Sunday, March 4, 2007

Hard to Comprehend

In a stunning example of the dangers of insufficient health care, a boy in Maryland has recently died from what began as a rotten tooth. This situation brings to mind the unconscionable consequences of our current system of health care. It also illustrates the dangers of negative freedoms versus substantive freedoms (capabilities). Using the capability approach put forth by Amartya Sen, we can see how the current system in the U.S. could have allowed this to happen. While this boy's family experiences, in theory, many diverse negative freedoms (freedoms from things), such as freedom of speech (freedom from censure), freedom from imprisonment without due process (clearly in theory here), etc., their ability to express these freedoms is significantly limited by unfreedoms that diminish their ability to achieve desired functionings. In the capability approach these unfreedoms represent capability disabling elements that restrict what an individual can do.

In the United States there is no substantive freedom to have basic health care. Being free of preventable disease is a core functioning for Martha Nussbaum, another author who has written extensively on the capability approach. The lack of basic preventative health care for millions of Americans serves to magnify the effects of the income inequality that continues to grow in the U.S. Inequality experienced in Canada and Europe is significantly less extreme than what is experienced in the U.S. Even for cities with comparable inequality, those in the U.S. experience significantly more extreme gradients of health as there is not a basic health care system in place to mitigate some of the effects of inequality.

This particular example displays the extreme effects that deprivation can have on individuals. It brings to light larger issues that go unnoticed by media. In the article it is noted that the boy's sibling also had rotting teeth and there was an attempt to take care of his because they seemed to be more pressing. Discussion of these sorts of "personal" problems are ignored because they are often not considered interesting because they are experienced widely by the poor in the U.S. By minimizing these problems that are being suffered by millions, their collective power is diminished in an era of "individual responsibility" that has come about in the current neo-liberal era.

The article also notes the significant costs that the family now faces for the emergency care that was required to attempt to save the life of the child. While the initial extraction would have cost less than a hundred (a cost too high for many to bear for something as seemingly small as a rotten tooth) the bill has now risen to hundreds of thousands of dollars in the cost of surgeries and other emergency care that was given. It is hard to imagine how a family that could not afford a tooth extraction will deal with such an extreme form of debt. I noted in a previous post how this sort of emergency is one of the largest reasons for bankruptcy in the U.S.

This case is provocative because it points out glaring disparities in the current U.S. health system. There are many other examples of lesser problems that go unnoticed in the media but are experienced be individuals without a voice or real political power. In order for the family of this boy to get any sort of attention, a death had to be involved. Until this system is reformed in a meaningful and structural way, little improvement can be expected.

1 comment:

Susan Ellison said...

Dear Man of Little Risk.

Your blog popped-up on google alerts for the Capability Approach, and we wanted to alert you to an organization you might find of interest: The Human Development and Capability Association (Sen is the past president, Nussbaum is the current president). Visit to learn more about our network of scholars and practitioners...