Undisciplinary
Undisciplinary
Solidarity, Ethics, and Global Justice with Peter West-Oram Part1
**Below is AI Generated**
What if the key to equitable healthcare lies in the power of solidarity? Join us as we explore this profound question with Dr. Peter West-Oram, a senior lecturer in bioethics, who offers a nuanced perspective on the intersections of history, ethics, and politics in healthcare. Through his expertise, we tackle the pressing issues of systemic racism laid bare by the COVID-19 pandemic and examine the philosophical underpinnings of global health justice. Dr. West-Oram sheds light on the social determinants of health and the complex web of responsibilities shouldered by governments and corporations in combating systemic inequality.
Embark on a reflective journey through Dr. West-Oram's academic career, from his early fascination with political and moral philosophy to his impactful work in bioethics. We revisit his 2017 paper on the ramifications of repealing Obamacare, where he argues for a healthcare system that enhances freedom through solidarity. Together, we ponder shared global challenges such as climate change and pandemics, urging collective action that champions our common humanity.
Our conversation navigates the delicate balance between personal liberty and societal cooperation, questioning the narratives that often skew public perception against socialized healthcare. From the ethics of mandatory treatments to the emotive rhetoric surrounding healthcare reform, Dr. West-Oram challenges us to rethink the narratives that shape public opinion and underscores the importance of solidarity in achieving equitable healthcare outcomes. Tune in for a thought-provoking discussion that dares to challenge preconceived notions and advocate for a more just distribution of healthcare resources.
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Undisciplinary - a podcast that talks across the boundaries of history, ethics, and the politics of health.
Follow us on Twitter @undisciplinary_ or email questions for "mailbag episodes" undisciplinarypod@gmail.com
Undisciplinary is recorded on the unceded lands of the Wadawurrung peoples of the Kulin Nation in Geelong and the Gadigal peoples of the Eora Nation in Sydney. We pay our respects to Elders, past and present.
Speaker 2:The world's first high-strung plant has been performed.
Speaker 1:Medical history has been made in South Africa Reports of systemic racism in the healthcare system, and COVID-19 has made the issue even more urgent.
Speaker 3:It can be characterized as a pandemic.
Speaker 1:Welcome to Undisciplinary, a podcast where we're talking across the boundaries of history, ethics and the politics of health, co-hosted by Chris Mays and Jane Williams. Jane Williams, okay, so welcome to another episode of Undisciplinary. Yes, jane, sorry, I'm still stumped with the conversation we were having off air, which I don't mind bringing onto air, which was about the gendered division of labour on this website. And, yes, you tend to do the introductions um, which I have offered to do. But you said you, what did you?
Speaker 2:just say that you like oh, I like trying to pronounce things that I don't know how to pronounce. I also like putting the. It puts the bulk of the hard stuff onto you, chris, and that makes me happy. I can just read the thing.
Speaker 1:Well, also you have to do the thinky parts.
Speaker 1:It is Speaking of sort of being able to pronounce hard stuff. I'm just terrible at pronunciation of even regular stuff, and my students and I've now have to remember that some of them may listen to this. I'm just terrible with their names. I apologise again for mispronouncing your names, Is it Jonathan? I'm not sure if I'm getting that right. And then also, when I have to sort of pronounce philosophers names, I threw in a bit of Latin. I don't know why I even it's sort of like I start saying something in Latin which I don't know, and then I just am thinking in my brain why are you starting to say words that you can't pronounce? And I think I lose a lot of credibility very quickly. So I'm happy to publicly admit these things.
Speaker 2:But, Jane, I really appreciate your willingness to give it a red hot go.
Speaker 1:So, without further self-abasement, let's get into this episode, because I think it's going to be a fun one.
Speaker 2:Yeah.
Speaker 1:And talking about some very interesting things. And talking about some very interesting things.
Speaker 2:Do you know? What has occurred to me, though, is that Pete I don't know how to pronounce the second part of your last name, orem Orem. I think I could have got that, I know, but then I think someone else said it differently and I was like wait, I've been mispronouncing you all this time.
Speaker 2:Could you just start again, jack, because I'm just going to have to do some editing. Today, we're talking to Dr Peter Westoram, who is a senior lecturer in bioethics at the Brighton and Sussex Medical School, which he joined in September 2017. Prior to moving to Brighton, pete was a Senior Research Fellow in the Division of Biomedical Ethics at Christian Albrechts University in Kiel, germany. He's got a PhD in Philosophy from the University of Birmingham and he wrote his dissertation on the subject of global health justice and the nature, justification and extent of rights to health care. Welcome, pete.
Speaker 1:Yeah, thanks a lot for having me great to be with you.
Speaker 1:So, to start off with, we like to sort of find out how people sort of ended up doing the kind of work that they're doing, and perhaps we haven't introduced just yet some of the topics that we'll be talking about, but one of which is solidarity. You've written quite a lot on solidarity in health systems and healthcare, and we'll also be talking a bit about bullshit, which we'll get to later on. But, yeah, it'd be interesting to hear how you got interested in the kinds of things that you work in in the kinds of things that you work in.
