Insights December 2011

Wanted: A Christopher Hitchens for Healthcare

Steven Lewis

The world’s stock of courage, erudition, and candour took a nosedive on December 15, 2011. Christopher Hitchens died, at 62. Like Orwell (dead at 48) and Camus (47), he was a superior essayist, journalist, and critic whose premature death left too much unwritten. My brain will feel a bit starved without my weekly fix of Hitchens’ Slate column, or an extended polemic in Vanity Fair. He was absurdly readable and absurdly gifted.

It’s not that he was always right or always fair. That would be far too much to expect from a writer and thinker of prodigious output and immense range. Hitchens was learned, gutsy, and willing to change his mind. He began as a Trotskyite and ended as a – well, his friends and enemies disagree, some labelling him a neocon for his support for the Iraq War and his assault on “Islamofascism,” others noting his unwavering commitment to equality and fairness. Never mind: his defining quality was his fearless search for truth and zeal for speaking it to power.

He took special delight in pouring his VSOP (Vicious Searing Outraged Prose) on false idols, liars, and hypocrites. He was no mere fulminator; he summoned shelves of evidence to buttress his argument and had a deep respect (and astonishing memory) for facts. In his takedown of Mother Teresa, he observed that she “…was not a friend of the poor. She was a friend of poverty. She said that suffering was a gift from God. She spent her life opposing the only known cure for poverty, which is the empowerment of women and the emancipation of them from a livestock version of compulsory reproduction.” You may find this offensive; you may deem it a skewed outtake from a lifetime narrative of devoted service; but you cannot wish away these troubling facts or deny the penetrating precision of the argument. For Hitchens, truth was truth, and inconvenience be damned.

In his hierarchy of sins, deference to unearned status and accommodating greed, corruption, and stupidity ranked very near the top. For the unjustly revered or forgiven, an obituary was the occasion for calling to account rather than a critical Mulligan. “The discovery of the carcass of Jerry Falwell on the floor of an obscure office in Virginia has almost zero significance, except perhaps for two categories of the species labeled ‘credulous idiot’” began his summation of the life of right-wing Republicans’ patron saint of creepy evangelism. “The way to mark [US Senator Jesse] Helms' passing is to recognize that he prolonged the life of the old segregated South and the Dixiecrat ascendancy and that in his own person, not unlike Strom Thurmond, he personified much of its absurdity and redundancy” concluded a “tribute” which an earlier paragraph seasoned with the term “venomous hick.”

Among the virtues, politeness did not make his A list. Hitchens was a debater who neither gave nor expected a free pass. He eagerly and patiently put his atheism up against all sorts of believers on campuses, in town halls, and in churches. He respected honest and coherent dissenters but was pitiless in his dismantling of demagogues and fools. Engagement without passion meant you were merely playing parlour games.

Imagine what such a mind and voice could do for Canadian healthcare. It would bring fresh energy and bite to the anaesthetized genteelness of our torrential musings on continuous quality improvement and slow, expensive incremental change. Every unremedied catastrophe and righteous interest-group posturing would be witheringly exposed. The magical thinking of grandstanding politicians (a doctor in every hamlet, an ER within 5 miles of every citizen) would get the Falwell massage. Heaping billions of unconditional dollars into the healthcare trough would be compared to buying six hundred dollar hammers for the army. How many population screening programs would be skewered as fear-mongering propaganda that collapses under the weight of epidemiological evidence? 

Then the debates would begin in earnest: real, tough, direct, in-your-face contests about logic and evidence, motive and power, values and visions. Scoundrels would be called scoundrels. Turf protectors would be called shameless monopolists. Perverse incentives and policies misaligned with declared objectives would be subject to daily ridicule. Speaking truth to and about power would become normalized, upgraded from the muted cynicism of the lunchroom to the op-ed column and the documentary.
It is one thing to have no clue about what’s wrong and what to do about it; quite another to know and be unable or unwilling to say it out loud or write it down with lively clarity. I have heard very smart people say that telling Canadians the unvarnished truth about how badly the system performs for the $200 billion we spend on it plays into the hands of the profiteers who want to bring down medicare. The tragedy is that they may be right.

And if they are right it is because the healthcare debate is deliberately devoid of bluntness, wit and moral clarity. Ritualistic assertions like “everyone in healthcare wants to do a good job for patients” are patently false. In fact, the system is organized principally for the convenience and enrichment of providers, and sensible proposals to improve the quality, timeliness, and convenience of care routinely meet with formidable resistance or shakedowns for unconscionable amounts of new money. There are few sectors where talking a good game and playing a bad one goes so cheerfully unchallenged.

A small Hitchensian corps would hardly know where to begin – healthcare holds an embarrassment of riches for the critic or satirist with an occasionally savage pen. (May Hitchens’s non-existent god bless Bob Evans.) But to be a Hitchens is to be beholden to none, and willing to part with long-standing allies when reflection and insight drive you to a new perspective. Above all we fear shunning, and being branded as “out there” or a “troublemaker”. So we sanitize our public expressions and confine our plain talk to the places no one will hear.

Damn shame, ain’t it?

About the Author

Steven Lewis is a health policy consultant based in Saskatoon and Adjunct Professor of Health Policy at Simon Fraser University.



Robert Gordon wrote:

Posted 2011/12/20 at 10:52 AM EST

Hitchens to thought was like Lady Gaga to art.


Michael Brennan wrote:

Posted 2011/12/20 at 11:30 AM EST

Thank you Steven. Thoughtful people everywhere will miss him. Now get thee to a mirror and want no more, for the task is at hand!


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