Healthy choices

I wonder how many Filipinos remember when we celebrated Independence Day on July 4.  Even today, some history teachers might still mention that date in 1946 when the United States granted us independence, which isn’t correct. A more accurate way of marking that date is to say we regained our independence on that day, nearly half a century after we declared independence and set up the first republican government in Asia, on June 12, 1898.

Having said all that, I actually feel strongly that we should give more attention to July 4, not as a holiday but as the American Declaration of Independence in 1776, and also as Filipino-American Friendship Day.  I can see some of my friends bristling with the word friendship but even if your feelings are not too cordial toward America, it’s important we try to understand Americans and America—as a nation and even as an idea—because it will help us to understand ourselves as Filipinos.  Like it or not, we are to a large extent shaped by our interactions with the United States, first as a colonized people and today, depending on your political views, as a neocolonized nation or at least an “Americanized” people.

In particular, I’m thinking of the radical experiment that was America in terms of transforming the ideas of the Enlightenment and liberalism in Europe—individual rights in particular—into a national ideology enshrined in the constitution.  More than two centuries of this experiment has translated into a rugged individualism that affects all spheres of life, from child-rearing to health care.

It hasn’t been smooth sailing in this more than 200-year-old experiment, the American constitution having been amended several times to better define certain rights.  Then, too, there have been countless challenges brought to court to interpret these individual rights.  The last few months have seen several intensive battles around the interpretation of these rights in relation to health care.

First there was US President Barack Obama’s directive in February requiring faith-based (i.e., religious) employers to include contraceptive services for their employees.  The strongest opposition has come from Catholic institutions, who argue that this directive is a violation of religious freedom.  The outcry is similar to the one here in the Philippines against the proposed Reproductive Health bill.

The second case involved an attempt to overturn the Affordable Care Act passed by Congress in 2010.  The law hopes to provide universal health care coverage for all Americans.  An important part of the law is the provision that by 2014, all Americans must purchase health insurance or pay a fine.  Each state has to establish an “exchange,” meaning identify health insurance companies and their plans.  The 26 states that filed their opposition to the law argued that this was a violation of the constitutional right to choose and Congress had no right to pass a law on this.  The Supreme Court ruled that the fine was actually a tax and therefore constitutional.

Libertarians

It’s interesting how in both these cases, the argument used by oppositors is that individuals have the right to choose.  These arguments are used most often by libertarian groups, who want as little government intervention as possible in people’s personal lives.   Whenever government action is seen as too intrusive, the libertarians protest and talk about the “nanny State” or “Big Brother.”

In recent years the libertarians have often found common cause with conservative Catholics opposed to family planning and abortion services provided by government.  In relation to the Obama administration, we find the strangest bedfellows of Republicans riding on with these libertarians and conservative religious groups.

Socialism?

Health care has become an arena for many of these battles because the US government does face the challenge now of having to solve numerous problems that come from leaving much of health care to the private sector.  Among the developed countries, only the United States does not have universal health coverage through a national government health service.  The argument against such a national health service is that it smacks of “socialism;” yet, such health services exist in the most capitalist countries including Japan, the United Kingdom, Germany, France.

The absence of universal health coverage has resulted in runaway health bills with people literally dying from a lack of access to health services.  Health insurance and health maintenance organizations make it particularly difficult for the most vulnerable people—those with so-called “pre-existing conditions” for example, or the elderly—from purchasing health insurance.  This would be unthinkable under a national health service, where everyone is covered on the principle of solidarity: healthy young adults subsidizing care for the elderly and children, for example.

We Filipinos will have to deal with similar problems, with a health care system patterned after the United States’ in the sense of a very dominant private sector which frowns on government involvement in health care, or in regulating businesses. So many good laws and policies to protect health, for example anti-tobacco legislation, are not enforced or are blocked by powerful businesses.

We have PhilHealth, which could be the foundation for universal health coverage but is still limited because many people—employers, the self-employed—are unwilling to shoulder the premiums, a paltry P200 a month.  Private health insurance and health maintenance organizations are even more expensive, and have many of the restrictions (i.e., pre-existing conditions) that are now banned in the US Affordable Care Act.

Many debates will continue in the US on the extent of government intervention around health care.  For example, New York city is debating a proposed ban on the sale of large sodas and other sugary drinks at restaurants, movie theaters and street carts.  “Large” is defined as anything more than 16 fluid ounces (473 ml or about half a liter).  The ban would include soft drinks as well as various beverages including energy drinks and pre-sweetened tea.  The ban, the first of its kind in the United States, is a response to the serious problem of obesity.  Opposition to the proposed ban has come from the manufacturers of these drinks and a group called New Yorkers for Beverage Choice.

Beware though with the rhetoric of choice.  Just as tobacco companies have funded smokers’ groups opposed to stricter laws on smoking, supposedly because these violate their freedom of choice, the New Yorkers for Beverage Choice is funded by the soft drink industry.  Increasingly, we will see, both in the United States and the Philippines, “choice” being used by the very people who oppose true, healthy choices.