Speaker 3:Sure, well, I'm a political philosopher and bioethicist and I sort of started, as Jane said, on the route I'm on now, during my PhD, where I started looking at questions of global health justice and rights to healthcare and the duties that correspond to them. So I sort of was initially kind of generally curious about what was going on with the fact that there are so many people without access to even basic medical care or healthcare generally, or even public health resources, and started thinking about how those failures of rights have come to happen and what needed to be done to fulfil rights that people have and why people have those rights to those healthcare resources, and by healthcare resources, I think, quite broadly, both in terms of access to pharmaceutical products, which obviously loads of people do not have, and things like safe spaces to exercise and clean drinking water. So to me, health care is not what you get from your gp or from your local hospital, but also it includes those things, but also things that are public health goods or health goods more generally, that are really vital the what we think of as the social determinants of health, and how those things are not delivered to people. Who's responsible for delivering them, how we might deliver them better, how we might ensure that everyone has access to those things. And also this, the sort of division of labor, as it were, for the fulfillment of those rights, because, obviously, because obviously, an individual citizen, unless they're insanely wealthy, is unlikely to have the same capacity to fulfil the rights of people thousands and thousands of miles away that their government does or that a major corporation does. So I'm very curious in not just what we in inverted commas have to do, but also what kind, what different types of agents have to do as well. So, um, and that ranges from the seemingly quite basic don't cause harm to other people. But that gets really complicated really quickly when you, when you recognize that actually there's lots of ways that the systems in which we all live are predicated on the infliction of harm on someone somewhere.
Speaker 3:Um, but also we have the things that, well, yeah, that's totally, that's a semi-reasonable course of action to take, except for these unintended consequences which perhaps you haven't thought about or which might come in after the fact, or which might be the product of undervaluing other people's welfare needs or health needs. And so that work was inspired by Henry Hsu's basic rights model and I'm still working on questions relating to that at the moment looking at what our obligations are to other people, where they come from and what, what, what we have to do, what we don't have to do. So, look, recognizing the differences in capabilities of different people to respond to the health needs and rights of other people. And so I started looking kind of at a pragmatic approach, both from a kind of moral perspective, but also going okay, there are lots of people who don't recognize various different kinds of rights. So, or only recognize that there are negative duties. So, as long as I'm not doing something harmful to someone, I'm fine, and so what I wanted to do following shoe is go, well, okay, but that leads.
Speaker 3:If you want liberty, for example, you know the political or rights, or political and economic rights, as they're often sort of uh, shaped, shaved up as or differentiated you're going to need these other things as well. So, yes, okay, liberty is really important. I hate being told what to do, hence why I went into academia. Um, but we're also good. If you want freedom, you're not really free. If someone can take away the means for you to have a decent, a minimally decent, life, you can. It can be very, very easy to coerce or control people if you are in the position of going. Well, if you don't do this, you're not going to have access to medicine or food or security. So this is shoe's model of basic rights, of recognizing the interconnected nature of certain kinds of rights that you have to have if you're going to have any rights at all.
Speaker 3:And so from there and so that framework, I started looking at the to illustrate the kinds of arguments I was making about duties and responsibilities for the people. I was starting looking at more of the I suppose you can call them applied philosophical bioethics examples. So looking at things like obligations to participate in vaccination programs and what that entails and what it doesn't entail, and from there illustrating this kind of political philosophy argument about the nature of rights and duties in global justice. Moving to these specific case studies of okay, we said that we have a duty to do X or Y or Z. What does that mean in this case and how can that illustrate where we go from there and how can we look at specific case studies to hopefully provide a more convincing argument to people who might be sceptical of the idea that, yes, actually you do have an obligation to participate in a vaccination programme during a pandemic, for example, or just generally speaking. And from there I moved.
Speaker 3:After my PhD I moved to Germany to to work with Elena Buchs on solidarity or political philosophy and bioethics more generally, focusing on solidarity but also looking at some more sort of clinical ethics kinds of examples.
Speaker 3:So I've written on conscientious objection with Elena and independently as well, all of which kind of come into these questions of what do we have to do in the healthcare context for other people and what can we expect in the healthcare context.
Speaker 3:So those questions of rights and entitlements and duties permeate through all the way, from the very theoretical why do these things exist and what do they require to what's going on in this particular scenario between a clinician and their patient or between a healthcare policy setting where the corporation suddenly gets rights to freedom of religion because the united states supreme court says so in in the early 2010s.
Speaker 3:So I I kind of got quite lucky in a sense that I was writing my PhD or starting that sort of senior graduate part of my career at a time when there was an awful lot of discussion in the United States around the Affordable Care Act and rights to health care, and while I have heard it said that, if you want to make anything sound plausible, you can start by saying in America.
Speaker 3:But in my case, the discussion surrounding rights to health care and access to health care and how it's distributed and how it's funded and who has responsibility to pay for it, came at the sort of for me a really helpful time in my academic career, because it was when I was writing on exactly those kinds of questions, and I still do at the moment, and so now I look, I work very much on questions relating to the nature of solidarity, what it means, what it does, how it functions, what motivates it, how it is relevant in the health context and how it can relate to this idea of rights and duties in healthcare at the individual, public and global levels. Relating to ethics and justice more broadly.
Speaker 1:Yeah well, heaps of interesting lines to take up with that conversation, and is that you both met at a conference recently or a workshop?
Speaker 2:you both met at a conference recently or a workshop? Yeah, I met Pete. So interestingly it might not be interesting, but I had some of Pete's work with Elena on my reading list in the olden days when I was teaching public health ethics, and so I knew Pete's name and then I met. When did we meet? It must have been 2019. It was pre-COVID.
Speaker 3:I think so. That's all I remember, yeah.
