Health Care and Structural Violence

by Valerie Elverton Dixon 07-24-2009

Just peace theory recognizes that there is more than one kind of violence. There is subjective violence that individual persons commit and there is structural violence, the violence that political, economic, social, cultural, and religion systems commit against individuals. America commits structural violence against more than 40 million of her citizens who do not have health insurance.

Violence is injustice. It is an unjust use of power, a force or array of forces that cause injury. The subjective violence of a personal attack, of war, terrorism, or torture is easy to see and to condemn. Structural violence is less visible, more subtle and therefore harder to critique and change. The structural violence of the health-care system in the United States violates distributive justice. It is a corruption of commutative justice because contractual relationships are forced.

When health insurance is linked to employment, employees are forced to work jobs they despise. They must too often travel farther, work harder and longer for less pay and less satisfaction in order to keep the job because they cannot afford to lose health coverage. This is not liberty. Such is especially the case when a spouse or a child has a serious medical problem that requires continual treatment.

Moreover, this system of health care is burdensome to businesses that have to include the cost of health care in compensation packages in order to attract and keep good people. For people whose employers do not offer health insurance, for part-time or temporary workers, for self-employed people, buying individual health insurance is not an affordable option. So, they go without primary health care that could prevent more serious illnesses in the future.

Now that the nation is facing this problem and is taking steps to address it, some members of Congress are worried about how to pay for it. I do not recall such worried, furrowed brows over deficit spending and the national debt when the George W. Bush administration took this nation to war in Iraq and Afghanistan. I do not recall an interest in going slowly and taking our time to “get it right” before going to war.

Spending billions of dollars a month in these wars while cutting taxes on the rich took this nation into deep debt and our members of Congress, for the most part, voiced no concern about the price. We rushed headlong into the subjective violence of war and did not count the cost. Now we have the opportunity to end the structural violence of an unjust, unsustainable, immoral health-care system and suddenly we are worried about whether the nation can pay for it. We are worried about moving too fast.

Good health-care legislation is a matter of political will, and where there is a will there is a way. President Obama is right to give Congress a deadline and to push for a change in our health-care system. Violence, subjective and structural, is expensive. We all pay the check every day. The questions are: Who pays? Who benefits? What is the currency of exchange?

Dr. Valerie Elverton Dixon is an independent scholar who publishes lectures and essays at JustPeaceTheory.com. She received her Ph.D. in religion and society from Temple University and taught Christian ethics at United Theological Seminary and Andover Newton Theological School.

To learn more about health-care reform, click here to visit Sojourners’ Health-Care Resources Web page.

Categories: Health, Human Rights, Violence and Nonviolence, War & Peace

xfree9

Don't get me wrong... we're on the same page, here. I just wanted to try my hand at explaining the illogic.

And isn't it ironic that all this "common good" is accomplished at the point of a gun?

KevinBatesville

Yes, I agree life, in general, isn't fair. But, does that mean we stand by in silence?

Fighting for justice? I'm not sure what that means anymore really. The powers are mighty.
As I said, the best one can do is to try to be a beacon of light in an otherwise dark world (as corny as that sounds).

I agree with your comments regarding both government and the banking system. That for all things financials. In terms of health care, it's the insurance companies that one has to fight.
They have a lot of power and influence in Washington, and I'm convinced that this government mandate requiring everyone to buy insurance is being pushed by that industry.

As far as my field, I'm in church administration.
I'm also a church musician and yoga instructor.

bhaack

Fair enough I understand your point. But by the "Church of Collectivism's" logic the violence extends to the poor in South America, Africa and Asia. And if the degree of poverty is any measure then the degree of violence is far higher toward the people on those continents that it is toward those in America.

My point here is simple: violence is an individual decision. And the kind of justice Ms. Dixon is talking about is also about individual decisions. It is far to easy to pass this off on society by voting for the right guy or by demonizing the right group (usually the right).

Rather than complain about the injustice, do something about it - serve, give of your time, give of your resources. Get involved...personally.

________________________________

xfree9

I think your skepticism is on point. Let me help you out a bit, here, and I'll have to exaggerate to make the point: Individuals only matter when they are in need. Otherwise, individuals are good for what they offer to "society," the "greater good," or "general welfare." So, on the one hand, it is not violent for you—the individual—to not pay for somebody else's health care. On the other hand, it is violent for "us" to not pay for everyone else's health care. At least that's how the Church of Collectivism looks at society.

xfree9

Kevin, thank you for sharing your thoughts and experiences. I don't doubt one bit that you work hard. I'm not sure what you mean by "fairness," though. Life isn't fair. It's not fair that God has permitted your life to go a certain way and facilitate making you into a stronger human being, while others who simply have things handed to them have no real substance to their personality. There are two ways to look at things.

