The word was passed out among the neighbors where they stood close packed in the little yard behind the brush fence. And they repeated among themselves, “Juana wants the doctor.” A wonderful thing, a memorable thing, to want the doctor. To get him would be a remarkable thing. The doctor never came to the cluster of brush houses. Why should he, when he had more than he could do to take care of the rich people who lived in the stone and plaster houses of the town.
- John Steinbeck
In the coastal village of La Paz, where Steinbeck’s tragic tale of need and greed, The Pearl, takes place, to want a doctor, or rather, to ask for a doctor, is a rare and memorable thing for the poor families of the brush houses who live off the sea. These people care for themselves, and for each other; when one is sick or wounded, as when the baby Coyotito gets stung by a scorpion, they all come together to help in the cure, or at the very least, to lend their sympathies and support. Theirs are lives of constant maintenance, constant vigilance, for to call for the doctor is simply unheard of, everyone knows that he will not treat them, as they have no money. Thus we watch sadly as Juana, in a desperate act to save her wounded child, brazenly marches to the doctor’s gate with her man, Kino, and the entire village in tow, only to be turned away because the rich doctor cannot be bothered to put down his chocolate and cookies and help a poor Indian family who cannot pay.
The stark contrasts highlighted in this timeless fable, between community and individual desire, generosity and greed, poverty and wealth, ignorance and knowledge, the bonds of familial love and the bitter boundless hate of the oppressor, speak to us in strong, clear tones, because they are the human contrasts that reside within each one of us. They are also simple, ancient themes, that still strike to the heart of possibly every major issue that continues to plague our modern and less modern societies even today.
Basic as they are, these are the themes that should be central to any analysis and debate about how best to reform our healthcare system. These are the themes that we must consider and weigh on our moral scales to find the solution for turning our sick and diseased system into a healthy, vibrant one that functions for all, not just for those who can afford its skyrocketing costs. For, it has been said, the greatest reflection of a society’s ethics is how it cares for its sick, its young and its elderly.
Instead, as we try to overhaul our failing system, the argument about the best approach inevitably finds itself framed in the old capitalism vs. socialism context, with the usual shouting from both ends of the political spectrum, and those in the middle looking both ways and wondering who to listen to. The usual hard-core free marketers say that any intervention by the government in healthcare will put the private insurance companies out of business and put us on the path to socialized medicine. Those of a more progressive view see nothing wrong with this, calling healthcare a basic human right that should not be left in the hands of the free market, but instead provided by the government, equally for all, like education. And, as usual, the politicians in Washington are duking it out over the details, and pandering to their electoral bases and campaign contributors, rather than doing what they were theoretically hired by the people to do: lead. For this is an issue that needs more than a few laws rewritten, or a few policies reworded. It needs a thorough philosophical analysis and overhaul. Much like during past turning points in our history, such as the civil war, or the civil rights movement, we need to ask ourselves, what kind of society do we want to be? We need to look inside, we need to find some answers to some basic moral questions, and we need to elevate the discourse beyond the deafening roar of ignorance. For this, we need philosophers, which, unfortunately – unlike in Norway – are rarely found among our policy makers.
It is indeed disheartening to see the same old games being played out in Washington, and the same old arguments trumpeted for the umpteenth time, when this time, it should be different. We are not talking about the banks, who do provide us with a genuine service, and play a critical role in our healthy functioning as a society, but without which, though inconvenient, each of us could survive on an individual level. We are not talking about who runs the company that you buy your car, mail your package, or catch your train from; again, all valuable services that fill a genuine need in our society, and without the efficient functioning of which our lives and nation would be greatly impacted for the worse, but without the need for which many people go for years, never even giving them a single thought. We are talking about a basic human need, one that binds us all together as mortals, and that every one of us carries in us every day.
Even if you are young and generally healthy, if you are uninsured in this country the thought is ever present somewhere in your mind: what happens if I have an accident? What happens if I am the victim of an attack, or if I suddenly develop some rare disease? More commonly: what happens if I want to have a child? The average medical cost of an uncomplicated birth these days is $7,600 (2004 dollars), but can go much higher, depending on location, complications and level of care, an amount that few middle class couples have stashed away, let alone working class couples. And then, even if you do pay for the baby out of pocket, now you have an uninsured child that you must pray remains healthy, so you don’t have to mortgage your home, if you are so fortunate to own one.
