And start advocating for what we’ve wanted from the beginning—Single-Payer
In 2009, I started a small group called Fight for Healthcare (now defunct). The purpose of this group was to advocate for what I and many others believed was candidate Obama’s promise to enact a public health care option. As far as we were concerned, the public option, which was popular among three quarters of the population, was as close as the United States was going to get to a universal single-payer health care plan. It was no surprise that single-payer was off the table from the start of the health care debate, but the public option could have been, and should have been the crucial first step toward that end.
As the health care debate wore on, Fight for Healthcare and numerous other groups, organizations and movements ended up on the losing end, despite significant popular support. The public option passed the House, but died under the one-two punch of Ted Kennedy’s deaht and the droop-face opposition of Joseph Lieberman. Lacking movement leadership from the President was no small handicap either. At that point, advocates for the public option had to choose between walking away from the debate entirely or licking our wounds, accepting the political stage of the time and fighting for what was left.
Many of us dedicated ourselves to health care reform for the long haul. We got behind President Obama and the Democrats to defend what became known as Obamacare. We weren’t deluded. We recognized Obamacare for what it was, a colossal letdown representing the collapse of liberal hopes for comprehensive health care reform. At best, it was a sorry half measure that offered some improvements over a hopelessly flawed system, but lost any pretense of reform with the fall of the public option. At worst, it was a betrayal of the liberal Democratic base on the promise of real reform at a time when such reform simply should have happened but for the inexperience of the President and internal subterfuge from more conservative elements of the Democratic Party.
Regardless, folks like me expended considerable energy defending Obamacare. We did so because, as weak as it was, the Affordable Care Act was the only song and dance in town. From the practical, liberal perspective, the Affordable Care Act was a bitter disappointment, but still the only hope to improve the lives of millions of people. It did contain some concessions to the liberal base, such as the end of pre-existing condition exclusions. Indeed, this lackluster piece of legislation was broad enough in scope that, despite its shortfalls, it really did represent an improvement for millions of people.
Many of us also found ourselves defending Obamacare from the legally questionable and politically reprehensible attacks against the bill. Conservative opposition to the law was perfectly understandable. Despite the ACA’s conservative roots, having been formulated by the Heritage Foundation and advanced by the Republican Party in the early nineties, and as the key legislative accomplishment of Massachusetts governor Mitt Romney, the Affordable Care Act had to be opposed by Republicans because…well…because President Obama supported it. Contemporary Republicans are just viscerally incapable of supporting anything in conjunction with this Democratic President and are willing to do anything…anything…to subvert him. Such was the political strategy. Opposition, even senseless opposition, is one thing, but the nature of conservative obstruction was quite another. An honest debate could have advanced the political goals of providing affordable universal health care and preserving free market principles in the medical field. An honest debate, however, was not what we had. Instead, health care advocates found themselves fending off a relentless attack of right wing wraiths spreading balderdash about the nature of the bill, most notoriously represented by the so-called “death panels” nonsense that became an integral part of the debate. The flagrant dishonesty of the opposition became the focus of liberal defense right up to the final passage of the law.
Then the political maneuvering took on a different aspect. Conservatives were at their most innovative in finding ways to forestall, underfund, undercut and eviscerate the Affordable Care Act, even denying funds to help get the Federal exchange running. Texas governor Rick Perry threatened to secede from the Union, because that worked so well the last time. Red states refused to participate in creating exchanges. With a nod from the Supreme Court, these same states often refused to expand Medicaid, thus creating a health care lapse for those whose incomes are not high enough to participate in the exchanges, but not low enough to qualify for Medicaid. The ultimate tactic, however, was the political hostage taking in the form of Debt Ceiling Blackmail. Conservatives even shut down the government for weeks in a last breath attempt to overturn Obamacare.
Through it all, we were there, writing letters, making phone calls, supporting legislators, trying to inform the public. We, as liberals, fought as hard as we could for a piece of legislation that we never really liked. With the expense of such energy, many of us became invested in the Affordable Care Act in spite of ourselves. Our hearts sank when the Obama Administration flubbed the roll out. Many of us continued to advocate for the ACA, pointing out that a computer glitch should not be a condemnation of the law itself.