But, if you chose to call that entitlement or envy, please feel free to continue to do so, I have things to do and precious little time any more to justify myself to anyone.

Quite frankly, you have educated me though. I've learned that it's really silly to fight for this kind of thing, because people with far less morals and much more power than I control the wealth of this country.

I can't judge your heart. Only God can do that.

I'm not sure if your education comment was a backhanded compliment, or not. It also wasn't clear about who has "far less morals" than you do. But as for power and control, you're exactly right. But don't look to government to save you, it's the source of your problems. The Federal Reserve System is inflating the money supply and making the buying power of your earnings less, and it hurts you the most because only the wealthy and powerful get that infusion of money first. Once it "trickles down" to you (and it will), the buying power of that money has already gone down, so it's worth less (or worthless). Inflation hurts people like you most.

I wouldn't stop fighting for justice. But I take up my fight against the central banking system, and any tendencies by politicians to centralize power into the hands of a few people who believe themselves wise enough to make decisions for the rest of us. Our society didn't used to be this way.

Out of curiosity, what field are you in?

KevinBatesville

I think you misread me sir.

I neither expect nor believe in entitlements. I work hard, and I'd happily continue to work to pay for my medical car and/or insurance, but despite my best efforts, I can't. That's not envy or entitlement, it's pure frustration.

I went to college being told that being educated was a ticket to some measure of success. I've discovered that that not's necessarily true.

I don't want entitlements, never have, never will. I work for EVERYTHING I've ever had, and damn hard to. I have worked 60 hours a week to get by, while others take a less honest root and barely work at all. I don't want entitlements, I want some fairness.

But, if you chose to call that entitlement or envy, please feel free to continue to do so, I have things to do and precious little time any more to justify myself to anyone.

Quite frankly, you have educated me though. I've learned that it's really silly to fight for this kind of thing, because people with far less morals and much more power than I control the wealth of this country.

My task really is to do the best I can, and try to be a happy, whole person. That's my contribution to an insane world.

prk

All of those proposals were tax neutral, taken from the employer and a tax credit to the employee. As well as an increase in gross pay. The check that was being written to the insurance company now goes to the employee.

WaveTossed

I will push hardest for cutting government spending. Cutting government spending on various expensive projects should be our highest priority. I'm so glad that Obama and his allies got rid of the spending for the F-22 (or 52 or whatever number) which many Repubs were supporting. Even the Pentagon officials stated that this plane isn't needed -- so why are so many Repubs (and some Dems) supporting this expense?

I just read today that there have been some cuts proposed for Medicare that will eliminate duplicate tests that aren't needed. Of course one reason that doctors order excessive tests are the fears of being sued for malpractice. Which is another issue that needs to be faced.

Then of course the ever-continuing Black Hole in Bagdad, that most polls show that people support cutting back in this spending -- both of money and of lives. There has been some progress made in getting some troops out of Iraq, but more progress must be made. The troops never should have been there in the first place (don't blame me, I voted for Badnarek, the Libertarian, the only truly anti-Iraq war candidate, in 2004). People are rarely made aware of just how expensive these military ventures are. You're talking trillions and trillions of dollars.

As for raising taxes: The last thing that I (as a worker) needs is yet another tax. Even if it comes with a small "deduction" that doesn't even come close to covering my health care expenses. I will fight hard against this option. Right now, it's mainly the Repubs who are supporting this raise in my taxes with their so-called "alternative plan" which they don't seem all that enthusiastic in promoting. Perhaps because they realize that it would result in raising taxes on middle and low-income Americans.

bhaack

"Structural violence."

A cute term dreamed up put a tax subsidized academic with the intent of politicizing social policy.

So let me get this right. My not paying for someone elses healthcare is an act of violence. Is that violence on par with say child abuse.

If it is violence to not offer free healthcare to all Americans then is it genocide to not offer free healthcare to everyone in Ethiopia. Why are Americans so special that they are entitled to free healthcare. Does God not love Ethiopians too?

