MARCUS: Whose fault is poor health?

September 19, 2009

The Rev. Robert Rector is a prominent minister in our community. Recently, he asked me to meet him in a local dive. As I entered the dimly lit bar, I could not find the clergyman dressed in black. Slowly, as my eyes adjusted to the haze of cigarette smoke, I found Rev. Bob in the corner, partly obscured by the jukebox.

“Hi, Rev. Bob,” I said.

He said nothing.

“What gives?” I asked.

He did not reply.

“Why this place for a meeting?”

“Get a beer and sit down,” he growled.

I went to the bar and returned with my beer, as instructed. Clearly, the good pastor was not in the mood for banter.

“Do you see what is happening in this country?” he asked.

“What?” I replied, knowing that whatever answer I offered would be unwelcome if it were not in agreement with his observation.

“We,” he said with that strong, stern voice I had heard so often from the pulpit, “are about to destroy sympathy and charity by insisting on personal responsibility in health maintenance. We are setting the stage for denying health care to folks we define as ‘sinners-against-self.’”

“I don’t understand,” I said. “I thought we achieved fairly universal agreement that everyone is entitled to health care. I haven’t heard anything about denying health care to anyone for any reason.”

“You fail to look deeply into the renewed Puritan morality being injected into health care,” Rev. Bob said. “The cult of insidious individualism is on the rise. Where once we believed people were victims of disease, we now insist that illness is a reflection of choices actively made. Instead of sickness being a passive state, our actions now are regarded as the determinants of our disorders.”

“You may be right,” I offered tentatively.

“I am right,” he asserted. “If you eat foods not on the ordained menu, your subsequent problems are your fault. If you smoke or drink, you are now beyond the new moral pale. Thus far, we still operate under the old philosophy of communal concern for the sick, but those days are limited.

“In days to come, we will punish those who become ill as a result of their choices. We may charge them more for health care (as we now charge smokers more for health insurance) or we may defer their treatment, ultimately denying them the benefits of traditional medical assistance.

“Soon, doctors turn from guidance to denunciation of those with ‘self-inflicted’ wounds. As our health care system becomes more and more one of fiscal entanglement (government or private), society demands that each person conform to the behavior dictated by contemporary medical thought. Let a study come forth that cucumbers are carcinogenic and eating pickles will make one a social pariah.

“Verily, the day approaches when environmental harm will be blamed on those who are damaged because they ‘chose’ to put themselves in the way of documented danger.”

“You are being extreme,” I said harshly.

“I think not,” he exclaimed. “Just when we finally accept the principle of universal health care, we are simultaneously setting the foundation for a new fundamentalism of ‘responsibility’ that will allow us to reject and deny millions of people whose actions are not approved by the entrenched health establishment.”

Sadly, I rose and left. Rev. Bob is right. It would be tragic if we again treat illness (physical and mental) as we have treated poverty and ignorance—as self-imposed conditions—when illness, poverty and ignorance often are the consequences of choices made by those with the means and the power to prevent and alleviate such suffering.•


Marcus taught economics for more than 30 years at Indiana University and is the former director of IU’s Business Research Center. His column appears weekly. He can be reached at mmarcus@ibj.com.


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