In this last matter, I was silent, however. Part of this was just fatigue. After so much time and energy put into defending what, to me, was a letdown, the least the Administration could have done was ensure a successful rollout!
More importantly, however, I knew that as of October 1st, the Affordable Care Act would rise or fall based on its own merits. I am tech savvy enough to know that computer glitches are short term problems. Once effective programming was written, everything else would fall into place. Indeed, it appears that that is happening. Opposition to Obamacare is now nothing more than political rhetoric. The Affordable Care Act is here to stay. By the time conservative Republicans are in a position to overturn Obamacare, too many people will rely on it, and will see that it is not the Obamageddon that it was made out to be. For what it’s worth, health care advocates have their victory.
But it’s not the victory that we wanted. As many advocates point out, the problems associated with Obamacare and the convoluted, Rube Goldberg nature of the legislation, would not be an issue had we simply switched to a single payer system. Had we just eliminated the sixty-five and over requirement for Medicare coverage, we would have a universal health care system under a popular single-payer. Yes, taxes would go up. The increase in taxes, as revealed by health care systems throughout the world, however, would have been more than compensated by the elimination of premiums and co-insurance payments that continue to plague us. So long as a mostly private system of health care access exists in a nation with an aging population, health care costs will continue to increase, albeit slower under Obamacare. Despite the Affordable Care Act, the United States remains in desperate need of health care reform. A single-payer system would put us in line with the rest of the world.
Now that Obamacare is established, it is time for liberals to stop defending it. If Obamacare is going to fail, let’s let it fail and gird ourselves for the next fight by educating people on the benefits of a single payer system. If Obamacare is, for the most part, going to work, which appears to be the case, let’s continue to educate the public about single-payer systems because such reform is the next logical step in this evolution.
This debate is not lost with the rise of Obamacare. It is only beginning. Now that the rhetorical sparring has stopped and the resulting anger and fear has subsided, a rational discussion can be had. I was just involved in a conversation with a man who was angry with liberals for forcing the Affordable Care Act “down my throat.” When I explained to him what liberals really wanted, a single-payer system, and explained it in terms of expanding Medicare, he crossed his arms and looked at me quizzically and said, “Well, why didn’t we do that, then? That makes a hell of a lot more sense than Obamacare.” He was right. That’s the reform we should have had, but this sensible message got lost in the rhetorical fight over the Affordable Care Act and associations with creeping socialism. Now that the craziness is done, maybe we can have a real debate.
It’s time to move on from Obamacare!
Just Hit the Genetic Lottery!
And Soon the Conservative Propaganda Machine Will be Revealed for What it Is
We just received our first Obamacare notices at the school where I teach. One memo informed me that current policies offered by my employer already meet and exceed the ACA requirements and the other filled me in on the health care Marketplace. In reading these memos, I couldn’t help but wonder how some of my Tea Party friends would respond to this information. There was no mention of a government run health plan that our Congressmen and President refuse to participate in (um…they already have a government run health plan). There was no mention of death panels. Nothing to indicate that we could not choose our own doctors. Indeed, the memos read just like, well, memos. They were totally innocuous.
Yet the right is desperate to kill Obamacare, willing to do anything, including defaulting on our debt obligations, to make sure that it never gets off the ground. This desperation is exemplified by Ted Cruz’s full throttled, ego-stroking, pseudo-filibuster in which he compared letting the Affordable Care Act stand to appeasing Hitler. (Yes, he went full Godwin’s Law). You know, Ted, I looked all through my memos and couldn’t find a single thing about invading Poland or blaming the Treaty of Versailles for our exorbitant health care costs.
