Death and Taxes
by Corey Robin on February 14, 2014
Last year I wrote, somewhat tongue in cheek, that socialism is about converting hysterical misery into ordinary unhappiness.
This is what I meant.
Socialism won’t eliminate the sorrows of the human condition. Loss, death, betrayal, disappointment, hurt: none of these would disappear or even be mitigated in a socialist society. As the Pirkei Avot puts it, against your will you enter this world, against your will you leave it. (Or something like that.) That’s not going to change under socialism.
(Oh, by the way, Happy Valentine’s Day.)
But what socialism can do is to arrange things so that you can deal with and confront these unhappinesses of the human condition. Not flee from or avoid them because you’re so consumed by the material constraints and hassles of everyday life.
I was reminded of that post reading this wonderful piece by Anya Shiffrin about the death of her father.
Last spring, André Shiffrin, the legendary publisher, was diagnosed with pancreatic cancer (he died in December). A New Yorker through and through, he nevertheless decided to spend his last months in Paris, where he and his wife had an apartment and where he had been born. It proved to be a wise move, as Anya explains.
So imagine my surprise when my parents reported from Paris that their chemo visits couldn’t be more different [than they had been at Memorial Sloane Kettering in New York]. A nurse would come to the house two days before my dad’s treatment day to take his blood. When my dad appeared at the hospital, they were ready for him. The room was a little worn and there was often someone else in the next bed but, most important, there was no waiting. Total time at the Paris hospital each week: 90 minutes.
There were other nice surprises. When my dad needed to see specialists, for example, instead of trekking around the city for appointments, he would stay in one room at Cochin Hospital, a public hospital in the 14th arrondissement where he received his weekly chemo. The specialists would all come to him. The team approach meant the nutritionist, oncologist, general practitioner and pharmacist spoke to each other and coordinated his care. As my dad said, “It turns out there are solutions for the all the things we put up with in New York and accept as normal.”
One day he had to spend a few hours at Cochin. They gave him, free of charge, breakfast and then a hot lunch that included salad and chicken. They also paid for his taxi to and from the hospital each week.
“Can’t you think of anything bad about the French healthcare system?” I asked during one of our daily phone calls. My mom told me about a recent uproar in the hospital: It seems a brusque nurse rushed into the room and forgot to say good morning. “Did you see that?” another nurse said to my mom. “She forgot to say bonjour!”
As Anya notes, it wasn’t that her father “was getting VIP treatment or had a fancy private plan. Not at all. He had the plain vanilla French government healthcare.” She also points out that health care spending is much lower in France than it is in the United States.
I should acknowledge here that I know relatively little about health care policy, and the comparative merits of France versus Britain versus the US. So I can’t really comment on that element of Anya’s argument.
I want to make a different point.
French health care couldn’t stop André Shiffrin from dying; nothing in this world could. Instead it created a space for him and his family to deal with his dying, without the distracting mayhem of our system.
When my dad began to get worse, the home visits started. Nurses came three times a day to give him insulin and check his blood. The doctor made house calls several times a week until my father died on December 1.
The final days were harrowing. The grief was overwhelming. Not speaking French did make everything more difficult. But one good thing was that French healthcare was not just first rate — it was humane. We didn’t have to worry about navigating a complicated maze of insurance and co-payments and doing battle with billing departments.
Every time I sit on hold now with the billing department of my New York doctors and insurance company, I think back to all the things French healthcare got right. The simplicity of that system meant that all our energy could be spent on one thing: caring for my father.
That time was priceless.
In my Freudian (late Freud) moments of despair, I sometimes wonder if the madness of American capitalism isn’t one massive contrivance to avoid the sad finitude of the human condition. Filing our insurance claims, haggling on the phone, waiting for doctors, we don’t have time or space to deal with death. At least not properly. That’s what socialism—or whatever variant of state-provided/delivered/guaranteed/ensured health care we’re talking about—might help us do. Perhaps that’s why we don’t want it.
Patri Friedman, grandson of Milton, says that libertarian imago and Paypal entrepreneur Peter Thiel “wants to end the inevitability of death and taxes.” That seems about right. And a useful way to distinguish libertarianism from socialism, with taxes meant only as a signifier of the reality principle. Marx, at his most utopian, thought we were “suffering, conditioned and limited creature[s].” And that that was an essential part of our humanity, the necessary and productive delimitation of our liberation.
Socialism is not a flight from the human condition; it’s a direct and unsentimental confrontation with that condition.