Speaker 2:Which was cool, because I think sometimes, when you, I guess, I wasn't used to meeting people whose names I knew from papers, and so I thought that was really cool. And so Pete and I have met a few times at the what's it called Oxford global health and bioethics conference, which is a lovely junket in Oxford. So I I've got a question going way back, pete Were you anything else before you were a political philosopher or has this always been your dream, oh God.
Speaker 3:That's a really good question. I mean, I think during my undergraduate I was always attracted more to those sort of applied questions and I think I think that there's much more of an overlap between political philosophy, political and moral philosophy and bioethics than sometimes they get presented as in curricula, I think, because the political sets the context for bioethics. But even even during my undergraduate I was very much I think my brain doesn't work the right way to do logic and metaphysics.
Speaker 3:I think my brain doesn't work the right way to do logic and metaphysics. So I was always much more interested in those applied questions about or about the nature of justice or the nature of our responsibilities. And so even back you know, even back then, which I still think of as about four years ago but is actually about 20 years ago now was much more interested in those kinds of questions, was much more interested in those kinds of questions, and then that sort of followed through my master's degree. I wrote on human genetic enhancement during my thesis.
Speaker 2:So it's always been your passion. You didn't want to be a police officer.
Speaker 3:No, no, no. Inside job with lots of sitting down, please. Inside job with lots of sitting down, please. You know but, um, but I think I I had after my master's. I I love studying it, but very much kind of felt like I, I am exhausted, I my, and then I'm gonna go and work in, you know, quote, unquote, the real world, and then went, oh, having a real job's rubbish.
Speaker 3:I'd like to go back to university, please, um, and really I think that the I needed some space to go. Oh, actually, no, I really do like thinking about these things and I like having the scope to to learn and to be argumentative and irritating and sort of ask questions and um, and I think just I got very lucky really because I, you know, I hadn't studied high philosophy at high school or anything like that, and just sort of went, that sounds interesting and it was, and um, kept finding myself without, very fortunately, with opportunities to keep doing it. So it was always the kind of, oh, that sounds cool and I, I think it's not so much. I went I want to work on solidarity when I was 19 and, like, kept going it, but it was, um, I think I'm, I'm kind of an academic, goes what that can't be right and then wants to find out more about it or that sounds interesting.
Speaker 3:So the the sort of kind of the breadcrumb trail has not been, um, it's not a trail. I've gone. There's the point that I want to get to. It's been, that sounds interesting.
Speaker 3:And now I'm in where I am going oh, this is quite interesting being here and there's other stuff, and so I've been very lucky, I think, in that regard. So it's definitely not been a a grand plan or anything like that yeah, yeah, it sounds like quite linear breadcrumbs there.
Speaker 2:It's quite nice, yeah.
Speaker 1:So that idea of what that can't be right or that doesn't sound right that you just referred to, is that something? So one of the papers that we'll talk about in this idea of solidarity generally is a paper you wrote in 2017, solidarity as a National Healthcare Strategy, and, you know, fill in the gaps here. But you know you're sort of arguing. This is around the time when the Trump administration is coming in or has, you know, just come in. They're going to repeal Obamacare or the Affordable Care Act, and there were arguments at the time that you know one of the reasons for doing this was that, I guess on an ideological level it was. You know, the passage of Obamacare or the Affordable Care Act was always seen as or rubbed up the conservatives the wrong way in seeing that it was a breach of fundamental liberties. That you know because around my PhD, I remember looking at some of this sort of stuff that you know, obama, it was going to lead to fascism and dictatorship and all this sort of stuff. So there was the ideological.
Speaker 3:The slippery slope to socialism is the phrase that was used an awful lot, and you're just kind of going. Do you know what that word means? Well, that's right.
Speaker 1:So that's on the one hand, but then it was also this other argument that it was more inefficient or less efficient.
Speaker 1:However, we want to phrase that um and that what trump was going to sort of or you know, in, in allowing the sort of return of a sort of more free market of insurance and freeing people from the um yoke of this uh, of the affordable care Act, was going to not just secure this ideological battle but was actually going to deliver a more efficient healthcare system. And you argue that basically each of those arguments are wrong and that not only is a more solidistic or healthcare system based on solidarity going to sort of have a more, I guess, sure, ideological footing, or a more ethical ideological footing. It's also going to sort of produce a healthcare system that enhances people's freedoms and liberties. So I guess you know that's my take on the paper, but it would be interesting to hear from you. Yeah, what was it that ignited your interest in this and why particularly did you bring in this sort of solidarity argument, and how did you conceive or define solidarity in this context?
Speaker 3:Sure, I mean, I think that's a really good characterization of the paper.
Speaker 3:So, but this paper in question is kind of a more applied follow-on from a paper that Elena Books and I wrote a few years earlier global health solidarity in which we argued that there's various different global threats, such as climate change, evolution of antimicrobial resistance and pandemic disease, were such great challenges that they should write, should reveal or highlight the similarities that everyone shares worldwide and that, while those the harms of those things will create will initially affect more vulnerable people first, they are going to start affecting wealthier people who historically been more insulated, as a result of geography or wealth or power or access to medicines, than their poorer counterparts worldwide. Covid happened, and while there were, there was definitely sort of gestures at solidarity, but from the WHO and moves towards funding and sharing vaccines, it didn't really demonstrate of, it didn't create the kind of global solidarity that one might hope for. But so this, um, this paper was kind of going in response, as you say, to the, the trump administration's move to repeal the affordable care act. Um, and and I'd written about the the obama administration's uh, bringing in the affordable care act previously. The Obama administration's bringing in the Affordable Care Act. Previously, one of the main objections to that was the restrictions on individual freedom, or particularly on religious freedom to make decisions about what one could do or what obligations one had to fund the healthcare of other people.
