And instantly the argument is all about the guns. I understand that, and I’m not even saying that it’s not about the guns.
And instantly we want to say these folks are crazy and of course that’s true. It doesn’t matter if they frame their reasons around Allah or “no more baby parts” or Obama’s impending takeover of the U.S. using ISIS fascist armies disguised as Syrian refugees pouring over the border from Mexico, doesn’t matter. Anyone who turns a gun on other human beings in a school, a clinic, a public street is we can safely say, nuts, if “nuts” has any real meaning any more.
But there are crazy people in every culture, and we have always had crazy people in ours. The percentage of people who are crazy does not scale across societies and across time with the number of people walking into theaters, malls, and bus stations with guns blazing.
Even the number of guns per capita, or the caliber and size of magazines people can buy, or the rules around buying them do not scale directly with mass violence. There is something else going on here.
If you are serious, if we are serious, about the health of Americans and the healthcare of the United States, we have to ask some deeper questions. The debates about guns and mental cases are important, but they mask the rest of the story — and that “rest of the story” is a lot harder to grasp and a lot harder to find answers for.
What is the context in which these crazy people are heading off the deep end festooned with guns?
A society in which almost daily somebody somewhere starts killing mass numbers of random civilians is a society that is visibly falling apart.
This society is one in which the middle class has been hollowed out over the last three decades, especially since 2009; a society in which income inequality has been widening for 30 years.
It’s a society in which the police have killed over 1,000 people so far this year — and the champion jurisdiction for per capitadeath by cop? Not San Bernardino, but right next door: Kern County, California. Rural California has been a seething cauldron of income inequality, poverty, and violence by the authorities since the “Grapes of Wrath” days of the 1930s.
This is a society in which the most popular single cable network makes its living by frightening Americans and working to get them to hate and fear one another; a society in which the most popular Presidential candidate in one party gains in the polls by mocking and slurring women, Mexican Americans, Muslim Americans, disabled Americans, African Americans, anybody who is, by his definition, a “loser.”
We are driving ourselves apart, we are being driven apart.
Healthcare has not been spared from this division and dysfunction. The concept of the “patient centered medical home” is not new. You remember what Robert Frost said about home? “Home is the place where, when you have to go there, they have to take you in.” That’s what medicine, what healthcare, has traditionally been: When you need it, it’s there for you. Those doctors, those nurses, may be able to cure what’s ailing you, or may only be able to ease the pain — but they will be there to care for you, to do what they can, to take you in.
Now healthcare has become a minefield of hidden costs and strange bureaucratic requirements. The web of human, face-to-face trust that has always been the undergirding of medicine has been broken and replaced by narrow networks, medical interference by insurance companies, doctors and medical teams driven to distraction serving the system before ekingout some time and attention to give to the actual suffering patient in front of them.
Trust been broken by a mostly code-driven fee-for-service system of vastly too expensive care that automatically, by its very nature, must make the patient into its adversary.
Along the way, the shattering of this web of trust has increased the role of healthcare in widening the income gaps, driving more and more of the middle class into bankruptcy, and more and more of the poor into utter despair. Even now, even with Obamacare, medical bills are the number one cause of bankruptcies. It’s one of the most important drivers of keeping the poor poor, widening the cracks in society, and making people on the edge feel even more isolated, unheard, uncared for.
There is not much of a home left in the heart of America.
We can do better. Better, stronger, more accessible healthcare, healthcare that did not make itself our adversary at every step, that did not batter us down and cast us out because we didn’t make the cut — is not the answer to all of society’s ills. But it would sure help. It would gather in the people who most need help, and reduce the number of people who feel utterly alone, desperate, unheard, unnoticed, and under siege.
This, my friends, is absolutely a game worth playing: Can we work this? Can we heal healthcare? Can we make healthcare a healing force in our brutally battered and fractured society.
I say we can.
Joe Flower is a healthcare futurist and author. He is a contributing editor with THCB.