And if all American's have a right to free healthcate then doesn't that for all intents and purposes wipe out charity and goodwill. My helping someone more fortunate than myself is not an act of charity it is an act to which I am obligated; after all by not giving of my resources I am in fact keeping something which if rightfully someone elses - their right to healthcare. Worse, according to comrade Dixon, it is an act of violence.

Isn't this just warmed over Liberation Theology?

Eric77

True, there is a way to finance it by cutting spending. I'd be up for that too, but it's unfortunately never going to happen.

joanneschnepp

You are right. The truth is, there are only 12-14M true citizens who don't have health insurance and wish they did. The most logical way to fix this is to change the parameters re: who is eligible for Medicaid. This that is coming from Obama is NOT about insuring people...it's about government control of yet another big industry. It's about giving up more personal privacy and control. We are being told lies about this whole thing. There are other ways to insure those CITIZENS who don't have it and want it. ANd there are other ways to cut costs. The US government has not YET delivered any health care in an efficient and affordable manner, so why would we want them to take control of more if it? First save $$ by fixing the mess of Medicaid, Medicare and the VA system...

xfree9

Kevin, I certainly don't envy your position. I've been where you are. It's tough working more hours than the "standard" work week, and I'm sure it is full of stress and frustration, not to mention disappointment. It's easy for me to sit on this side of the Internet and claim I know the answers and steps to solve your life problems. But that would be stupid, naive, and arrogant of me.

But please don't confuse access and affordability with freedom. You do have the freedom, you just may not have the means. Those are not the same thing. I have the freedom to become an actor, I simply don't have the talent, looks, or access. But that does not mean I'm not free to try. I'm not sure what line of work you're in, but perhaps there are barriers to entry for you to get ahead or work up the next step in the ladder. If there are barriers to entry, what are those barriers? Where did they come from?

You say you do not believe in entitlements, yet everything you're saying is complaining that you don't have access to something other people have access to. That's plain envy. You believe that you have a right to not fear being destitute, but do you realize that this is a problem of relative luxury? You live in an affluent society, so you can envy your neighbor because of it. Maybe someday you can travel to Cambodia, and tell the homeless and beggars along the street about your plight in life, and they will likely not care too much about your problems. Does that mean you don't have legitimate problems, or that God doesn't care about your plight? Not at all! But I oftentimes find myself complaining about this or that thing not being just right (like my cell phone dropping calls), and I realize that it's a problem that others would love to have. The very notion of "retirement" is a modern luxury, and has no scriptural basis. It is an modern Western creation.

I don't think I have "pat answers." But if you start blaming somebody else for your lack of freedom, you won't rise above the challenges that you face.

WaveTossed

Health care access can be financed by decreasing spending. Especially the spending that the U.S. government shells out in foreign military ventures, trying to be the Morality Thought Police of the World. The Iraq war was a total waste of money, time, and lives; we're still shelling out lots and lots of funds and lives into the Black Hole in Bagdad. The Afghanistan war is more problematic because here there are enemies of the U.S. who participated in murdering Americans on American soil back in 9/11/2001. However, at least we could study less expensive ways of deploying more effective attacks against Al Qaida.

There are also other government programs that can be cut. I wouldn't mind cutting out completely the entire Education Department. The schools should be run by the states or by local districts and funded accordingly.

As for health care plans, I don't completely like either the proposed Repub plan (which I've noticed the Repubs haven't spent a lot of time pushing, so I don't think they are united on it) or the Dem plan. I am opposed to doing nothing. I am also opposed to any plan that involves a single-payer system or which involves raising taxes on the middle class.

WaveTossed

I wasn't disagreeing with you here. I should have made myself more clear. I was making a comment (perhaps a side comment) where I discuss giving the government the sort of power it would have under a single-pay system.

Believe me, anyone who makes the State their Health Nanny will have to suffer the State's dictates about how to "take care" or not take care of yourself. Whoever pays the piper calls the tune.

Which is why I am opposed to a single-pay system, especially here in the U.S. with our obsessing over having armies of bureaucrats decide who is or isn't "worthy."