Speaker 3:And so the goal in this paper, or the initial motivation from this paper, was reading the, reading the news and seeing sort of arguments being made about efficiency or that this is going to be much better because it will be the free market and this is how it will work and kind of going. Which reality do you live in when you say these things? Um, as and I should say as well, meeting meeting Jane at Oxford, I think most papers that I've given at Oxford tended to be fairly sarcastic in their origin, because I find that a helpful way to communicate, which isn't necessarily the most professional sounding tone, but I've had very few things thrown at me when I'm presenting, so I take that as a win. But with this paper it's kind of going well. None of the claims that seem to be being presented are reflected in the data or the evidence or anything else. So my position is that the reason that everyone should have access to health care is that they have a moral right to it. They are people and that we have obligations to ensure that everyone, everywhere, has, at the very least, a basic standard of care. That argument doesn't work for lots of people. It isn't convincing to lots of people, and so what? This lots of people, and so what?
Speaker 3:This paper was done in a couple of other pieces I've done. The goal has been okay. Well, what are the things that are stated to be of value in in the, in opposition to a more solidaristic model? And typically it's freedom, and again, this is a massive generalisation but freedom or personal liberty, cost efficiency and choice, and so what I was hoping to do, or aiming to do, with this paper is go, ok, let's set aside the moral argument for the time being, though. That's why let's talk about freedom. Let's work out. Let's talk about freedom, let's work out. Okay, if you say that you want freedom to make decisions, what decisions do you care about being free to make?
Speaker 3:And, as I said with the sort of the broader theoretical work on rights and duties, if you don't have access to healthcare, it's very similar to lacking access to a secure, in the sense of protected from the violent actions of other people, because your wellbeing can be taken away from you at any time. Your ability to care for yourself, your ability to make choices, your ability to feed yourself, to house yourself, can be taken away if you get unlucky and get ill. So there's that. There is also the fact that in in circumstances without access to health care, or where a large proportion of the population doesn't have access to health care, that is more dangerous epidemiologically and epidemiologically in a very, very broad sense, for everyone, even those who do have access to health care protections. So I think there's an example in I think it's infections and inequalities by paul farmer, where he talks about new york city cutting funding for tuberculosis control, and they did so for about 10 years and they saved about 200 million dollars, which is lots of money.
Speaker 3:The problem is that because they've cut funding for tv control, lots of people didn't have access to vaccinations or treatment or anything. So what happened is, in the 10 years where there was less availability of um treatment and support and then all the rest of it, lots more people got TB and lots of people, which led to the evolution of antimicrobial resistance. So you ended up in the following decade having to I think they had to spend about five times as much money getting things back under control, so it was incredibly costly and loads more people got TB who otherwise wouldn't have had it, because it wasn't because they had access to healthy environments and treatment and vaccination and all these other things. So this is kind of okay. You want to be free and you don't want to have to pay for other people's health care, but paying for other people's health care helps you be more free to make more choices because you're less vulnerable to harm. It costs you less money in the long run and you're broadly more safer. I'm good at grammar, so the argument is kind of going okay. You say you want freedom, but freedom to do what under what circumstances, and that doesn't seem to be borne out by the model of have health insurance go bankrupt because your health insurance will deny your claim and then you have no option, no choices whatsoever.
Speaker 3:The other side of that and it's the the claim by Dworkin is that, realistically, health is so complicated and we're so vulnerable to so many different things, and we're all vulnerable to so many different things and we're all so unique in order to make informed choices we need a level of information that really you only get if you're an incredibly well-trained, very, very good doctor, which most of us are not. So it puts an enormous burden on the individuals like, okay, you can make choices, but if it goes wrong you're free to make choices, but if it goes wrong, that's your fault because you made the wrong choices, and so you then have to carry the consequences of it. And it places an enormous burden to become informed enough to make those informed choices, which sort of crowds out the opportunity to make, to have other kinds of information or other space in your life. And if you get it wrong, the consequences can be absolutely disastrous. Added to the fact that every other wealthy country in the world has some variation of, um, different levels of regulation of public or national health system, even systems that are sort of hybrid models, like you have in Australia. There is some degree of public models, so that everyone has at least some healthcare or they have to purchase it and the cost of it is based on their income. So it doesn't become well. I'm going to spend 10 million dollars a year and have the best healthcare and somebody can't afford that gets nothing.
Speaker 3:You have this collaborative cost sharing which functions fairly well in most other wealthy countries in the world. In fact, the US is the only country that doesn't work like that. There's an organisation called the Commonwealth Fund that do a kind of evaluation and ranking of wealthy countries' healthcare systems every few years and the US almost always ranks last or second to last in most categories and overall most of the countries rank, and every other country with some variation of what we might think of as socialised or national healthcare does way better in almost every metric. Despite the last 10, 15 years of austerity in the UK or 14 years, I should say, of austerity in the UK, the British NHS, which has been deliberately underfunded for ideological reasons, is still far, far better and outperforms the American system because it is nationalised and because it has that buying power and so they can buy drugs much cheaper, they can enforce deals much more cheaply and, more importantly, there isn't a profit motive. So there isn't a group of shareholders who are going we need 3% of profit every year to draw out.
