Health Care and the Categorical Imperative
“This Fourth of July is yours, not mine, You may rejoice, I must mourn.”
Frederick Douglas
On July 5, 1852, Frederick Douglass, an escaped slave and perhaps the greatest orator in American history, was invited to give the keynote address at an Independence Day celebration at Corinthian Hall in Rochester, New York. It was a friendly audience, friendly to Douglas and friendly to his cause, negro emancipation. What they heard, however, while respectful of his audience was hardly a soothing paean to American exceptionalism. He delivered instead a scathing indictment of the vast hypocrisy of the American experiment. He asked, “What to the slave is the Fourth of July?”
In perhaps the greatest speech ever delivered to an American audience, Douglas took his devout Christian listeners to the Old Testament and likened their pious entreaties delivered up to God for His special blessings upon the American “City on a Hill,” to the temple sacrifices offered to the God of Israel by a people who had turned their backs to the Lord, favoring greed over compassion:
“Your burnt offerings are not acceptable, nor your sacrifices pleasing to me.”
Jeremiah 6:20
Douglas reminded his listeners that a just God would not stand by forever:
“Hear, O earth; behold, I am bringing disaster upon this people, the fruit of their devices, because they have not paid attention to my words; and as for my law, they have rejected it.
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Jeremiah 6:19
A little more than two months earlier in March 1852, a Boston publisher named John P. Jewett, at the urging of his wife, published a new novel, the compilation of a successful magazine series. The book was entitled “Uncle Tom’s Cabin” and its author, Harriett Beecher Stowe, was a proper New England school teacher and an ardent abolitionist. The themes of the novel were the evils of slavery and the transformative power of Grace. It sold over 300,000 copies, an immense number in those days. In a little over a decade, it had been translated into all major languages, and in the United States, it became the second best-selling book after the Bible.
“Uncle Tom’s Cabin” is not great literature; by today’s standards, the work is quaintly sentimental and melodramatic. Yet for all this, as many historians agree, it may have been the single most important factor in transforming American opinion concerning chattel slavery. What had been an embarrassing, but seemingly inevitable fact of life, an issue between prudish Boston abolitionists and distant southern plantation owners, became for many — after reading this book — a present and palpable abomination. Mr. Douglas, Mrs. Stowe, and others had put a human face on slavery. America came to believe, as did President Lincoln, that “if slavery is not wrong, nothing is wrong.” The “peculiar institution” was no longer to be tolerated. What had happened?
It is possible to express Kant’s “categorical imperative” as the fundamental human urge to regard one’s fellow humans as possessing innate value and dignity, as worthy of respect and protection as is our own. This most powerful of moral impulses is acted upon for its own sake, without contingencies. Doing the right thing is its own justification. Most of us know this as the Golden Rule, something we’re taught as children. Whether we believe this to be one of God’s primary mandates or simply a natural law, we try to observe the Golden Rule for its own sake, without preconditions or expectation of reward.
Powerful forces can be unleashed when a social issue is transformed from a complicated, nuanced “problem” into a simple violation of the categorical imperative. Sometime in the 1850’s, slavery crossed that line, and when it did, it was doomed. But first, there was going to be Hell to pay. What had been smoldering since the founding of the Republic suddenly became an open conflagration. A “radical” president was elected, an avowed enemy of slavery. The South, sensing the inevitable and feeling very much under siege in a Federal Republic that had grown “foreign” to most Southerners, reacted by withdrawing from that Republic. What followed was the world’s first modern war, costing over 700,000 lives, resulting in the utter eradication of both the economy and culture of the old South.
Many historians have come to regard as mere sophistry any assertion that the proximate cause of the Civil War was anything other than the existence of chattel slavery in the South. What causes other than the righting of a terrible, categorical wrong would have driven the North to such bloody exertions in the face of such desperate, and yes, heroic resistance.
Perhaps in much the same way, Jim Crow was doomed the moment Dr. King took to the podium on that summer day in 1963, and the American people caught a glimpse of what might be possible if we could but turn to the “better angels of our nature.” Or perhaps it was when we saw peaceful demonstrators — our neighbors — spat upon, blasted by fire hoses, or set upon by police dogs. Again, a complicated and politically charged “issue” of states’ rights suddenly, and for the most human of reasons, crossed a line to become a categorical imperative. And again, it took a consummate politician like Lyndon Johnson, one of the ablest since Lincoln, to use the political capital he inherited from his slain predecessor to put the final nails in the coffin of that pernicious system with the Civil Rights Act.
Despite Obamacare, the United States stands alone among first-world nations in lacking some sort of universal health care system. To put it another way, we are the only “civilized” nation on earth to maintain that access to health care should be a function of one’s ability to pay.
For me, the imperative to reform our nation’s inefficient and manifestly unfair method of providing for the health of its citizenry crystallized several years ago when I watched a woman slide out of her chair and collapse to her death on the floor of the waiting room in an overtaxed and underfunded urban hospital. The security camera caught it all: a shabbily dressed old woman of color, entreating the staff for help, waiting for help that never came, and the unseeing or uncaring people who ignored her as she breathed her last, sliding slowly to the floor of the waiting room, alone and forgotten.
If this is not wrong, then nothing is wrong.
