is provided with good health care, regardless of their income or employment status, it is astounding and horrifying. It was only after spending time in Europe that I started looking at those collection jars on the counters at stores and gas stations, raising money for life-saving operations and transplants, with new eyes. Instead of just feeling pity for the poor individual needing to raise thousands upon thousands of dollars in order to save his or her own life, or the life of his or her child, I started feeling anger, disgust, revulsion. Not at the individual, obviously, but at the system, here in the biggest superpower in the world, that forces low-income and even sometimes middle-class people to literally beg for their lives. You would never see such a thing in Europe. You would never see somone denied a life-saving operation because they did not have the money to pay for it.

Recently at the high school where I teach, a student died in a terrible car accident. He was in the hospital on life support for several days before they decided that the brain damage was so severe that he would never regain consciousness. His family did not have insurance. Their home was in foreclosure; the student had been selling candy on the sly at school to take home money to his parents to help keep the lights on. So, on top of losing their teenage son, they are also hit with thousands and thousands of dollars in medical bills, not to mention funeral costs--at a time when they already could not afford to stay in their home and keep the lights on, when they were having to choose which bills to pay which months. Our students, lovely compassionate souls that they are, managed to raise over $5000 in donations among the student body, faculty and staff of our school. Their love and generosity are truly heartwarming. Nonetheless, I felt, and feel, that same revulsion toward a system where a hard-working family mourning the loss of their adolescent son must also be made destitute by the costs of trying to save their son's life, and then of burying their son.

Yet popular thought in our country tends to blame the victims. If they don't have good medical insurance, it is their own fault. They should budget for it (never mind how when their wages already don't pay the rest of their bills...). Or, better yet, they should have worked harder or gone to school longer so they could have a job that provided insurance. I have a friend whose beliefs are usually the complete opposite of my own who tried to convince me of this one night not too long ago. I asked him, "What of working-class people, janitors, hairdressers, cooks, waiters, maintenance men, who don't get health care coverage through their jobs and who don't make enough money to buy insurance for their families, but make too much to qualify for Medicaid?" His response was (I kid not), "Well, they're just not ambitious enough. I see people in jobs below mine all the time who are just lazy. If they cared a little more, if they worked a little harder, they could have a better job and get health insurance. Why should I have to pay for their medical care? I've busted my ass to get where I am today and to make as much money as I'm making, and I don't want to share it with anyone."

I am not going to deny that he has worked hard. He graduated from college, he got a job in the entry-level in his field and worked his way up. Granted. My problem is not with how hard he has or has not worked, but with the assumptions he starts out on. He seems to presume an equal footing from the start line. His attitude is that everyone else out there was born into the same type of family as he was (middle-class) and afforded the same opportunities (good schools, the chance to go to college). He ignores the fundamental inequalities in our society that profoundly shape the direction people's lives take.

And perhaps I shouldn't criticize him too much, for his attitude is very similar to the one I had for years until I became more culturally aware. I remember feeling somewhat offended by things like need-based college scholarships, minority scholarships, the very idea of affirmative action. I felt I was a living example of why none of that was necessary. After all, I went to college for free with the scholarship I got for National Merit, based solely upon my PSAT scores and regardless of my parents' income. If I could do it, what was stopping anyone else? I felt entirely deserving of every opportunity that fell in my lap. That was all thanks to my own brains and my own hard work (I grimace as I think this now, considering how very little work I actually did in high school). And if my parents had more money than other people's parents, well, that was because they had earned that, too. They went to college, they got good jobs, they worked, they deserved everything they had, and that somehow made me automatically deserving too.

