Tag Archives: health

Individualizing Healthcare and the Contradictions of Liberalism

The recent public musings of our provincial Minister of Health and Wellness, Leo Glavine, in our local paper (here), don’t exactly inspire confidence in our now almost 6 months old provincial government.

Scott D at Left Turn East has rightly called Glavine’s style “Social Darwinism with folksy charm” (here). And Atif Kukaswadia calls Glavine out for ignoring social and structural determinants of health (here), as well as his bizarre banking analogy (more on that momentarily). And the paper in question already has a few letters to the editor up (including one from me). But there is more to say about this than can fit in a letter to a community newspaper.

One thing that is striking about the column is the swift move from “proactive healthcare” (“medical help” can come in the form of diet or lifestyle advice, as well as a pill), to an individualization of health. Our health is shaped by the choices we make: what we eat, how often we exercise, how much we drink, and so on. Of course this is true, but as someone once said, “people make choices, but not under conditions of their own choosing.” Kukaswadia points out the difficulties that smokers have in quitting, and the higher costs of healthy food. Browbeating people living in poverty to “make healthy choices” when the “choices” are things like buy fresh vegetables vs pay the heating bill are unhelpful, to say the least. And we also get decidedly mixed messages about what the “right” choices are. Just consider how many ads for pop and fast food people saw while watching icons of athleticism representing our country on our public broadcaster over the last two weeks.

But liberalism (small-l, which is much broader than the Liberal party) has long struggled to reconcile an ideological commitment to individual freedom with bourgeois morality. And commitments to some kind of welfare state and a belief in the need for austerity just sharpen the contradictions. You are free to make your own choices! But you’ll be punished severely if you don’t choose correctly!

This ideological contradiction I think is the way to explain Glavine’s banking analogy, the point that has drawn most attention because it is just, well, weird:

Imagine if healthcare worked like banks. Patients would have to prove they practice a healthy lifestyle before receiving assistance. They would have to prove that they practice the basic tenets of proper eating and exercise. Such a system would save money for those who have not abused their health and need medical care.

There is a whole lot to say about the view that banks operate as public services providing “assistance” rather than profit-oriented businesses. (They could, of course, but then they would have to be socialized.) Glavine’s message, though, seems to be that we should re-impose the Victorian distinction between the “deserving and undeserving poor” on contemporary health care. It is an astonishingly reactionary view. And Glavine seems to know it as soon as he says it. The next paragraph opens with:

But, copying this approach would be archaic and inhumane…

[Why does he ask us to imagine something archaic and inhumane? Never mind.]

…and it is not for me to judge those who are dependent on the system.

And yet, trapped by contradictory ideological commitments, judge he does. A few lines later he gets to:

Then there are people who are cognizant abusers of the system. They accept government assistance, yet still have money to travel.  These people are abusing their neighbours’ hard-earned money.

How have we got from recommending healthy lifestyle choices to an attack on welfare cheats? Maybe with the accumulation of neoliberal ideology and austerity logic this short-circuit makes a certain kind of sense. All the more reason, then, to take it apart:

We ALL “accept government assistance” whenever our public health insurance pays for a visit to a doctor or a nurse. We also “accept government assistance” whenever we send our kids to public schools, drive on public roads, take our garbage to the curb, eat food that has been inspected and drink water that has been tested.

Now, most of us who accept these kinds of government assistance – myself, bankers, and Minister Glavine included, no doubt – “still have money to travel.” Nobody tells us we should feel ashamed about it. Guilt-free, because we have “earned” it, we visit family and friends, expand our horizons, or take a stress-reducing vacation. All of those things, and not least the feeling that we have “earned” them because we see ourselves as valued and productive members of society, are good for our health.

And this, finally, is the irony: with his attempt to publicly shame people living in poverty, who have had the temerity not to “choose” properly, the Minister contributes to the view that “these people” are a drain on society. The more they are seen in that way, and the more they see that they are seen in that way, the more likely they are to make “poor” health choices.

As minister of health, it is my job to improve the health of all citizens.

Respectfully Minister Glavine, you are not doing your job.