The moral case for health reform was not the focus of President Obama’s address to Congress Wednesday night. It did, however, form the core of the most eloquent and compelling section of the speech, which followed the invocation of the late Senator Ted Kennedy:
That large-heartedness – that concern and regard for the plight of others – is not a partisan feeling. It is not a Republican or a Democratic feeling. It, too, is part of the American character. Our ability to stand in other people’s shoes. A recognition that we are all in this together; that when fortune turns against one of us, others are there to lend a helping hand. A belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgement that sometimes government has to step in to help deliver on that promise.
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You see, our predecessors understood that government could not, and should not, solve every problem. They understood that there are instances when the gains in security from government action are not worth the added constraints on our freedom. But they also understood that the danger of too much government is matched by the perils of too little; that without the leavening hand of wise policy, markets can crash, monopolies can stifle competition, and the vulnerable can be exploited. And they knew that when any government measure, no matter how carefully crafted or beneficial, is subject to scorn; when any efforts to help people in need are attacked as un-American; when facts and reason are thrown overboard and only timidity passes for wisdom, and we can no longer even engage in a civil conversation with each other over the things that truly matter – that at that point we don’t merely lose our capacity to solve big challenges. We lose something essential about ourselves.
Congressional Democrats may have capitulated to the idea that the moral case for health reform is politically nonviable and, if that’s what it takes to pass legislation, I can’t condemn them. But that doesn’t mean that we should forget the argument altogether. If we can escape the suffocating echo chamber of craven Washington politics, the moral case for action is quite strong.
There are many facets to the argument, but one of the strongest is drawn from empirical evidence. A long-standing, but perhaps not all that well known, research finding is that one’s socioeconomic status in early life is a strong predictor of health outcomes throughout adulthood and old age. This relationship holds through the exclusion of any number of potentially confounding variables, including physical activity, diet, smoking, occupation, and any number of others.
Scientists have long suspected that there is a critical period in early life for the fine-tuning of the stress-response system in our bodies, and that low early life class can cause disruptions in its function that remain for the duration of one’s life. A paper published recently in the Proceedings of the National Academy of the Sciences offers evidence that supports this theory.
A group of researchers lead by Gregory Miller from the University of British Columbia examined differences in the expression of certain genetic factors in subjects who had different early life social statuses to search for evidence of altered stress response and immune system function. In particular, they looked at genes involved in control of the autonomic nervous system and glucocorticoid receptors.
Despite dramatically different early life experiences, the subjects in this study were identically matched in current socioeconomic status as well as a variety of lifestyle factors. Nevertheless, there were significant differences both in genetic expression and in hormonal function. Early life misfortune manifested in what the researches called “the adoption of a defensive phenotype,” with higher levels of circulating stress hormones (despite identical perceived stress), elevated autonomic nervous system signaling, and compromised immune function.
The consequences of these biological changes are both real and serious: increased risk of infectious, respiratory, and cardiovascular disease. Fortunately many of the subjects in this and other similar studies had managed to move up in life, and might be able to afford the medical treatments they will be cursed with. Others, however, are not so lucky, and with the ever-accelerating income inequality in this country, even more will continue not to be.
Senator Kennedy’s older brother, when speaking at Amherst College in his last public address as President of the United States, remarked that “there is inherited wealth in this country and also inherited poverty.” This remains true, only now we know that along while some inherit estates, others inherit a lifetime of disease.
I respect the conservative commitment to individual responsibility, but I don’t see how you can look at this science and yet fail to see the moral case for increased collective responsibility in tending to the sick. It proves that the goal of egalitarian policy is not just the fulfillment of an abstract moral code but the achievement of real consequences for the lives of other Americans. Liberals should care about fairness not as an end in itself but as a means to the end of making the world a better place for others.
And I believe we can do it. The main focus of this blog is how we might understand our own nature. Concluding his speech at Amherst, President Kennedy shared Robert Frost’s thoughts on this subject:
Take human nature altogether since time began,
And it must be a little more in favor of man,
Say a fraction of one per cent at the very least,
Our hold on the planet wouldn’t have so increased.
Miller, G., Chen, E., Fok, A., Walker, H., Lim, A., Nicholls, E., Cole, S., & Kobor, M. (2009). Low early-life social class leaves a biological residue manifested by decreased glucocorticoid and increased proinflammatory signaling Proceedings of the National Academy of Sciences, 106 (34), 14716-14721 DOI: 10.1073/pnas.0902971106
