Health Care and the Hunter-Gatherers

by on August 28th, 2009

You know something is up when proponents of the Obama health care plan are not merely shouted down at town hall meetings, but hanged in effigy. Republican pollster Bill McInturff, quoted by Dan Balz in the Aug. 8 Washington Post, was right when he observed, “We’re not having a health care fight…There is a broad and underlying unease about the state of the economy and the country.” But the fears and fantasies in this debate are both broader and deeper than fears about the economy, or even about the country. They reflect not only deep cultural divisions in the country, but divisions within our cultural and psychological evolution as a species.

We can begin to understand this when we examine that bellwether of primal fear, former Alaska Governor Sarah Palin, who recently pronounced the Obama health care plan “downright evil,” and claimed that the plan creates a “death panel” that will decide whether the elderly or disabled are “worthy of care” — a claim refuted by, a non-partisan website. That the terms “evil” and “death” were invoked by Palin in what is ostensibly a debate about modifying health care points to the irrational forces at work in this conflict — arguably, forces that have been underestimated by the President and his top advisors.

We can look at the health care debate in terms of various historical and philosophical dichotomies: federalism vs. anti-federalism; societal vs. individual rights; socialism vs. free-market capitalism, etc. But a much more ancient division in mankind’s history suggests itself: that between hunter-gather societies and settled agricultural societies. As historian Thomas Greer explains, sometime around 6000 BC, much of mankind shifted from a nomadic-hunter pattern of existence to one of “settled agrarian life”, involving domestication of plants and animals. As Greer notes, we “became food-makers instead of food-finders.” In their book, The 10,000 Year Explosion, Gregory Cochran and Henry Harpending argue that along with this settled, agricultural society came the notion of property rights. Eventually, property-holding farmers came to rely on government for safety and protection.

In contrast, hunter-gatherers had little need for, or emotional investment in, government protection of food or property. Indeed, as Cochran and Harpending argue, the hunter-gatherers “…could usually obtain food fairly easily, since constant local violence kept human numbers below the land’s carrying capacity.” For the hunter-gatherers, “bursts of strength in war and hunting” were more important than the agrarians’ “bourgeois virtues” of maintaining safety, stability, and property.

I believe we find echoes of this cultural dichotomy in the present, often shrill debate about health care. Opponents of so-called “Obama Care” often state the matter in terms of a “government takeover” of health care, or raise the specter of “socialized medicine.” Many of these critics believe that individuals should be left essentially to their own devices — or to the “free market”–when it comes to finding health insurance, or, indeed, health care. They see government as an all-powerful enemy — one that, in Sarah Palin’s world-view, will seize even the power of life and death from those it ostensibly serves. Palin’s fears — irrational though they are, in my view — are those of the archetypal hunter-gatherer, zealously guarding the freedom to roam, hunt, and survive on one’s own wits and wiles. These are not necessarily bad traits, under certain circumstances — but they may not serve or protect those who are least able to care for themselves.

In contrast, those who favor Obama’s type of health-care reform generally see government as a benefactor in the service of civilized society — one that protects certain fundamental rights, including that of decent, affordable health care. The anxiety of this constituency focuses on the break-down of the social safety net, leaving the sick to fend for themselves amidst predatory insurers and callous capitalists. This, in my view, is a vestige of the settled agrarian’s primal fear: the break-down of order, and the abandonment, by government, of those most in need of its protection. These fears, too, may be exaggerated — though as a physician, I believe the present anarchic state of health care in this country is not very far-removed from the worst fears of the “settled agrarians.”

There are, to be sure, fair and rational criticisms that may be leveled against some of the Administration’s health care proposals. But I don’t believe the vitriol and hysteria coming from some opponents of health care reform can be explained solely in terms of economics. In President Obama’s more extreme critics, there is a good deal of the ancient, hunter-gatherer crying out, “Don’t fence me in!” Before we can persuade these critics to support genuine health care reform, we need to understand the origins of this cri de coeur– even if it sounds, to this physician’s ear, much like the howl of the nocturnal predator.

Ronald Pies MD is a psychiatrist in the Boston area, and the author of Everything Has Two Handles: The Stoic’s Guide to the Art of Living.

Ronald Pies MD

Ronald Pies MD is Professor of Psychiatry and Lecturer on Bioethics & Humanities, SUNY Upstate Medical University, Syracuse, NY; and Clinical Professor of Psychiatry, Tufts University School of Medicine. Dr. Pies is the author of several textbooks of psychiatry, as well as books on philosophy and religion. He is the author, most recently, of Becoming a Mensch: Timeless Talmudic Ethics for Everyone; Ziprin's Ghost (a collection of short stories); and The Heart Broken Open (a collection of poems).