02 August 2009

Solidarity and Health Care Reform

Photo © John Moore/Getty Images North America.
Hundreds of people arrive in darkness for morning admission to the
Remote Area Medical (RAM), health care clinic July 25, 2008 in Wise,
Virginia. The free weekend clinic, staffed by more than 1,400
doctors and medical personel, is the largest of its kind in
the nation and
organizers expect more than 2,500 patients to turn
out for the 2 1/2 day
event. Residents of the area, most from the
"coal counties" of Appalachia,
come from one of the poorest and least
educated areas in the United
States. Most are underinsured or have
no health care at all, and for
many the annual RAM event is the
only medical treatment they may
get all year.

Last night I watched a segment of Bill Moyers Journal on Health care reform. The segment consisted in a discussion with Wendell Potter a former insurance executive who has testified before Congress regarding the practices he industry engages to both maintain profits by refusing coverage to allegedly "insured" people and to fight meaningful reform of the system by which we currently ration health care. (I say ration because that is what we do - we use an institutional mechanism called 'the market' to distribute health care to some and deny it to others.)

Two things are interesting about the segment. The first is delicious, if somewhat tangential. At one point, while discussing how the industry's talking points have infiltrated public debate, Moyers referred to the inimitable Bill Kristol as a "Republican propagandist." Ouch! But I suppose the truth is sometimes painful. Perhaps Kristol's public incompetence and venality is initially catching up with him.

The second is that Potter's conversion lends some support to the importance of seeing problems in a new light. I had read about Potter here in The Guardian. Turns out that his particular road to Damscus ran through a little place called Wise, Virginia where, largely by coincidence, in 2007 he witnessed throngs of uninsured Americans receiving free medical and dental care at what has become an annual outdoor event - the Remote Area Medical (RAM) clinic which is coordinated by the University of Virginia Health System. So much for worries about government getting involved in providing medical care. While the personnel at the clinic are volunteers, they would not have been in Wise without public resources.

The RAM is not responding to a natural disaster; the mess they are cleaning up is wholly man made. The clinic was recently held again and you can find photos here. But what is the role of photography in all this? I think there is a lesson available. When discussing photographic depictions of disaster and mayhem it is common to be told that the images show us the "reality" that remains conveniently out of sight as we go about our privileged lives. The idea is that photographers confront us with "truth," and thereby dispel the comfortable and self-serving appearances that obscure social and political and economic reality.

There is another way to understand how vision works here though. Richard Rorty sees solidarity as consisting in our ability to think of others "as 'one of us,' where 'us' means something smaller and more local than the human race." He argues that we are prompted to extend solidarity to new groups, when we do, on the basis of "detailed descriptions of particular varieties of pain and humiliation."* Although Rorty is preoccupied with literary descriptions, photographers too regularly provide just such detailed description. But the aim of these descriptions is not to penetrate appearance, but to provide a cogent or salient re-description that allows us to see others as like us in ways that we previously had not. In this sense depictions - whether literary or photographic - are tools for creating solidarity. And solidarity, in turn is profoundly dependent on imagination.

For Mr. Potter, it had not been possible, prior to his experience the RAM clinic, to imagine that such large numbers of "Americans" might find themselves in such dire circumstances. His encounter there, which he saw and photographed, constituted a conversion experience precisely insofar as it has compelled him to re-describe the world and act accordingly.
* There is much to disagree with in Rorty's view - especially his insistence that solidarity s a "feeling." But that is a story for another time.

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