Speaker 3:So you don't have that, um, that extra cost center, as it were, pulling money out of the system, which is quite a long-winded answer. Um, but yeah, I hope that sort of it covers the, the kind of argument, and you also are sort of the definition of solidarity. Um, there are lots the. The one I tend to work with is the one suggested by Leonard Berks and Barbara Pranesack, which is the willingness to carry costs, and that can be emotional, financial, physical, social. What have you for other people as a result of recognition, of a shared similarity in some regard, so that can be something as formalized as citizenship, or we both support the same football team, or oh, we're both on the same delayed flight and my phone still has battery and yours doesn't, so we're both inconvenienced. So it can be something as transitory, as shared inconvenience, or something is sort of formalized and institutional, as nationality or language or religion or whatever it might be.
Speaker 1:It would be good to come back to some of those definitions in relation to your later paper, um, the, if this, what you see, is something specific about health that seems to capture the, I guess, the libertarian imagination, um, that it really is, symbolically and literally, a hill to die on that. You know that this idea that there is something about health and medicine and the idea of healthcare systems that is seen as a infringement on liberty, that, even if it provides, even if it were the basis of all these other actualisation of liberties, this infringement of a liberty, if it is such, you know, just buying their argument, is, you know, something that can't be, um, transgressed, or, you know, is something that is a should not be entertained. Have you, I guess, uh, any insight into why you think that may be the case?
Speaker 3:so if I, if I've the question, it's like why is it that healthcare is the target of, or the focus rather of, sort of this tension between freedom, however defined, and cooperation and sort of the evils of socialism?
Speaker 1:Well, sort of like maybe and you correct me if I misunderstood your paper but in some ways it seems that you're running a kind of consequentialist argument around solidarity that if you accept a solidarity-based care system, not only will you have better health care but you will also have better acts, better opportunity to actualize your freedoms. Yeah, but there seems to be something that, at least in and in certain sections of the sort of libertarian and some of these people are very likely bad faith actors, but there are also plenty, maybe who do hold on to this idea that no, there is something. You know to quote my six year old, my body, my rules you know that any kind of intervention at that level is some kind of encroachment, even if you know there are all these arguments and evidences to show that not only is that intervention going to help you and your community, it will help you actualise these other freedoms.
Speaker 3:But I think that thanks, sorry, I misunderstood the question I think that's a really good point and I think that there's an important distinction, I think, between this idea of mandatory treatment, which I think, generally speaking, is something to be highly sceptical and cautious about. There are arguments that you can say that there there is an obligation to to participate in vaccination programs because the failure to do so can create or contribute to risk in a way that other treatment does not. I, um, there's other problems around sort of how we regulate that, because obviously interventions in the, in the person, are so in significant and, yeah, my body, my rules is a pretty good set of principles to stand by, not only to brush their teeth.
Speaker 3:Yeah okay, yeah, um and I yeah sorry, um the. The thing that is important, though, is that what, what is sometimes the framing, is sometimes, I think, conflated by I think in many cases bad faith actors who are saying what is happening is that if we have socialised medicine, you will have to have X treatment or you will be denied X treatment. It isn't really the case.
Speaker 3:And the other thing as well is that people are denied treatment all the time under the hyper-individualist system in the US. Medical bankruptcy, or medical debt, is the leading cause of bankruptcy in the United States. People die because their health insurance doesn't want to fund their treatment anymore. Though the Affordable Care Act was intended to try and address that, the degree to which that was successful is something that can be considered, I suppose. But the issue at stake is not you will be made to have this treatment, but is more kind of, you're forced to pay for other people's treatment through taxation. And this is this is some kind of massive moral wrong, and I don't think it's actually some.
Speaker 3:And I think there's a couple of things. So the first is the, the reason it becomes such a sort of flash button or a hot hot button, is health is really important. It's you know, as I say, without it you can't do those other things. So the threat of it being you know not, of it being taken away or you're not getting access to it, is very frightening. Quite reasonably, it's also something where, quite rightly, we don't want other people making decisions for ourselves. We want to be able to make decisions because it's my body, my rules. I don't want the doctor just coming in, turn up and jab me with something and then leave without telling me what's going on or asking me if it's okay or whatever, because like ow on the most basic level. But also that's a violation of the sort of physical autonomy that we should all have expect to be respected.
Speaker 3:On the flip side of that, I think that the focus from the kind of libertarian objection to a more socialised programme of health is not principle based. I don't think it's about principle. I think it's about money and I don't think it's about efficiency. Because if it is about efficiency, you know then the US I can't remember who it was. Someone used the example of well, the US military has one health care provider and it's all done through that and you don't get to make choices about it. I mean partly like yeah, you sign up to do what you're told in the military, but if a free market and personal choice was the most effective and efficient way of distributing healthcare, the military would go here's your pamphlets, infantry, go and make a choice.
Speaker 3:They go, we're going to fund it. This way. It's the most cost effective way of doing it. I can't remember who had that example. It really bugs me because I think it's a really interesting argument.