That’s just the point, of course. Soon the whole country will start getting memos like the ones my colleagues and I received. Soon, people all over the country will visit HealthCare.gov or state supported exchanges and the truth will be revealed. Premiums will not skyrocket. The government will not intervene in individual health concerns. Yes, they will almost certainly experience setbacks, bureaucratic red tape, snags and glitches, and policies they don’t care for. Indeed, many will bristle at the fact that they were mandated to purchase insurance; who wants to be mandated to do anything? People may not be ecstatic about what they see, after all, buying insurance is never a fulfilling experience, but they will certainly stop being afraid. Once the fear is gone, the right has nothing.
So, in a way, the efforts of Ted Cruz and his FreedomWorks, Tea Party, Koch addicted minions isn’t so much about killing the Affordable Care Act beast before it hatches as it is a desperate attempt to keep the fear alive. If it turns out Obamacare isn’t the dystopian nightmare predicted by the right, then what about all the other apocalyptic signs prognosticated by the neo-cons?
Maybe, just maybe, Weimar level inflation isn’t going to happen as a result of the Stimulus.
Maybe Mexicans aren’t re-invading the United States.
Maybe all Arabs or Arabish people aren’t terrorists out to destroy America.
Maybe there isn’t a secret cabal of neo-fascist, socialist environmentalists allied with every scientist on Earth to trick us into believing in global warming so they can somehow, mysteriously institute their New World Order.
Maybe Obama really isn’t a Marxist Muslim radical. He may even be American.
Maybe there really isn’t a war on Christmas.
I realize that my comments above are snide. Intentionally so. My active involvement in the healthcare debate of 2009-2010 was an eye-opener in the nature of conservative paradigms. Before the healthcare debate I was naïve. I believed that the differences between the right and the left were sincere variations on how we understood the world and the nature of government. Perhaps, occasionally, the rhetoric got out of control. Certainly each side used slanted data and slippery slope arguments to advance their worldview. I saw the debate as an over-all honest competition of paradigms in which the truth would, ultimately, win out.
Then the health-care debate.
As an active participant in the health-care debate I had the good fortune of not being an expert in health policy or insurance. I only knew that my insurance was becoming more and more expensive and offering fewer and fewer benefits. Something had to be done. My research led me to understand that a market model was not an effective means of providing health care to everyone in society. It was my belief that access to health care was a right that could not be understood as a commodity. After all, it is in the market interest of the insurer to not pay for services, yet the interest of the provider to charge as much as was possible for services, while the beneficiary wanted only to stay healthy and could be coerced into paying just about any price. The exchange was too complex and lopsided for a market system. My research indicated that a single payer model was the most optimal. Granted, I knew it wasn’t a flawless model, but it was certainly an improvement over what we had. So when President Obama ran with the public option as the centerpiece of his health care reform, a claim which he has since denied, I was on board. Implementing a single payer system would have been impossible in that political climate, and would perhaps even be detrimentally destabilizing if done too quickly. A public option, however, would allow for a slow transition to a single payer system. In that vein I started an ad hoc group called Fight for Healthcare.
Clearly, we lost.
During this time, however, I was witness to the worst abuses against the rational discourse I had ever seen. Previously I’d been involved in the peace movement and human rights. Yes, people disagreed with my approach if not my vision, but the rhetorical combat over health care was unique to my experience. In arguments over war and peace it is not unusual to hear arguments about an evil enemy constituting a danger to our freedom and way of life if we do not drop lots of bombs on them. Yet in the healthcare debate, the enemy became those of us suggesting that health care was a common good of which our public institutions have a vested interest in securing. We were the enemies of freedom and the right came out swinging. I was willing to accept that I may have been wrong about a single payer system, but I was reasonably sure I wasn’t an enemy of freedom. The debate…well, there was no debate. There was only a rhetorical onslaught of utter nonsense from which we on the left could not recover.
I must admit that we on the left spent most of our time on the ropes deflecting a barrage of blows well aimed at our most sensitive areas. Instead of getting out in front of the debate and defining the paradigms, we found ourselves trying to explain to people that there were no death panels, that this was not a government take-over of our health system, that our rights were not being taken away. Rhetorically, whenever one finds himself explaining what his argument is not, he has lost the debate. The right used every fear held by Americans, whether it was valid or not, to defeat the Affordable Care Act. During the summer recess, conservative groups sent out directives for conservatives to disrupt town halls with false accusations and to shout down any attempt at reasonable discussion. Neo-con superstars were given prime-time slots in which to spew fantasies of government bureaucracies pulling the plug on grandma and forced abortions and access to health care based on political affiliation. They insisted that any attempt to get health care costs under control was the cradle of tyranny. And rational discussion was futile, as their claims were irrational.
