One of the texts from graduate school that I remember most was titled “Who Shall Live?” It was used in a health policy class at NYU and focused on the tough choices in health care. The title struck me because it really described the arbitrary manner in which Americans are afforded health care. That book has been on my mind the last few months as the health care debate has heated up on Capitol Hill and angry confrontations took place at town hall meetings this summer hosted by Members of Congress.

What is clear to me is that Americans want health care so long as they don’t have to pay for it, they are not paying for someone else’s care, and the government keeps its distance. It is the second point that is most disappointing and exposes a degree of selfishness among Americans that belies any sense of national unity. This attitude has infested much of the current debate and reveals how quickly we are ready to jettison our neighbors when it appears self sacrifice is necessary for the national good. True, Americans react during incidents of national emergencies such as Hurricane Katrina and the terrorist attacks on September 11, 2001 but get squeamish when asked to consider the plight of their neighbors in the context of life’s daily struggles. It’s not “one for all and all for one” but “all for me and the hell with anyone else.”

The hysteria we have witnessed over the so-called “public option” is a prime example. The attacks on the President over a possible role for the federal government in universal health care were irrational. Given the numbers of Americans who are uninsured or underinsured, no option should be foreclosed until fully considered and vetted for its potential fiscal impact. The anger is clearly not simply directed toward President Obama but also aimed at the poor, even though some are among the most vocal critics of the President’s plan, and Blacks and Latinos who are seen as non-deserving of government assistance. The criticism is remindful of the “states’ rights” rhetoric associated with the era of Jim Crow and the southern resistance and northern indifference.

This is one debate where Blacks remain silent at our own peril. If there was any population that has been impacted by the dysfunction of our health care system, it’s Black Americans. Across the board we show up in most indices of chronic illness and suffer disproportionately to whites. If it’s not cancer, HIV/AIDS or hypertension; its diabetes, asthma and obesity that is impacting Black mortality. Complicating matters is lack of access to primary care in our communities and overreliance on emergency rooms for routine treatment. Complicating matters is poverty and unemployment, as health insurance is tied to employment and the lack of a job means many Blacks are uninsured. Worse, an uninsured adult means that children are also not covered and therefore not receiving proper preventive medical care.

Despite the obvious statistics that show racial disparities in health care, much of the debate has been centered on the self-centered Americans who, many to their own peril, view a public health care option as some sinister socialist plot. In a country where we pay taxes for universally provided law enforcement, fire safety and secondary education, opposition to government or quasi-government provided health care is hypocritical. While many have attributed the anger we are witnessing during this debate to “fear,” I am inclined to believe that it is really borne from the same cesspool of hate that turns a blind eye to gun violence in the Black community, hunger among children and horrendous housing conditions in our cities.

Now that the Senate Finance Committee has cleared the Baucus bill out of committee, the real battle begins. President Obama is walking a tightrope in his own party, with liberals pushing for the inclusion of a public option in the final package and “Blue Dogs” resisting such calls to please their more conservative constituents. Meanwhile, the Republican Party seems intent on a campaign of confusion to frighten the public into believing a communist takeover is at hand. Worse, responsible individuals within the GOP are allowing the party’s far-right fringe to engage in hate mongering toward this President that calls into question their own patriotism. When the smoke clears we will truly see who best represents the so-called “American values” espoused by the hypocrites who wrap themselves in the flag.

For now, the answer to the question “Who Shall Live?” is being shouted out loud and clear during this debate and it certainly isn’t Black Americans.