Putting the Shoes On

Correspondent McCall Wells reflects on “Aging and Future Long-Term Care” episode and childhood memories with her dad to explore Americans’ capacity for empathy in the face of national strife.

If it doesn’t affect you, is it a problem? Don’t worry, this isn’t a riddle that’ll leave you wondering whether or not the tree made a sound in your absence. Rather, my question references a national conundrum that’s been making news headlines nearly everyday since 2010: Is health care coverage a personal or governmental responsibility?

An article published last month by The Atlantic cites a 2016 Kaiser Family Foundation survey demonstrating many Americans’ contradictory views of publicly funded health care coverage. The survey finds that while 70% of respondents support a “Medicare for all” policy, these same people overwhelmingly disapprove of a health care system labeled “universal” or “single payer.”

Dr. Joshua Wiener, a Distinguished Fellow at RTI International, and the guest on this week’s episode (“Aging and Future Long-Term Care”), has found similar results in his own research on public perceptions of coverage for long-term care. Simply put, long-term care refers to the sorts of resources and facilities that support an at least decent quality of life for older individuals. Take Grandma’s nursing home or Uncle George’s in-home health care provider, for example. When we refer to long-term care in terms of people’s elderly loved ones, Dr. Wiener finds that support for public programs comes easy. How could anyone deny their aging relative good end-of-life care?

However, no sooner does Dr. Wiener step outside of this context than the notion of a social benefit like Medicaid seems to become tainted, a dirty word that can only be uttered in hushed tones. In the modern American lexicon, it’s a word that connotes “mandates,” “higher taxes” and, worst of all, “socialism” – all concepts that seemingly don’t mesh well with the American ideals of freedom and independence. When Medicaid crops up in discussion, some Americans – perhaps naturally – go on the defensive, wondering why it is their responsibility to supplement the health care needs of complete strangers.

Dr. Wiener’s research shows distaste for Medicaid and Medicare to be the direct result of inadequate information about the precise details of these and similar programs. If only the facts were communicated better, he posits, maybe more people would understand that some of the programs they deem unfair are the same ones that’ll ensure they themselves will be taken care of at an old age. While I think that the problem of misinformation – and miscommunication on the part of experts – is an important concern, and one that should be addressed in myriad other realms, personal experience puts another issue on my radar.

More than a decade later, I can still recall the names of the intersecting streets that marked the spot where my dad, then a registered Republican, introduced me to the pillars of Conservatism. I remember the specifics of this conversation less well (probably because he’d lost me about three minutes in), but I do remember, as if it were yesterday, this statement: “Conservatives tend to be more cautious with their money; more financially responsible.” Responsible. It was then, at the ripe age of ten or so, that I internalized the belief that my money and my expenses were my own responsibility.

I must admit that my strong conviction in this belief has long since waned as I’ve grown to realize just how expensive life can be. Though Dad’s fundamental values haven’t since changed, I think his outlook, like mine, has shifted somewhat in response to time and experience. Without going into too much detail about the circumstances of the occasion, I will say that I’m fairly certain the word “responsibility” wasn’t the first thing on Dad’s mind when he had no choice but to log onto a much derided version of healthcare.gov in search of an affordable health insurance plan for his family. Or maybe, responsibility was on his mind, but not in a Darwinian “every man for himself” sense. He felt a responsibility, a duty even, to his family to ensure that any health concern that might arise could be taken care of without a second thought, just as we had very fortunately been accustomed to.

Reflecting on these two experiences with him, I can’t help but wonder how the older and younger versions of Dad would react to one another. Surely, the younger, more Conservative version wouldn’t have been so callous as to think ill of a man who opted for mandatory healthcare coverage if he knew that that same man had been employed since the age of 15, earned an MBA from a well renowned school, held multiple senior management positions, and turned towards government subsidized insurance as a last resort. The day Dad had to begin looking for a new healthcare plan, he had to try on a new pair of shoes for size. While they were certainly uncomfortable, at least they were his own.

While I don’t wish experiences of financial uncertainty on anyone, I do wish that there were more incentive for each of us to empathize with the needs of our fellow Americans. I’ll be the first to say that no American health care system to date has been perfectly designed, nor will one ever be, but I can imagine a system that fairly represents the health needs and desires of a greater majority. This will only happen, however, if and when more of us make the effort to understand why our friends, neighbors, and even perfect strangers, feel the way they do about healthcare coverage. It’s possible that Omar won’t be able to pay for his daughter’s after school care if he must also cover the cost of a mandatory health insurance plan. It’s simultaneously conceivable that Nadia advocates for using more tax dollars to fund nursing homes because she has no remaining family members to care for her in old age.

I’m not too naive to know that empathy of this sort is extremely difficult to achieve, especially as more and more Americans gravitate toward physical and virtual ideological bubbles. But, I hold firm that once the seeds of understanding are planted, it doesn’t take much for them to grow. In the age of Fitbits and Apple Watches, I believe that we need not even go so far as to track the miles we might walk in someone else’s shoes. We just need to put the shoes on. Furthermore, Dr. Wiener says there’s hope in the healthcare debate yet. Download this week’s episode to hear what he has to say and maybe you too will be yearning for a new pair of kicks just in time for Spring.


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