Speaker 3:But I think in the, the polemics and the the, the conflict point comes because there's an enormous amount of money to be made selling medical devices, selling drugs, because we all need to be healthy. So it's something that we need to have and I think that it's a way of. It's a place where, if we have a private market, we can make money. We in the, you know generic sense, someone can make lots of money from it. There's less money to be made if we have to sell drugs to a single provider, because they can negotiate much more effectively than lots of individual hospitals and clinics and insurance providers effectively than lots of individual hospitals and clinics and insurance providers. And there's an enormous amount of highly emotive language and because health is so basic, you can use lots of very emotive language to criticise attempts to make it fairer or more accessible. So, in response to and I can't remember the politician's name, but it was one of the leading figures who opposed the clinton administration's attempts to go for sort of a more nationalized health care model. Um, one of his repeated statements was oh well, you know I, I really love my mother and I want to protect my mother. What the clinton's plan will do is do you know, take away health care. And I, you know, I and um, this repeated thing of I, I'm scared for what will happen to my mom if we have socialized medicine. And the same thing was was repeated by sarah palin. So this, the death panels idea, and that's kind of I mean, that's what already mentioned. We're going to talk about bullshit and it's the same kind of thing. Possibly they genuinely believe that that's the case.
Speaker 3:I'm a little bit sceptical about that justify the system, which is demonstrably unfair and demonstrably inaccessible and demonstrably inefficient, which the american healthcare system is, which privatized models of healthcare demonstrably are, but say, leaning on the well, you know I'm the only one. This is the only way of protecting the people you care about is quite a rhetorically powerful tool. Which, if you're not, if you don't know, if you don't have access to this data, if you don't know that actually the British NHS was for decades the most efficient, most effective, most accessible, most successful healthcare system in the world, certainly there's flaws with it. It sounds pretty compelling that there's a change to the system and, yeah, okay, the system's not great, but what they're telling me is they're gonna kill my mum. That's a pretty compelling argument from seemingly a trust, a figure that we're told we should trust. So that's quite a powerful narrative and I think that kind of um a.
Speaker 3:So I think it's not so much. I think there are people for whom it's ideological. I think that kind of um a. So I think it's not so much. I think there are people for whom it's ideological. I think that they're they're being deliberately or they are they're being misled or they are being deliberately ignorant or misinformed.
Speaker 3:But I think there's also a lot of people who recognize that they can make an awful lot of money by selling medicine to people and selling health care, because it's kind of a classic your money or your life situation, it's like you don't have to pay us all this money but you are going to die. So you know, make your choice. And that's not a free choice, that's not the kind of freedom that is sort of just used to uh criticize, uh cooperative models of healthcare provision. I mean, there's a kind of running joke. You know, socialized medicine is so complicated that no country in the world, apart from all the other wealthy countries, have ever been able to get it right. And it's just far too complicated for america to deal with. And that's not to kind of denigrate american. You know america as a concept or as a nation, but it is telling.
Speaker 2:I think that medical bankruptcy is a thing in the united states and I'm not sure if it's a thing very many other places um, can I jump in with a community of friends from the US who are all insured and all around my age and, you know, relatively health literate and so on, and quite often I hear them say things like oh, the US health system is just so terrible, and then they almost inevitably follow it up with but there's nowhere I would rather be.
Speaker 2:If something really bad happened to me, like if I got cancer, I would, I would want it to be in america, because all of the best health care happens in america, as well as the worst. And I don't, I have no idea if that's true, but it it it's really. I mean I doubt it's true, but it fits really. I mean I doubt it's true, but it fits really nicely with that whole thing of the free market, provides the best options, right, and so that's a thing that they say sort of unthinkingly, and it's always interesting to me that you can both acknowledge a system as being really harmful and also be really grateful for it because it works for them. But I also wanted to talk about the but it's my mom thing, so that I think at the most recent conference Pete, we were presenting at the same time but my presentation was called, but it's my mom um, so I wish, I'd seen it well, but a big part of it was like trying to.
Speaker 2:So it was about antimicrobial stewardship and about how people see, I guess, rules and restrictions around certain things as being fine until it's about someone they love or care for. And I wonder if this is a thing with solidarity also right, because in the abstract we know that it's good to act solidaristically with people with whom we have some sort of connection, whether it be like really fundamental or fleeting or whatever, and maybe that's an easy thing to do in the moment. You know, I have no problem giving my phone to someone so they can make a phone call because this has run out of battery. But maybe when it maybe. So I'm just thinking two ways of doing this.
Speaker 2:Maybe when it's about an uncertain future, then it's much harder to see the benefit. You know, if you don't know exactly why you're doing something that might be slightly inconvenient to yourself, then maybe you don't want to do it. That sort of uncertain, kind of unidentifiable people. Future is a is a mark against solidarity. I don't know. I'd like to know what you think. But also, um, I think it works the other way as well. The more identifiable something is, the more that you want to like. Change the rules so that they can benefit yourself I mean I think you're right.
Speaker 3:Um, I like which is a really unhelpful response to a question, but I think it's more of a comment than a question, people sorry, a really unhelpful response to a comment.