It was only years later that I became aware of how our beginnings in life shape our lives. I liked to boast that it was my own initiative, my own brains and hard work, that had gotten me everything I had; my parents hadn't given me anything, I had earned everything. I think of that now as quite a joke. I was born and raised with advantages most people never have, and not just materially. My parents' income assured that I never wanted for anything, that is true. We always had a nice home in a safe neighborhood, food, clothes, transportation, all of that. But I also enjoyed other advantages that are not quite as obvious at first glance. My success in school, for instance...can I truly give myself full credit for that? To do so is preposterous and arrogant. Yes, I am of above average intelligence, and other than genes, that is not something my parents could influence too much; I am pretty sure that you are born with the intellectual capacities you are born with, regardless of who your parents are or how much money they make. But there are plenty of extremely intelligent people out there who end up in entirely different walks of life. My success in school was not due entirely to my intelligence; it was, in large part, due to my parents' fostering of it. One thing I will always give my parents credit for is the high expectations they always maintained for me. Both of them were college-educated, and understood the fundamental importance of education in having a successful life, so from early childhood on, education was a priority. My mother always read to me and I started learning how to read and write before kindergarten. Throughout my years in school, I was expected to bring home the best grades on my report cards, and consequently I never made a "C" on a report card until my first semester of college (when I got two: the first and last I would ever make in my life). My mother is an English teacher herself, always reading, and her love of reading was passed on to me from the time I was old enough to listen, much less read for myself. I was expected to go to college; there was never a doubt about that. There was never any question of what I would do after high school, if I might look for a job, take a year or two off, choose a career. That was true for both my sister and my brother as well. All of us were expected to go to college. What would have happened if we hadn't done that? If one, or all, of us had chosen a different path? Probably nothing; my parents would most likely have been disappointed, but reluctantly supportive. But I remember feeling at the time, especially in high school, as if choosing not to go to college would have been treason, something worthy of getting disowned. And the fact of the matter was, there was never any question about paying for it. My parents had a college fund for each of us. They "bribed" me to get a scholarship by telling me that if I got a full scholarship, they would spend my college fund on a new car for me. This motivated me to study for the PSAT and score highly enough to win National Merit--which I did--and they did indeed use my college fund to buy me a new car (which I drove until January of last year, incidentally). But in my life, the question was never if I would go to college, or even how I would go to college; it was, rather, where I would go to college, if I would get a scholarship, what I would study once I was there.

I have several friends who are intelligent like me, but who came from families where education was not the priority; working families, where the parents were too busy trying to pay bills to worry too much about pushing their kids to succeed in school. These parents loved their kids just as much as my parents did, but things were different for them. In some cases, they hadn't finished high school themselves, much less gone to college; it was never in their minds that their children absolutely must go to college. Sure, they could, and they would be happy about it; but it was never a given, and there was certainly no money in the bank for it. If they wanted to go that route, they would have to find their own way to pay for it: scholarships, loans, grants, a job. And while all of those things are out there for the student industrious enough to seek them out, it does require quite a bit of motivation. For your average eighteen-year-old who was never particularly in love with school in the first place, and whose parents are not pushing him or her to go to college, it is a lot to ask them to do, and many are simply unaware that those opportunities are even there for them.

