Choice

Image of Oklahoma state Capitol building and a church

Can we ever have an intelligent and deeper discussion about this issue of people who make poor lifestyle choices related to their health here in Oklahoma?

For years, The Oklahoman editorial page has taken the smug monolithic position that, say, anyone who smokes or drinks too much or eats too much or does hard drugs, such as methamphetamine, is simply making a bad decision. No amount of health insurance or medical access, so the reasoning goes, really matters. Bad choices are simply bad choices. People could choose differently. Case closed.

The newspaper has used this reductionist argument, of course, to oppose the Affordable Care Act, also known as Obamacare, and virtually any government expansion of health care coverage or access. On Sunday, The Oklahoman editorial page whines yet again:

We would add that a long-existing body of evidence suggests that healthy lifestyles increase life expectancy and that no level of insurance coverage can overcome the effects of smoking, obesity and the substance abuse problems that Oklahoma grapples with continuously.

The editorial makes this claim in response to a new study that the mortality rate has dropped in Massachusetts as more and more people have been able to get health insurance there. Parsing the study and omitting basic information about socio-economic issues, education and health in Oklahoma, the editorial takes its rigid position as its own compliance with a conservative ideology that rejects humane, responsible action. It’s as if the poverty and the low college education rate and the high drug addiction rate in the state doesn’t affect anyone but those held captive by their own “bad choices.” That’s an error. It's illogical.

Let’s be clear that all of us, whether we make bad choices or not, whatever our income level, are affected by Oklahoma’s stark socio-economic failures and its government’s stubborn refusal to fund education at anything close to an adequate level. The state’s governing apparatus, and this includes Democrats in the past, creates its own crisis and washes it away with the bad-choice trope.

Tax dollars go to prisons instead of schools. Drug addiction often leads to more extreme criminal behavior. Poverty is all around us, seen in Oklahoma City’s urban plight or the dilapidation of main street in small towns. Our state’s low graduation rate means fewer cultural opportunities for all of us. Perhaps the very rich can escape from the stultifying effects of the wrongly conceived bad-choice argument, but 99 percent of us simply endure the depressing spectacle.

People make bad health decisions for a variety of reasons. They do drugs to escape because they lack real opportunities in their lives in a society that privileges the wealthy. They become overweight because they can only afford foods that lead to obesity. They don’t have the money to afford regular medical checkups so they lack crucial information about their bodies. They develop mental illness because of the personal psychological chaos created by long-term poverty. Some are undereducated because our schools lack appropriate funding and can’t give enough individual attention to at-risk students.

Will universal medical access—and, in particular, the expansion of Medicaid here in Oklahoma—solve all the problems? Of course not, but it’s the crucial starting point in any holistic strategy to improve the quality of life here. It’s much easier to make good choices when you’re healthy and knowledgeable about your body. The bad-choice argument is simply a way to marginalize people and enable conservatives, even many right-wing religious folks, to shrug off their responsibilities in society. Our churches here are filled with people who make pious gestures towards the poor, but in real-life the parishioners are overwhelmingly voting for politicians who simplistically view poverty and illness as choices, not as conditions.