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

KevinBatesville

Valerie,

Bravo on your article. I say these things all the time.

I work nearly 50 hours a week JUST to get by. I also don't have health insurance, because I can afford $300-400/month AND high deductibles.
I pray that I never get seriously ill, because I can't afford to get medical care.
I recently heard a doctor say that health care in America is a privilege, not a right. How is this a free country when such truths exist?
I feel less than free quite often, so to hear some one else say these things is both encouraging AND invigorating.

Thank you again for the article, hopefully it can raise some aware about the truth of what's happening in our country.

xfree9

Kevin, I pray you do not get sick, either. It's no fun being trapped by high costs for something that very well could be affordable.

Unfortunately, I don't agree that health services should be (or are) a "right," because we do not have the right to the free use of someone else’s labor. If you object that you are willing to compensate the health industry for its labor, where does this compensation come from? From the labor of others. And that, you can be assured, is not yours to give away.

You are free, Kevin. You are free to work as hard as you possibly can, for yourself, and for your family. You are free to make decisions about what you buy, where you spend your money, and how much you save. It's not easy, it's not simple, and it is certainly not a quick solution. You are free to be creative and innovative. You are free to provide services for people that others cannot provide, or do it at a better price and therefore serve others better. But the fact that you (and others) do not have access to something that others do does not mean you have the right to their money, wealth, or access.

I will however, mourn with you the fact that health care is not affordable to you. It is not affordable for a variety of reasons, some of which is the insurance companies, some of which is the government, and some of which is our thinking that we are entitled to things to which we are not truly entitled. There are many problems to our health care system. There are many possible reforms. The ones that make you more free to choose your health insurance and negotiate privately with insurance agencies and doctors is going to be the best solution. What won't work is a government plan or legislation "guaranteeing" somebody else's labor to you and to others. That is not freedom, that is domination.

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.

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.

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.

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

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.

xfree9

America commits structural violence against more than 40 million of her citizens who do not have health insurance.

Umm, no. Some of those 40 million are not citizens, some are eligible for already-available health care such as Medicaid or Medicare, and some still make enough money to purchase affordable health insurance but choose not to for various reasons (that is liberty, btw—see below). Of the 40 million, about 10-15 are truly uninsured for reasons that might qualify for "structural violence," though that is difficult to prove statistically.

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.

Neither is the health care system that Barack Obama is wanting to implement. He lied when he said he wants all thoughts and views on the table, yet not a single pro-market reform advocate/scholar/think tank was invited to his healthcare summit.

Spending billions of dollars a month in these wars while cutting taxes on the rich took this nation into deep debt and our congressmembers, for the most part, voiced no concern about the price.

First of all, I agree that we shouldn't have gone to war, let alone quickly and excessively. But lowering taxes on the rich had nothing to do with it. The federal government actually took in more revenue after the tax decrease on the wealthy. JFK himself said that it is a paradox that when taxes on the rich are lowered, the government takes in more revenue.

Second, "they hastily went to war, so now it's our turn to hastily make policies" is very immature. A better approach would be to slowly consider and weigh the costs and make the right decision. A first step would be to actually read the freakin' bills before voting!

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...

WaveTossed

"[from the article]Now that the nation is facing this problem and is taking steps to address it, some congressmembers 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 in Afghanistan. I do not recall an interest in going slowly and taking our time to 'get it right' before going to war."

Amen, Valerie! People just don't realize, in the heat of dashing off to war (usually sending someone else, our young soldiers) the budget-breaking expense of these wars. Plus the situation of solders returning maimed and wounded with PTSD and other physical and psychological problems.

I personally support Ron Paul's plan of having 100% tax deductions for all health care expenses. And those who treat people who are disabled or unemployed (and therefore lack sufficient income to be taxed) would get 100% tax deductions for their service. Of course this will never happen because then the government would have to reduce spending. And would have to stop spending the trillions it takes to send soldiers off to foreign countries (which Rep. Paul firmly opposes) in order for the U.S. to put itself up as the Morality Thought Police of the World.

However, I would support President Obama's plan rather than doing nothing. Until the Repubs actually come up with a concrete alternative to what we have now, then I'm going to have to side with the President on this one.

Eric77

Wave,
You've mentioned several times before that the Republicans don't have an alternative plan and that therefore our only choice is to support Obama's plan. I did a basic google search and came up with this:

http://coburn.senate.gov/public/index.cfm?FuseA...

I don't know whether it's "THE" Republican plan but it's certainly "A" Republican plan. Check it out. The problem with Rep. Paul's plan is that income tax deductions won't help people afford insurance who don't pay income taxes (most of the poor). Tax credits would help, but deductions are basically useless.

(Also, sorry I never got back to you on the Episcopal Church thread but my Disqus isn't working that well. I didn't mean to leave you hanging there!)

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.

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.

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.

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.

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.

prk

"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 to keep good people."

Wow, is Sojo saying that workers are being over compensated?

prk

Yes health insurance is linked to employment because of tax law. Tax law that unions worked very hard to craft.

I am fine removing the tax benefit for employers, but that does not relieve the company of my total pay package. So the burden of compensation will remain the same for the business.

If I write the check for my health insurance it must come from somewhere, so my take home pay would increase.

xfree9

If I write the check for my health insurance it must come from somewhere, so my take home pay would increase.

And if that is the scenario, more individuals are looking for and competing for affordable insurance... which means costs will go down. Gee, it's like basic economics actually works!

WaveTossed

"I am fine removing the tax benefit for employers,"

And sticking workers who have employer-based health care with a hefty tax increase? This is what McCain wanted and one reason why I voted against him. The last thing we need is a tax increase that hits the middle-class such as what this one would do.

xfree9

That's not a guaranteed consequence. Besides, if employers were not providing insurance, workers would then compete for insurance, thereby reducing costs via competition. Also, if employers aren't mandated to provide insurance, employers are also able to pay more.

WaveTossed

What is this insistence by people who should know better to stick middle-class workers with a tax increase? Are the top 20% wealthiest people the only ones entitled to tax relief? And if anyone believes that the employers are going to suck up the loss of their own tax deduction and not pass it on to their employees, then I have some swampland in Arizona for sale.

And what is wrong with employers offering insurance? Originally, the offers of insurance were measures taken to attract quality employees. I don't think that employers should be required to offer insurance, but I certainly don't think that they should be stuck with dis-incentives to do so if they wish.

Someone mentioned (on either another thread or another line of conversation) about what happens if someone doesn't make enough money to get taxed. How would they benefit from tax deductions or exemptions? In two ways. One could be a "negative income tax" that would give them the money to pay for health care. The other would be 100% tax incentives (deductions and/or exemptions) to medical agencies who would offer care to those who cannot afford either insurance or the medical care they need.