Something is very very wrong with this picture. And it doesn’t even take into account the vast numbers of people who are not healthy, who are sick and need healthcare, but can’t receive it for all of the many reasons that we have heard countless times by now: their insurance won’t cover it, or they were dropped by their provider for some technicality, or, they are just uninsurable.
This is not humane. With all of the hurling of statistics and figures and finger pointing and name-calling taking place, the true, real, honest discussion of what is the best and most humane system for healthcare is simply not happening. There is too much appeasement to the free-marketers stomping their feet and screaming about capitalism being slaughtered, and the profits of the massive, bloated insurance companies being threatened. Those who suggest that this is not – and should not be – the central issue are dismissed as blasphemous socialists. But the truth is, they are not going far enough. Not only should the central issue not be the financial profit of the insurance providers or the hospitals or the doctors or, for that matter, the patients or their lawyers – it should not even be part of the discussion. The central issue should be the people of this nation, and how to provide them with the best possible care given all the resources, knowledge and tools at our disposal. This is, quite simply, a moral issue, something that every other advanced free-market democracy in the world has realized, except us. There should be no profit motive in healthcare.
Yes, I know. Take the profit motive out of anything and the quality declines. Really? Is there truly no other way? Have we really become so cynical and hard about our own nature that we succumb to the power of greed at every turn rather than looking deeper into ourselves and searching for a higher truth? Is it totally naive to believe and hope that this nation of humans can do something for an aim other than personal wealth or material gain?
Kino and Juana and Coyotito had a happy, albeit very simple and modest life. But then Kino, in his mad effort to pay the doctor to cure his sick child, found The Pearl of the World, and it destroyed their happiness. They lost everything they had, instead of gaining what they dreamt of. An old old story, certainly, but no less true in the telling today than ever. We are looking for an answer to our ailing healthcare system, which makes a few rich, and leaves many to go bankrupt or die. We are looking for The Pearl of the World, a solution to healthcare that keeps the rich getting richer, and yet provides universal coverage, a solution that makes everyone happy, capitalists and socialists alike, solves all the problems. It doesn’t exist, it can’t exist, because where there is greed, where there is profit to be made, it always wins out, and someone always loses. In the case of healthcare, what they lose may just be their life.
As Kino struggles to sell his pearl to better their lives, he is tormented by the music of the pearl, which is evil, harsh, yet hypnotic. It changes him, he becomes fierce and brutal in his quest to realize the wealth that should be his, now that he has the pearl. It drowns out the song of the family, that happy music that has always brought him peace, and joy. He must pass through a tragic journey to finally acknowledge that the pearl is not the solution, the pearl brings only evil and wrong, and he must abandon the pearl, if he is to regain the true, right path, if he is to regain any semblance of the happiness and peace he knew before. As he prepares to rid them of it, he hears “the music of the pearl, distorted and insane.” But he does it, perhaps the hardest thing he has ever done, or will ever have to do, he flings that glorious pearl back into the sea. He and Juana “saw the little splash in the distance, and they stood side by side watching the place for a long time.”
The lesson is a simple one, but not an easy one to learn. We cannot put our healthcare system on the right path without letting go of the illusion that it can provide the kind of care that is needed to all people of this country, regardless of race, gender, age, class, or medical history, without letting go of the pearl, the promise of wealth, greed. There is no happy ending if we hold onto the illusion of the pearl, and listen to its evil music. We must toss it back to the sea, and look at what really matters in this whole discussion of reform: people. If we can do that, if we can let go of the Pearl of the World, we can possibly redeem ourselves, and our nation’s ability to care for one another. If we cannot, the droning, driving, maddening music of the pearl will win, as it always does.
“And the pearl lay on the floor of the sea. A crab scampering over the bottom raised a little cloud of sand, and when it settled the pearl was gone. And the music of the pearl drifted to a whisper and disappeared.”