Of the individuals I know coming from this type of home environment, a few did end up going to college, either right away (out of personal motivation) or after a couple of years off working, during which they realized that they did not want to struggle the rest of their lives in a low-paying, dead-end job, which is the typical outcome for someone with no college degree or vocational training. Others never went, and are now, years later, trying to gain the skills or experience needed to establish a real career. They are all making their lives their own way, and all of them are doing OK right now--but it has definitely been more of a struggle for all of them than it was for me, and I have to recognize now that that is not because of any personal intellectual or moral superiority on my part, but simply because I was given opportunities that they were not, and felt a need to live up to expectations that they did not. And when I think about how I was as a kid--smug, slightly arrogant, self-righteous, somewhat lazy know-it-all--there was nothing superior about me in any way. I was a perfectionist, and always wanted to be the smartest one in the class. At the same time, I generally did not challenge myself all that much: I chose to take regular classes at my school rather than being in the magnet program, because I could make great grades while doing less work. I was a good student, I made straight A's, but I also slept through my classes quite a bit, skipped quite a bit of school (particularly my last year), and I don't remember ever doing homework at home (though I did get it done--during other classes). I didn't study. I made good grades by taking relatively easy classes (too easy for me, anyway) and because good grades came easily, so I did a bare minimum (e.g., doing my homework during other classes) to ensure that the grades stayed high. I was anything but extraordinary. I look at some of my students now, taking 6 Advanced Placement classes for college credit, maintaining straight A's in those classes, doing community service, serving as officers in multiple clubs at school, and some of them working on the side as well, and I realize my own mediocrity as a student. I was so smug then, so sure that I was just smarter than everyone else and that's why I was doing so well. How stupid I was. The point of this tangent being this: How on earth can I presume to know what I would have ended up doing had I not had well-to-do, educated parents pushing me from childhood on? Had I grown up in a house where my parents were often at work and where I had little supervision or direction; where my parents did not particularly value education over other interests, or where they perhaps even expected me to get a job and help the family rather than go to college; where, if I had chosen to go to college despite their lack of interest in it, I would have been on my own to come up with the money needed for it? How could I really sit here and say I would have done things the exact same way, that things would have worked out for me the same way? Who am I to say I would have been different from my friends, just as intelligent as me, who are just now trying to catch up?

(And this relates back to health care how...???) I think my point in this long, long tangent is simply that blaming the poor for being poor is simply too easy. It is easy to point fingers at the "welfare moms," but when you get down to it, there just aren't that many of them. There are far more "working poor"--people slaving away, often at two or more jobs, well over forty hours a week, who are still coming up short on their rent and bills, who are having to choose between food and doctor's visits or prescriptions. How can my friend, making something like $80K a year now, single without kids, say with a straight face that his hard work has earned him his salary (which he should not have to share with anyone) and his benefits, and that those people cleaning toilets sixty hours a week, they are less deserving of health care than he is because they are just lazy? How can anyone make such a claim and still look themselves in the eye? How can you call someone who does manual labor fifty hours a week lazy? Furthermore, what would we do without people to do those jobs? At the end of the day, we depend on those people cleaning offices, scrubbing toilets, mowing grass, washing windows, filing papers, etc., etc. We need them to do the job they're doing; businesses don't want to pay them too much to do it; and somehow we think they don't deserve health care for themselves or their families.

And little surprise: our media, as well as our government, are in the pockets of the health care industry. Insurance companies and the medical field have lobbyists working night and day to make sure that a single-payer option is never put on the table. Media works along with them to ensure that the general public believes that somehow our broken, backward system that only values the lives of those with the money to pay for it is actually beneficial to them, and that they'll get better care under our current, for-profit system.

This is fundamentally a moral issue. Are we a country that lets citizens, including hard-working men and women, children, and the elderly, die because somehow we don't feel that they're worth saving (since they can't afford to feed the health care industry's profits)? Is it really acceptable for us to allow the health care industry to be for profit anyway? Why should saving lives be about making profits? After all, the insurance industry seems to find overwhelmingly that it is more profitable to deny claims than to honor them, and thus more profitable to let people die or fall into ill health than to help them. Does everything in this country have to be about how much money businesses can make? Can people finally take enough interest in their own self-interest to make our government come up with an equitable solution that does not bow down to the profit margins of the health care industry? Can the American people finally get the information they need to realize that becoming more like Canada, France or Great Britain in that respect is not a bad thing? When I look around at our society and the way government works, everything is aimed at helping corporations be more profitable. They try to tell us every day that the more profitable corporations are, the richer our citizens will be. It takes a blind man not to see that that is simply a lie. The executives have gotten richer and richer and richer; the middle-class and the working poor have simply gotten poorer. We are told that the quality of our health care will go down if it is made available to everyone. We are told this so that the health care industry can keep making their profits. Maintaining the status quo is in no one's interest except the health care industry.

All options need to be on the table...including, and especially, single-payer. The only Americans who don't want it are those who are profiting off other people's misfortune...and those who are ill-informed enough not to know any better.