Goodman 1 Marc Goodman Instructor Korbett NRS 203 25 March 2011 Universal Health-care: Radical Freedom or Unfreedom?

The case against health-care reform as the Trojan horse of socialized medicine and, by extension, socialized medicine as the Trojan horse of socialism proper, could not have been more plainly stated than it was in these words spoken by Ronald Reagan in 1961: Well, let us see what the socialists themselves have to say about it. They say once the Ferrand bill is passed this nation will be provided with a mechanism for socialized medicine capable of indefinite expansion in every direction until it includes the entire population. and behind it will come other federal programs that will invade every area of freedom as we have known it in this country until one day as Normal Thomas said we will wake to find that we have socialism This vision of socialized medicine may be contrasted with the version understood to be a key component of any socialism worth having as depicted by Fredric Jameson in his essay Actually Existing Marxism published in 1993: Socialism has always surely meant cradle-to-grave protection for human beings: the ultimate safety net, which provides the beginnings

of an existential freedom for everyone by providing a secure human time over and above practical necessity: the beginnings of a true individuality, by making it possible to live without the crippling anxieties of self preservation, along with the less widely identified but equally paralyzing anxieties of our powerless yet well-nigh visceral concern for others (the majority of people spoiling their lives, as Oscar Wilde put it in The Soul of Man under Socialism, by an unhealthy and exaggerated altruism," indeed, being, forced so to spoil them"). This is the sense, indeed, in Goodman 2 which socialism means guaranteed material life: the right to free education and free health care. What can explain the unbridgeable gulf between these two conceptions of what socialized medicine would entail - the utter unfreedom imagined to accompany its dystopian realization and the thoroughgoing freedom promised by its utopian realization? Mindful that Reagan was speaking at the height of the Cold War and that Jameson was writing after the dissolution of the former Soviet Union, while at the same time acknowledging the complex relationship between life as lived under actually existing socialism and its representation in various media popular or otherwise, this paper will endeavor to explore at the level of affect some of the hopes and fears

that animate the health-care debate. It is a starting assumption that nurses can and should play a role in this discussion and that nurses, insofar as they regularly encounter the hopes and fears of their patients in regards to their own health-care, may be in a unique position to address the feelings evoked when such matters are spoken of in a larger context. One of the greatest fears expressedperhaps the greatestin the face of any proposed system-wide change in the provision of health care has been that a given individual might suffer a reduction in the quality of care that she already receives and has come to expect. Why the expansion of health care coverage to

Goodman 3 all is reflexively believed to be a zero-sum proposal is not necessarily clear. Nonetheless, it may be suggested that, that it is precisely to remove the fear of no care, whether by extending the reach of those covered or by prohibiting insurance companies from dropping riskier individuals from their rolls, that health-care reform as such has been proposed. Nurses may speak of their commitment to public health in its broadest possible sense by voicing the view that any one who needs care ought to receive care.

Another concern expressed is that providing health care to all regardless of situation rewards bad behavior as a matter of course, whether it be smoking, overeating, substance abuse, certain sexual practices, and so on. As caregivers trained in evidence-based practice, nurses are in an excellent position to address the misbegotten assumptions of this belief. Much of what happens to us in our bodies is well beyond the purview of any conscious choices we might make and, as a consequence, we should not be punished for what, by any objective standard, can only be described as the utter contingency of our circumstances. In a related but slightly different register, nursing may be seen as exemplifying what the cultural theorist Mark Fisher terms an impersonal affectionate practice. That is, nurses are called upon to perform extraordinarily intimate work with individuals they barely know in any conventional sense in what are often highly fraught circumstances. This unique vantage point affords nurses a view into just how badly things can go for people through no fault of their own.

Goodman 4 Universalizing the insights gained through such a perspective should properly lend itself to an unqualified support for health-care access for all. Lets now consider the effects of an impersonal affection writ

larger. What would such a society look like? Would it more closely resemble Ronald Reagans fears of an America radically diminished in its freedom? Could such an enlarged perspective be the foot in the door that, in fact, changes everything? Is this what Ronald Reagan fears will invade every area of freedom as we have known it in this country? Or would it appear as the society Frederic Jameson imagines when he describes what may prove to be the beginnings of an existential freedom for everyone by providing a secure human time over and above practical necessity? Ultimately, speculative answers to these speculative questions hinge on what one believes humans to be capable of. Again, nurses may be in a privileged position to weigh in on what human nature may be understood to be. Or rather, whether such a thing as a human nature can even be said to exist in the first place. Everyday nurses bare witness to the singularity of the patients they care for. It is from this vantage point that they may conclude with Spinoza that we do not yet know what a body can do.

Goodman 5

Works Cited

Jameson, F. (2008). Valences of the dialectic. London, UK: Verso.

Fisher, M. (2004, December 20). Too many poets, too few nurses [Web log message]. Retrieved from http://k-

punk.abstractdynamics.org/archives/004599.html

Zorn, E. (2009, September 2). Ronald reagan on medicare, circa 1961. prescient rhetoric or familiar alarmist claptrap? [Web log message]. Retrieved from

http://blogs.chicagotribune.com/news_columnists_ezorn/2009/09/ronal d-reagan-on-medicare-circa-1961-prescient-rhetoric-or-familiaralarmist-claptrap-.html