I was born in a country usually described by those subscribing to the dominant paradigm of development as being poor and developing. Year after year, beginning from first grade, in our classrooms both public and private (we have a national curriculum), we learned mathematics, reading and writing, but also world history. We studied world civilizations, cultures, economic foundations, imports, exports and religions. We learned of most things as facts, only questioning choices – within political systems, for instance – when we reached the senior classes. There was, however, one thing that it would never have occurred to a Sri Lankan student to ask: Do American have the same access to health care that we do here?
In order to ask such a question, Sri Lankans would have to be suffering the same deprivations that Americans suffer today. They would also have to take it as a given that health care is something that is not commonly provided to all but, rather, reserved for a few. In the absence of those realities, no Sri Lankan child could conceive of a society where people are routinely denied medical care, where children remain un-vaccinated, and where the elderly perish because they cannot afford to visit a doctor. They would have to imagine a milieu where parents must decide between food and medicines, between dead-end employment with health care v. fulfilling work without health insurance, and between taking care of a sick parent and going into debt, or setting those parents adrift and saving for their children’s future. Indeed, they would have to conjure up a way of living that was routinely, relentlessly, psychotically preoccupied with the dread scepter of sickness rather than the much more joyful activity of the conduct of life.
Sri Lankans cannot do that. While I have joined this American life where all of the above have become my reality, every single one of my countrymen in Sri Lanka continues to enjoy first-class medical treatment in hospitals which provide it to them entirely free. Should a Sri Lankan not wish to avail themselves of free medical care, they have the option to visit a multitude of private hospitals. The same caliber of physicians serves at both. After a free education, Sri Lankan doctors are required to serve in public hospitals. They are also free to engage in private practice so long as that fundamental requirement – giving back to the country what it has given to you – is met. The decision of a patient to go to one or the other depends upon the patient’s idiosyncrasies; I have wealthy friends who have preferred to give birth in a shared dorm in a public hospital rather than in a private room at a fee-charging medical facility, my father vacillates between one or the other.
Yes, it is not perfect. Last time I checked, they do not have the capacity in Sri Lanka to separate twins sharing hearts or lungs. They do not have the Childrens’ Hospital of Philadelphia (CHOP), they do not have Memorial Sloan-Kettering. What they do have are the kinds of services, including advanced care services, which are pertinent and ought to be accessible to 99.9% of human beings. And what they do have is a society where should a particularly specialized form of medical care unavailable in the country be required by one of its members, citizens will routinely donate the funds necessary to send that patient overseas. It’s a lot cheaper to chip in the equivalent of about $5 to help a fellow-citizen about once a year than to live as we live (and die), now, here in America.
We are here today on the brink of a vote on making health care substantially more compassionate than it is currently is in America. It is a day that dawns with one of the last independent hold-outs from the left, Dennis Kucinich, deciding to make possible what is possible rather than wait for what will forever be denied. It is a day that alters the fate of three close neighbors, all of whom are professionals with doctorates and halves of two-income families in one of the wealthiest suburbs in America, who are trying to make ends meet without health insurance. They aren’t poor people, they have jobs; nonetheless, they cannot afford health care in this country. What then of the millions of others struggling with neither wealth nor employment? Which reminds me of a few words spoken on January 20th, 2009, in Washington DC by a new President:
“For as much as government can do and must do, it is ultimately the faith and determination of the American people upon which this nation relies. It is the kindness to take in a stranger when the levees break; the selflessness of workers who would rather cut their hours than see a friend lose their job which sees us through our darkest hours.”
This will, hopefully, be the end of that darkest hour for Americans. It is an hour that has lasted for more than five decades. Surely it is time for the leaders of this country to recognize their obligation to their fellow citizens. Surely one of the wealthiest nations in the world can finally do for its people what one of its poorest has done throughout its history.