The Insurance Gamble approach to health care has worked for a while. Specifically, it has functioned well enough since World War II, when it was invented to keep people well enough to work in war factories. But the fact that this scheme has managed to work for a while was mainly a matter of timing. There was a revolution in medicine after World War II, featuring the discovery of antibiotics and the further develoment of public health and sanitation measures from the early part of the 20th century. As a result, many more children born in the post-war euphoria of the late 1940s and 50s survived childhood than would have been the case a generation earlier. Fewer of their mothers died in childbirth. Fewer of their grandparents died of the heart attacks and cancer that killed people in their 40s and 50s a generation earlier.

So, the gamble worked for a while. The sheer numbers of young and healthy people alive from 1960 to 1990 meant that insurance companies could make money without denying care too obviously.

The same factors fed the development of a culture in the U.S. that glorifies youth and health and denies that sickness and death are a normal part of human life. It was possible for a child like me, born in 1953, to reach adulthood without ever having seen a family member or friend die. There were many parents like mine who thought it best to shelter their children from the very existence of death, so that when family members did die, the children were kept away from the funerals and other aspects of the process. Families lived separated from each other by greater distances than in previous generations, so it was possible to hide very large things behind the emotional furniture.

One has only to read a sampling of what is available in the mainstream media on human health to see this culture in action. The ugly outcome of it is that when a person gets sick and eventually falls prey to the human condition, the person is blamed for it. The blame can be subtle or blatant, but there has to be an explanation for such a thing happening, because the assumption is that it should not happen.

This is also attributable to the roots of U.S. culture in Protestantism and especially Puritanism, which held as part of its creed that the quality of your life was a direct indication of how much God did or did not like you. If you were poor or sick or miserable, it was a sign of God’s disfavor. While fewer people believe in that sort of God today, you do not have to look far to find the assumption that sickness is the result of something the sick person has done wrong.  The fact that everyone gets sick must forgotten, or else someone might notice that there is no way to get it right, and the entire structure of guilt, blame, and self-criticism might collapse like the house of cards it is.

That structure has made a small number of people a great deal of money. But, as everyone who has not been locked up in a cave for the past ten years knows, the jig is up. All those young and healthy people who held up the walls and roof of the insurance industry’s pyramid scheme and the culture’s self-deception are getting old and getting sick. If we are to avert a collapse that could take a lot of us along with it, there are going to have to be systemic changes.

1) The insurance model must be removed from the process of caring for the sick.

2) The culture as a whole must allow the existence of illness and death back into the light of day.

3) The culture as a whole must recover the basic human capacity for love and care in the face of imperfection.