Eric77

That's fine if you don't like their plan, but the Republicans are offering alternatives. It's not like they're just sitting there shouting "No! Status quo!" And I've yet to hear of any plan that doesn't either put us deeper into national debt or raise taxes on middle class Americans. You can't finance universal health care solely on the backs of the wealthy.

ando

You obviously missed my point. I suspect that most countries with single
payer systems put a healthy emphasis on making good choice related to
nutrition, exercise, etc. It's called taking responsibility for your own
actions, and not making the State your nanny. A single payer system would
just make it that much easier to neglect taking care of yourself, because
you'd just run to the doctor to take care of every ailment.
And next time, please read the whole of my post before responding.

ando

Eric - you make a good point. I'm not a gun owner, and am not a big fan of
the NRA, but that's another story. As a Christian, I'd rather my brother
and sister have a right to good health care than the right to own a gun.
Perhaps that's where the church needs to step in -- not gun control, but
helping those with health needs -- ...but the current health care system
makes that quite difficult. Perhaps it's a render unto Caesar moment...The
state giving right to bear arms, but people of faith stepping in to help
those with health needs. I need to think about it more...

WaveTossed

"I don't think employers should be mandated to provide health insurance."

They aren't in my state. And I agree with you. I remember cringing when Hilary was running and talking about requiring everyone to have insurance and/or requiring employers to provide it. In Maryland, they passed a "Wal-Mart law" that required employers who employ more than a certain number to provide insurance. And a court threw it out as being unconstitutional.

I distinctly heard Obama last night saying that he opposed requirements for everyone to have to have insurance. I believe that he also expressed opposition to requiring employers to provide insurance. As I said, in Maryland, this sort of scheme was declared unconstitutional.

"And I don't think workers should pay taxes on health insurance, whether or not that health insurance is provided by an employer or bought outright. Health insurance should be pre-tax (of course, I think everything should be pre-tax, but that's a different story)."

Amen! Agree with you 100%.

WaveTossed

Thanks for the link. Which enabled me to link to some more details -- which I'm not happy with. Because this is the old McCain plan which will end up raising taxes for those who work at jobs that offer health care benefits.

From the Wall Street Journal

http://online.wsj.com/article/SB124277551107536...

"The nexus of their plan is redirecting the $300 billion annual tax subsidy for employment-based health insurance to individuals in the form of refundable, advanceable tax credits. Families would get $5,700 a year and individuals $2,300 to buy insurance and invest in Health Savings Accounts."

Here is that "redirecting" the tax subsidy for employment-based health insurance. In other words, abolish this subsidy and start taxing the job-related health benefits as income. Of course the employer could suck up the extra cost, but it's highly doubtful that they would do so. Instead, the workers get stuck with a tax increase.

Okay, families get $5700 a year and individuals get $2300 as tax deductions. Most workers (including myself) pay a lot more than that each year for health insurance benefits, deductibles, co--pays, etc. So again, working people end up getting stuck with an increase in taxes and a decrease in take-home pay.

As for the Dems plan to require everyone to get insurance. I distinctly heard Obama tell the reporters at the press conference that he was opposed to that idea. And he has re-iterated his opposition with sticking workers with a tax increase by removing the deduction for employer-based insurance plans (which some of the Dems, along with some Repubs have been pushing).

I agree that the connection of health insurance and jobs is something that needs to be explored. However, raising taxes or eliminating tax deductions is not the way to deal with this.

xfree9

I don't think employers should be mandated to provide health insurance. Currently, if you employ over a certain number of people, you have to provide health insurance. So employee #49 costs you a certain amount per employee, as soon as you hire #50, you're now buying lots of health care to cover 50 people, not just that one extra. So employers have to have the capital to do this, or simply not hire more people.

And I don't think workers should pay taxes on health insurance, whether or not that health insurance is provided by an employer or bought outright. Health insurance should be pre-tax (of course, I think everything should be pre-tax, but that's a different story).

KevinBatesville

I am not free sir. Certainly, as you say, I'm free to do this and that in order to be upwardly mobile, but one has to have financial resources to be upwardly mobile. I don't have such resources.

And, I do work. I have worked as many as 60 hours a week, but sadly the wages I was paid were relatively low. I'm essentially a wage slave. I have enough money to live, but no money for insurance, no money for a 401k. Nothing.

I do strive to better myself, and certainly being financially stable is an element of that. I do agree with the idea that work as much as you can and be frugal. I do both of those, and still I struggle.

Giving pat answers to such complex questions is a bit patronizing, although I'm sure you don't mean to be.

Finally, I don't believe in entitlements either, and I agree there are plenty folks who think they deserve this or that. But, medical care is too expensive and the right is that we live in a free country, we shouldn't have to fear that we'll be made destitute by affliction.

Health care reform is a complex issue, to be sure, but not as complex as Congress is making it.