Speaker 3:I think the yeah, but it's my mom is is a is. I mean there's a reason that when we're teaching trolley problems, right, it's like on the one one hand it's five people, but the other one it's your. You know, it's one person, definitely one person. What if it's your parent? Or what if it's someone you really care about and if, like because those get really much, much harder. And I don't think, and I, I think that, um, I think you're right that in the abstract, it's quite easy to say, well, yeah, of course we need to, you know, level down a bit, level, change things and, you know, make sacrifices for other people. That's really hard to do when you don't, you know, when you may not necessarily feel any kind of emotional connection to people at all because you've never met them, they're far away or whatever it might be. I do think, um and this is possibly where I start sounding like a highly naive, starry-eyed optimist but I think that, in the main, when in a lot of circumstances, people do generally want to help each other, in a lot of cases we're just very frequently in circumstances where that might be really costly, and I think it's important to recognize, though, that what we can be obliged to do can only be proportionate to the, the costs that we can reasonably bear, and I think that you know the antimicrobial resistance point. It's Actually, let me rephrase that, I think it's, I think it helped.
Speaker 3:What I'm thinking is the carbon footprint. It's the really helpful thing of talking about it, because that was I believe that that was a term devised by the petrochemical industry to kind of individualize it and make it an individual's responsibility, rather than because that makes it feel, really, but what about X or Y? And actually we as individuals shouldn't have that responsibility at all. And I think the same is true for antimicrobial resistance, and I think is true for health care decisions. Think is true for healthcare decisions, it those should, those should be much higher level, much broader scale, so that we're not being got given the sort of awful choice of, you know, endanger people you care about and love in order to protect someone you've never heard of, or something like that. And I think that is a, as we saw with the carbon footprint, as has been increasingly discussed at length, it's really effective to go like you need to use a paper straw. Pay no attention to the fact that Taylor Swift is flying her private jet to get groceries and Taylor Swift probably not one of the biggest offenders, but maybe I don't know. You know it makes it personal. It's your fault if you use antimicrobial drugs. It shouldn't ever be the individual's responsibility to make that decision.
Speaker 3:I think it's totally unfair, it's totally unjust, and while it might be really hard to and of course that doesn't get away from the fact that then you've got to try and convince people to support a policy and I think that's kind of gets the value of something like the original position. Ok, we're not talking about your family, we're talking about everyone in a whole. You don't know where you're going to end up and that's, I think, the the the sort of the most effective response to that, or an effective response. Maybe not the most effective and only really if you're a massive rules nerd like um, but um, who are all very cool people, I'm sure we can all agree, um, but I think the making it impersonal is really important in these kind of decisions, because otherwise it's just too difficult to go. Okay, yes, I'm going to endorse policy which I know will endanger people. Care that I care about and actually it might, it might not it, it.
Speaker 3:You know it's the you know it's it becomes.
Speaker 3:When it's about everyone, it's easier to make those decisions we might regret those decisions, but that doesn't necessarily mean that they were unjust or unethical or wrong To go to the terrible system, but good for me. In extremism, I think what the US does do is if you've got money, or if you have access to it to those really good treatments, you can get amazing, very high quality treatment. That is the case. It might also bankrupt you, but even if it doesn't, you could still get incredible treatment. Possibly that's better than elsewhere. Possibly that's more effective choice. That to to say, okay, we're going to allow a minority of people to have access to this incredible treatment and but we're also going to make that in. But that happening means that a huge proportion of other people don't. And that kind of comes to us.
Speaker 3:And this isn't to criticize your friends, because I've got friends in the states and I've had similar conversations and um, but to sort of go, that's very much. That's a pretty risky gamble to take because you're much more likely to end up, statistically speaking, again from the original. You know the position of ignorance in that group that doesn't have access to anything or loses their house or has to work until they're 80 in order to afford fun because they get insurance through their employer and that's the only way they can get life, life-sustaining medication or whatever it might be. And that's the political choice and that's the kind of solidarity decision as well. It's like do I want to be in the group that might have a small chance of being in the group that get of having access to that treatment, or do I want to be in a group that has possibly a lower threshold of like quality but has everyone has access to that? And I would argue that it's kind of wrong to have a. It was not kind of wrong what I said. We're framing that state. It's wrong to have a system where a tiny minority of people can get access to incredible treatment that is just fundamentally inaccessible to the vast majority of other people.
Speaker 3:And I think that this is this is the political choice. Um, like, it isn't about. Uh, I would also question how accessible that excellent treatment would be for the vast majority of people. I know friends who've lost homes that they've lived in for their entire lives as a result of medical debt in the States, and so the yeah, okay, you can get that treatment. However, the cost of that existing is kind of the, to use a sort of more flippant example, yes, I can have. Second, I can have next day shipping for X, y and Z, but the climate is dying while it happens. I guess is the kind of analog is like okay, yeah, that's really good, but the consequences of doing that or what is required for that to happen are so harmful to so many other people. It's kind of a case of it's a failure to sort of respond adequately to that harm.
Speaker 1:I think a parallel to the Australian situation from your group of friends, jane, that you were talking about. I'm actually quite surprised you have a group of American friends, considering the way you've slandered Americans before on this podcast. But is what's slander? What's?
Speaker 1:when you just dissed them two episodes ago, you were having a go at the way they talk yeah, yeah, they do talk funny um no, but uh, in australia, um, I think the growing divide between private and public education and the way that people who may feel committed to public education will still send their children to private schools because they can afford it. I'd be interested in your opinion on this. Pete brings me to a sort of definition of solidarity that I think and I could be wrong about this, but I think maybe comes out of someone like Simone Weil and talking about sort of solidarity as a sort of placing yourself and sharing the kind of material conditions that other people who you are in solidarity with are experiencing. I mean, this ended up, arguably there's debates about how and why she died, but you know, I believe she, even though she was in england at the time, was limiting herself to the same kinds of rations that people fighting the spanish civil war.