Ultimately, conservatives defeated the public option and managed to get the biggest part of the Republican health care proposal of 1993 passed. You’d think they’d be happy. If it was about promoting policy, conservatives would have been happy, but that’s not the game. It was during the lashing we received in the health care debate that I realized that conservatism isn’t a philosophy. It is a strategy. Policies are irrelevant. Conservatism is about tactics. The primary weapon of the right is fear.
This is a power game in which conservatives use fear to cultivate their base and to vilify the opposition. The health care debate of Obama’s early administration was just one example this. As I re-examine the history of conservatism I see that fear is the only real tool the right has to perpetuate itself. To be fair, the conservative base, like the liberal base, is mostly sincere about their beliefs. Like liberals, conservative beliefs are cultivated by reference groups that shape the stories and paradigms told and thus reify a largely unitary worldview. All reference groups do this. This is where the equivalence ends, however. Yes, I will admit that groups like the Center for American Progress is, largely, an apologist propaganda group for the Democratic Party and that they often present skewed data and emotional claims to make their case. However, they don’t typically present information that is clearly not true and fear is not a central theme of its work. There is no central, liberal institution so dedicated to misinformation and fear-mongering as one sees on the right.
Conservative think tanks (or should I say fear tanks) use what may be a natural fear of change, or an innate and cultivated fear of the other, immigrants, commies, terrorists, to perpetuate elite interests. This is almost reactionary. For decades, a socially entrenched fear of communism was the cudgel of right wing attack. Anyone suggesting that the government do something to help marginalized people immediately faced accusations of “socialist” “communist” “Marxist”. This continues. Even before President Obama was able to accomplish anything in his administration he was targeted by the right as an outsider, foreigner, radical. Contemporary uncertainty about the economy inspires conservatives to link any reforms to economic catastrophe—Stimulus will create Weimar level inflation, the Dodd-Frank act will destroy the economy, Obamacare will cause another recession. Be afraid of terrorists. Be afraid of gays destroying your marriage and converting your children. Be afraid of Mexicans taking your job. Fear is always the central theme. Facts are rarely ever offered unless they affirm professed fears. All they have is fear.
This fear-mongering is evident in the notorious anti-Obamacare ad recently released. The ad links “signing on to Obamacare” with the rape a young girl at her most vulnerable. No factual claims are presented. Indeed, the ad begins with a lie that this girl “signed on to Obamacare.” She would have signed on to a private insurer through a marketplace exchange. Facts are irrelevant. The rape imagery is the conservative money-shot. Conservatives don’t want you to know anything. They want you to fear. They don’t want you to think, because even the slightest amount of thought will reveal them for what they are—frauds. They want you to react. Imagery is everything. Substance is irrelevant.
The data does not matter. I’m a huge fan of New York Times columnist Paul Krugman, but he cannot fathom why conservatives seem immune to factual evidence. Of course he can’t. His life is guided by data and reliable models. Nothing can be further from the conservative mindset. Simply put, factual evidence is the one thing that mitigates senseless fear. Since fear is the fuel of conservatism, factual evidence is verboten. It’s not that conservatives don’t know or understand the facts. It’s that the facts get in the way of the conservative agenda, which coincides with elite interests.
That’s what makes the fulfillment of Obamacare so dangerous to conservatives. The Affordable Care Act itself is not necessarily dangerous to elite interests. After all, the Affordable Care Act created a mandated market for insurance tycoons. Rather, Obamacare can become the peak behind the curtain revealing the true, anemic nature of conservative power.
That’s why Obamacare must be killed at all costs.
But it won’t be. Soon the fraud will be revealed.
