Thursday, April 21, 2005

Life: Is It In Fact Fair?

Ever notice that the only people who ever say 'Life isn't fair' are people on the happy end of the unfairness? When I was a kid, it wasn't me telling myself that to soothe the sting of some familial injustice, it was my parents saying it to shut me up. That's the purpose of 'Life isn't fair': to shut up the people who might otherwise presume to imagine they deserve better, by making them think the circumstances of their infelicity are beyond human control. It's not we who are unfair, you see, it's Life.

On my health policy listserv, there lurks a libertarianoid toad among the well-meaning liberals. He takes great delight in trotting out at every opportunity lengthy but dimly-understood free-market arguments for leaving the American healthcare system in the hands of the private insurance industry jackals. Usually it's easy to dismiss his arrant nonsense for the unreflective regurgitated cant it is, and he's pretty generally ignored on the list.

But yesterday into the debate over the NYC Health Security Act (see below), the toad injected the following statement of principle: '*Life is not fair* and people should look out for their own health care, it is not the government's responsibility to provide it.'

The unapologetic heartlessness of this, coming from a future doctor no less, took my breath away. People should look after their own health care. And if they can't? Presumably they should die. Life is not fair.

The truth, of course, a thousand times duh, is that the vast majority of the 'unfairness' Toad-Boy attributes to Life is in fact the direct result of human endeavor. Material factors cause poverty, unemployment and ill health, in infinitely greater measure than does, say, a random spin of the genetic wheel. Material conditions are the result of human activity, and can be altered by same.

The 43-odd million uninsured Americans are that way because of the material, i.e., privatized capitalist, structure of our healthcare system. That structure is contingent, as evidenced by the fact that not all nations have developed the same one. Therefore it is mutable. Now, you may think it's the best of all possible structures, which is a different (if equally wrong) argument. You may not think it should be changed, or feel like getting off your ass to try to change it. But don't try to tell me that it is inherently unchangeable, that the plight of 15% of the American population is the immutable result of some ineluctable existential anti-levelling effect.

What 'Life isn't fair' really means is, 'The way life is currently suits me fine. Sucks for you.' In medicine, as in the rest of human society, that's a whole world of not good enough.

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