Tuesday, June 30, 2009

A Buddhist View of Health Care Reform

The basis of Buddhism is the The Four Noble Truths and The Eightfold Path that the historical Buddha taught in his first sermon following his enlightenment. What is this Four Noble Truths?

Thus have I heard…

Now this, bhikkhus [i.e. monks], is the noble truth of suffering: birth is suffering, aging is suffering, illness is suffering, death is suffering; union with what is displeasing is suffering; separation from what is pleasing is suffering; not to get what one wants is suffering; in brief, the five aggregates subject to clinging are suffering.

This is the First Noble Truth. All of life is suffering. At first this seems a horrible view but it is not intended to deny that there is joy and happiness in life. Far from it. Rather to point out that suffering is an inevitable part of all aspects of life. Life is a wonderful thing. But ask any mother if there is some suffering involved in birth. Children are a source of great joy but ask any parent if there is not some suffering involved in parenting. And so forth.

The five aggregates, also known as the five aggregates of existence, or the five skandhas, are form, sensation, perception, mental formations, and consciousness. Our sense of self is tied up in these aggregates of existence. At the heart of any suffering is our clinging to some form or other of one or more of these aggregates in our mind.

Now this, bhikkhus, is the noble truth of the origin of suffering: it is this craving that leads to renewed existence, accompanied by delight and lust, seeking delight here and there; that is, craving for sensual pleasures, craving for existence, craving for extermination.

This is the Second Noble Truth. Craving. Craving after what we do not have. Craving derived from the five aggregates of existence and given body and strength by our clinging or attachment to them. Including, craving for the relief from craving, craving for the relief from our own delusions. This is the true source or origin of suffering.

Now this, bhikkhus, is the noble truth of the cessation of suffering: it is the remainderless fading away and cessation of that same craving, the giving up and relinquishing of it, freedom from it, non-reliance on it.

Detachment from and extinguishment of our craving and clinging behaviors and nature. If you’ve ever wanted someone else (a child or spouse perhaps) to do something and experienced the powerlessness of watching them do what they want to do regardless of your wants and desires then you know clearly the nature of craving and clinging. If you’ve ever freed yourself from the resultant suffering simply by detaching yourself from your own desires for that person then you have experienced the cessation of that suffering. It is as simple, and as hard, as that.

Now this, bhikkhus, is the noble truth of the way leading to the cessation of suffering: it is this noble eightfold path; that is, right view, right intention, right speech, right action, right livelihood, right effort, right mindfulness, right concentration.

So what does all this have to do with health care?

Without going too much deeper into Buddhist thought which traverses the borderlines between western philosophy, psychology and religion, let’s see how the eightfold path might clear some of the muddle going on in Washington, DC as well as the deep fog enveloping the traditional media reporting on the debate.

Right view: bi-partisanship, triggers, co-ops, public options, market competition, socialism, single-payer, profit margins, trillion dollar price tags. In what way do any of these describe a working health care system?

Right view would be to start by looking at the problem. What is, are, the problems with health care? Primarily, that some 45 million or more don’t have access to affordable coverage; that the costs for those of us that do are spiraling out of control; that the current structure of our health care system is unable to address these problems.

Right Intent then, would be to define goals that solve the identified problems. We need a health care system that is affordable and accessible for everyone regardless of economic status, changes in status (unemployment, age, sickness, marriage, divorce, etc), health or lack of health (“pre-existing conditions” in other words).

This health care system must be designed to provide at least basic health care needs for everyone and then, as cost and resources allow, expands available health care services to everyone up to the point where resources are no longer available (OOOOH! Scary! We’ll talk about that some more later).

Going back to Right View for a moment, Right View is one that isn’t driven by an “I got mine” attitude but rather by one that includes the needs of everyone. A self-centered view (Wrong View) sets people at cross-purposes, creates inefficiencies in the system and the market place and ensures that we do not achieve the best possible health care system for all. An inclusive view (Right View) is a cooperative one without wasted effort, wasted services, wasted dollars and wasted lives.

Right Speech is honest and forthright about our needs and intent. Right speech is not wasted on talk of “bi-partisanship” and “market competition” and “socialism” but rather on problems and solutions. It isn’t spent talking about profit margins but rather about meeting the needs of the people.

Right Speech demands a health care system that works for the citizens and doesn’t stop demanding it until the problem is solved.

Right Action is working towards creating that solution. Right action involves compromising between the realities of cost and the realities of need. Right action does not include compromising need in order to gain votes. Right action does not include compromising need in order to appease powerful lobbyist dollars. Right action knows when to compromise want and desire and when to hold firm in order to ensure a system that actually works.

Right livelihood steps back to take a look at other factors in play. Right livelihood involves business practices that produce ill-effects, whether intentionally or unintentionally. Right livelihood is responsibility, personal and corporate. Right livelihood means replacing old technologies and power sources with new, clean, sustainable, renewable technologies and power sources. Right livelihood means recognizing where the line is between profit margins and ethical behavior, again, personal and corporate. Right livelihood means engaging in businesses that enhance the well-being of self and others. It means phasing out and ending business that harm self and others.

A healthy environment will make for healthier people. Healthy people have fewer health care needs. Less strain on the health care system means lower costs. Lower costs means greater affordability for all.

Right Effort is soft and non-threatening, peaceful and non-violent but also as immovable as a mountain and as irresistible as an ocean. Right effort listens. Right effort seeks to understand. Right effort seeks to form common understanding, to find common ground, to create consensus, and to move forward together as a unified whole.

Right effort does not stop but it does so without attachment or stubborn clinging. Right effort does not get side tracked by anger or frustration… or self-centered greed.

Right mindfulness remembers what the problem is, what the goal is; what suffering is; what the cause of suffering is, what the cessation of suffering is, what the path leading to the cessation of suffering is. Right mindfulness is open, unconditioned. It does not overlay a situation with its own pre-conditioned views. Right mindfulness meets the needs of self and others equally as they arise for the betterment of all beings. Right mindfulness remains open and unconditioned in order to not get lost in the moment, its tangents, its frustrations, its delusions.

Right Concentration remains focused on solving the problem at hand. It doesn’t get lost in the past or the future. It resides here and now. It is only here and now. By existing here and now it does not get distracted or confused by propaganda, sales pitches and fear mongering.

Right concentration understands that governments are formed by common consent of the governed in order to meet their common needs and solve their common problems for their common benefit. Right concentration remains focused on solving the health care needs of American citizens and only once that problem has been solved concerns itself with the desires of corporations and the ephemeral arguments of markets competition and triggers, co-ops and socialism, profit margins and trillion dollar price tags.

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