Now the conservatives should not worry about losing their base. Those who mindlessly absorb their daily sermons from FoxNoise or WorldNut Daily are unlikely to leave the fold. They will not be turned by any evidence because, after all, anything that contradicts FoxNoise is nothing more than left wing propaganda.
However, the right wing reference groups, like Heritage, and FoxNoise, et. al. will certainly be working overtime to conjure some fearsome phantom aimed at convincing people that the sky really is falling, or to distract them with some other ghoul until they forget about all that silly death panel stuff.
A Sigh of Relief is Appropriate, but a Victory Lap is Premature
Figure 1: Click the Image to Watch the Video
I will admit that I am breathing a sigh of relief that the Supreme Court upheld Affordable Care Act (ACA) as constitutional. Readers of this site know that I was not optimistic about that outcome. Perhaps, as David Corn observed, the Supreme Court is not immune to public outrage. Perhaps the decision was a masterful political move on the part of Justice Roberts. Then again, Roberts could be simply upholding his status as the most corporate friendly justice in memory by maintaining what is, in essence, a multi-billion dollar boondoggle to the insurance industry. Regardless, health reform has survived three branches of government and the twisted process of checks and balances that are the result of contemporary, schizophrenic politics. Overall, that is a good thing, and something to be relieved about.
Our relief, however, should not blind us to the realities that the ACA is, at best, a second rate reform. Many of the elements of reform are no more than minor tweaks for equalizing an inherently unbalanced system. These tweaks are popular, but with our current system, they are sustainable only with the implementation of a grossly unpopular individual mandate. Thus, the ACA upholds and even reinforces the current system, which most Americans feel is inadequate. Despite the benefits of not having to worry about being dropped from your plan once you are sick, or denied coverage because of a pre-existing condition, will the ACA improve the quality of care in the United States, and make health care access more affordable? The jury is still out. The best we can say is that Massachusetts, the model for the individual mandate, indicates that there could be some benefits.
We should not lose sight of the fact that though the ACA may be the best we can do at this point, it simply isn’t good enough in the long run. The Journal of a Mad Sociologist has always advocated for the development of robust public option, leading ultimately to Medicare for all. We were almost there. The fight for an affordable public option should not be punctuated by the political maneuverings of Joseph Lieberman. Nor should our relief over the ACA decision cap the goals of health care reform. Obama became president, in part, because of his commitment to this next stage of health care reform. A public option remains popular.
The Affordable Care Act may be a step in the right direction, but it is only a step. There’s a lot of work that needs to be done. It’s time to reject a commodity paradigm and recognize access to healthcare as a universal right. Obamacare, regardless of its benefits, does not address this.
A couple of days ago, Michigan State Representative Lisa Brown had the audacity to use the “V” word during a debate on a topic involving
”V’s”! She wasn’t being politically correct, she was being anatomically correct!
As it stands, the vagina is the only human body part that so-called small government conservatives demand to regulate. In Brown’s words, “These lawmakers predominantly men have no problem passing laws about my vagina. But when I dared mention its name, they became outraged.”
Forward this post to Michigan House Speaker Jase Bolger and floor lead Jim Stamas and maybe they will become comfortable with a real, uncensored discussion of women’s health issues.
Click Here for contact information of the Michigan House of Representatives.
Preparing for the Worst
If I were President Obama, or the head his re-election campaign, I might, in a purely strategic and cynical way, hope that the Supreme Court does, indeed, strike down the Affordable Care Act.¹
I say this on the premise that an old adage is true, that people do not appreciate what they have until it is gone. As it stands, millions of people currently benefit from the ACA, though they don’t necessarily realize it. According to the Kaiser Family Foundation study (Linked in the first graph), 59% of respondents admit that they do not know enough about the ACA. Between 49% and 65% of respondents do not recognize key provisions of the law. In fact, 14% believe that the Supreme Court has already struck the law down!
However, once they start losing their subsidies, and preventive service, once their adult children are kicked off of their insurance, or they are denied payment due to pre-existing conditions, people will better understand their benefits under the ACA.