Speaker 1:I think I may be getting these right you know that she was sort of in solidarity with them only consuming the same right. You know that she was sort of in solidarity with them only consuming the same amount of money and ended up sort of money, same amount of food and ended up sort of starving, and I guess you know these. It is a more extreme form of solidarity but that idea of I have the money to send my children to an elite school or I have the money to access elite or you know better health care, but choosing not to.
Speaker 1:And again, actually this has come up in Australia recently. There was um, there are. Because we have this hybrid system, you can pay more money to access things. You know, jump the head of the queue. You know Australians hate queue jumping when it comes. You know, quote unquote queue jumping when it comes to asylum seekers. But we're more than willing to do it if there's an avenue to pay for it. So yeah, I guess I'd just be interested in that conception of solidarity, sort of those that shared material conditions, I guess.
Speaker 3:I think that's a really good point. I mean, I think we have, I don't think, quite as much of a private public hybrid in the UK as you do in Australia, but it is increasingly the case that there are lots of private providers that you can purchase and you can get salary deferments and things like this through employers and get quicker access. And equally with private education, I think that private schools fundamentally shouldn't exist, like there should not be a separate tier and the same for private healthcare.
Speaker 3:It just shouldn't be the case that it is possible to jump the queue in that way or to purchase massive advantages that other people don't have access to. It's fundamentally unfair. It's fundamentally unjust.
Speaker 3:Years ago I was talking to a very good, a good friend of mine and he'd um, who um has similar views to it as me and he was, but he'd had um and he'd done something to his back and hurt his back very badly and couldn't really do anything, um, and he went to his gp and a general practitioner a family, a regular doctor and the doctor's like I can get you to see a physiotherapist, but it will be in eight weeks time or something because there aren't enough public physiotherapists.
Speaker 3:And at the time he was in incredible amounts of pain, couldn't sleep, couldn't do anything, um, and so he went to, went through his uh, I think his employer provided everyone by default which he'd never, which he objected to and had opposed and said, okay, I need to go and see a private physio or like a consultant, and so did that and he was like, yeah, it's wrong, but I couldn't live for eight weeks like that, like there's just the cost of doing that is so much pain that it would have just been. You know it, I couldn't have survived, and you know, I think he wouldn't die, but it would be so detrimental to his well-being that he was willing to. Just he just thought high. You shouldn't have to be a moral hero to qualify to do the right thing.
Speaker 3:Like it. It gets to a point where you have to acknowledge that actually, this is it. It's acceptable for me to do something that I think is wrong. Still thinks that private healthcare shouldn't exist as do I, you know and I think, generally speak, I think it's not.
Speaker 3:And again it comes back to this thing about James question what about my mum is? It shouldn't ever be down to the individual to go like I've got to be a moral hero, in this instance, to do the right thing. That is unfair and unjust and the system shouldn't is working you know what? Or whatever the system is should not work in that way that that puts the responsibility in the wrong place. I think when it comes with something like um, and it's easy to think of exceptions, right, so these kinds of cases like well, like private school shouldn't exist.
Speaker 3:However, if every other school around you is dangerous and your kid is getting bullied and no one else will take them, and like the private school is the like that, it seems like a reasonable case. But these are really fringe cases and actually what should be happening is not individuals having to endure really horrible circumstances in order to be good people quote, unquote. This is like the money that goes to private health care should go into public health care. The money that goes the school fees that people pay, which are ridiculous, shouldn't be spent there. It should be spent in public health, public schools, so everyone can go have a good quality education that is safe and supportive, and an environment for people to thrive and here the private schools are funded in the same way pretty much as public schools, which is just so bizarre like by the government, I mean.
Speaker 2:So it's not even that fee-paying parents should be giving that money that they have presumably extra to the public school system. So the government should not be funding private education. I don't think.
Speaker 3:I mean, a lot of private schools here will have charitable status, so their tax codes are all very different and it's effectively a subsidy so that, well, your kid gets to go to school with the right kind of people.
Speaker 1:Well, I think it's arguable that the nastiest and most dangerous people come out of the private schooling system. So, on that bombshell, which I do think is true and could be backed up with empirical evidence, we've decided or I have decided to cut this into two episodes. So we're going to have part one, which you just listened to, which was a conversation about solidarity, which I hope you enjoyed, and I will soon be uploading part two, which is a conversation about pete's work on bullshit, which is related to this work on solidarity, as you'll hear in the conversation. Um, but, yeah, rather than having one long super episode, I thought it would be better to break them up into two shorter or at least manageable episodes, uh, so, uh, look forward, or you look forward and I look forward to uh, you listening to that.
Speaker 1:Uh, part two of this conversation. And, as always, you can uh contribute to this conversation on facebook. We've started up a facebook page. Um, we also do have twitter, but that seems to be a hellfire at the moment and also a instagram account, and you can send us an email, undisciplinarypod, at gmailcom. Alright, take care, jane, are you happy to do the bio?
Speaker 2:Sure, I do feel like it's the lady. Yeah.
Speaker 1:I know. Well, I don't want it to be the lady thing I know, but it's like the game show.
Speaker 2:I feel like I'm the person turning over the letters and the numbers. Let's stop this. No, no, it's not all good. It makes me feel like super awkward. No, it's very good because I won't say it again out loud, but I really like it when I have to try and pronounce terrible things that I haven't looked at before, like christian albrecht University. Thank you.