Where's the Care in the Health "Care" Debate?

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As long as I have rediscovered the centrality of care to sustainability, I will continue for a few posts. I have been teaching a course at the Harvard Institute for Learning in Retirement focussed on the writing of Alfred North Whitehead and now a brief tour of Martin Heidegger. There is quite a bit in common between the two. Both are trying to explain how meaningful objects show up, rather than our seeing nothing but atoms and empty space. The other commonality is that both are so dense as to make reading a huge chore. Fortunately we are using a commentary on Heidegger that does a great job of explaining his philosophy, mostly in understandable language.

Both thinkers argue that meaningful objects show up out of some form of care. Whitehead uses value rather than care. Heidegger uses care and compound terms like “for-the-sake-of.” But the meaning is much the same. We exist as human beings rather than some nondescript objects because we care about the world around us and create that world through our caring actions in a kind of circular dance. Caring in this sense is not about compassion or loving, but simply about acting in a way that reflects the competence acquired through interacting successfully with the world of nature and human beings. At the bottom of every act we undertake and accept responsibility for is some form of care. When asked why we do anything, the final answer after giving all sorts of intermediate explanations is something like, “I do this for-the-sake-of my role as parent, spouse, manager, tree hugger, and so on.”

Heidegger and others, like Erich Fromm and myself in my book, argue that we have lost the ability to exist as the caring beings we are at the roots. Why is a long story and I will point to only one important reason here. Caring itself, or better the lack of caring, has an obvious connection to the sad state of the world of nature and of humanity. Although all human beings on Earth have a common bond at the level of our DNA, evidence of great disparities abound from the abject poverty of many and the consequent inability to function at a minimal level of humanity to the way we take care of people’s health in the United States.

Care of the body is one of the fundamental domains of being. When that domain is neglected, it affects everything else as one cannot care about much else when the body is not functioning competently. The central arguments in the health care debate revolve around some sort of right to some level of medical treatment and the nature of the institutions from which that treatment comes. I am not going to speak to any particular variation of this, but to the very notion of “right”

The existential notion of care gets converted into a mechanistic metaphor when some sort of “right” is assigned. The nature of our political/economic system has become such that it can only deal with mechanisms, not human beings. The health care system has become fully medicalized. Health is a holistic quality that shows up when Being is present, but is now viewed as the functioning of an assemblage of parts that show up in MRI’s and other devices, and then is addressed through some sort of technological fix. It is very difficult to hear even a distant whisper of care in all the noisy proceedings about health care reform.

I always try to tie my blog posts to sustainability even when the tie may be tenuous. But it should be clear that this current debate is very much aligned with sustainability. Health is just one aspect, albeit a very important one, of flourishing—the central quality we think about when we talk about sustainability, or more accurately when we try to do something about the sad, unsustainable state of the world. As long as we fail to see the critical place for care in the model of human Being, we are locked into thinking in terms of mechanism and empty symbols, like money, for flourishing. Contrary to the talk about health “care,” care is almost totally absent. In this case, the what for question should have the answer, “for-the-sake-of our/my [fundamental] role as a human being.” Even if something does happen soon, we will not have addressed the question of how to recover this sense of Being that creates responsibility for who we are and how we act in the world. And without that, sustainability will continue to be beyond our grasp.

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