July 18th, 2014


Thoughts on the public good and why half-and-half healthcare doesn't serve it

So I got a letter last night from the rheumatologist. To summarise, they are underfunded and only taking 'the most urgent' cases. They regret that they can't offer me an appointment. They realise that this will probably cause me some distress, but they wish to be honest, and I should go back to my doctor to discuss my options.

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And this is the basis of my resentment. This half-pie thing we have in New Zealand is not working, because I was refused healthcare that I am paying more than most people for. I am being directed by this system to shun the public good that I put 30% of my income into, and instead to use my privilege of income to pay for more privilege, which separates me further from any vested interest in helping support public health. I am trying to do the right thing, and it's being subverted into the complete opposite of what I believe is a good life.

I can see that someone who was less stubbornly determined to live by their principles than me, would very easily think "Why should I pay into this at all? It's not as if I use it!" and start working out ways to pay less into the public good. And from there, it's not hard to see how a class of wealthy people with zero interest in furthering the public good can become so detached from the concept of shared wellbeing that they no longer feel any sense of social responsibility - which leads to being completely ok with some people being unable to have the same access to quality of life that they themselves have.

I think Sandel is right. There are some issues that can't be effectively discussed without including moral judgements about what is right and good. And in my opinion, 'the good life' is one where we are all invested in each other's wellbeing, where we share difficult burdens and where those who have advantages use them to make everyone's life better. I would happily pay more tax if I knew it were going to make sure everyone gets to see a rheumatologist when they need one. But everyone includes me, and our system is excluding me because the tax I pay is not going to universal healthcare. It's going to fly ministers to the US to discuss dodgy trade deals - made by people who can afford to go private - that will put healthcare even more out of reach for most kiwis. But probably not me, because I have a high income. So that's ok, right? Because choice is justice!

I don't think the current managers of our healthcare system have the same view of what is good as I do, somehow.

* I have had moments since I got that letter in which I've berated myself for being a hypochondriac. Maybe I'm not really sick enough to warrant wasting valuable healthcare resources finding out what's wrong with me. But then I remember that I've been waking up in pain every day for the last 10 months - pain bad enough so that I've on occasion needed help to get dressed - and that the only reason that right now I feel ok enough to question myself is because I'm taking twice-daily doses of a medication that'll eventually destroy my stomach. I deserve healthcare. I have to keep telling myself this.