The right wing propaganda machine has effectively destroyed the legitimacy of the ACA in the eyes of the public. That’s not hard to do when a majority of people do not know what’s in the law. It’s also easy to do when health care advocates, like myself, are disappointed by the anemic outcome of what could have been a true reform, the passing of a moderate conservative idea. Such activists find it difficult to cultivate the necessary zeal to defend the law against extremely zealous attacks.
Despite general disapproval of the law, however, people largely approve of the actual provisions of the lawby overwhelming margins. Outside of the individual mandate, the specific elements of the ACA are very popular. Let’s face it, who like’s any “mandate”? However, if the more popular provisions of the ACA are to be sustained, the individual mandate is necessary. I don’t like it any more than anyone else, but it is the truth. Insurance companies cannot be required to sell insurance, a provision that 69% of respondents approved of, if people can simply wait until they are diagnosed to purchase insurance.
So if the ACA is struck down, that provides the Obama campaign a Marc Antony type opportunity to soliloquize over the bloody corpse of the ACA.
Conservatives are honorable people, and they say the ACA is evil. They must be right
but here is Mrs. Smith who was able to provide health care for her daughter who is just starting out in her career. Now here daughter must purchase her own insurance, without help, because her entry level position does not pay enough to secure those benefits.
But conservatives are honorable people, and they say the ACA is tyrannical. They must be right
but here is Mr. Jones, whose cancer was in remission because he was able to get care despite his pre-existing condition. Now his cancer has come back because he can no longer afford the treatments.
But conservatives are honorable people
Few are satisfied with the American health care system. Sixty percent of respondents say that they would expect lawmakers to develop alternative health care reforms if ACA is struck down. More people would prefer the ACA to be expanded or kept as is over replacing it with a Republican proposal (ironic, since the individual mandate was a Republican proposal) or simply letting it go. Americans want health care reform. The elimination of health care reform, if the Obama administration can inform Americans of what they have lost, can be a rallying cry for even more viable reforms.
Unfortunately, in our musings about political strategy, we must not lose sight of the fact that loss of the ACA, as inadequate as many of us believe it is, would inflict a devastating blow against the uninsured. Mr. Jones above may make for effective political theater, but he still has cancer and will, most likely, die.
The greatest failure of Democrats and the Obama Administration is in allowing the right wing fringe to “educate” the public on the value of the ACA. Now the health of millions of Americans is speculatively in the hands of Justice Anthony Kennedy. Health care activists and the Democratic Party, at this depressing stage, have little else to do but hope for the best and prepare for the worst, hence this rather cynical post.
¹I am neither of those, so I am not so hoping.
Hope for the Best
Expect the Worst
We know the Affordable Care Act is constitutional. We don’t need the Supreme Court to tell us this. One could use the Elastic Clause and explain that the individual mandate is necessary and proper in today’s health care market, a market the likes of which was inconceivable to the Founding Fathers. Or there’s the Interstate Commerce Clause which is obviously applicable. After all, if I have health insurance in Florida and get sick in Georgia I use the same insurance, and if I don’t have insurance, then the people of Georgia pay with higher premiums. That this is even being heard by the Supreme Court indicates that the gig is up for Obama’s signature piece of legislation.¹
My prediction is that the corporate patsies on the Supreme Court will strike down the individual mandate, and thereby cripple the law. They will do so because that is what they are there to do, to destroy any attempt to create a level, working playing field for average Americanseven admittedly flawed attempts. As indicated by the Citizen’s United Decision, this is a mission that they take seriously.
Citizen’s United offers a glimpse into the future. Not only will the Supreme Court shoot down the individual mandate, but they will take the extraordinary leap of nullifying the Affordable Care Act in toto. Remember, Citizens United could have been decided in narrow terms, specifying that the specific documentary about Hillary Clinton did not constitute a campaign piece, therefore it’s release was not a violation of McCain-Feingold. But SCOTUS didn’t do that. They decided on the broader issue on the constitutionality of another perfectly constitutional piece of legislationagain, flawed.
How will they justify themselves? Think about the case of Summum vs. Pleasant Grove. In this case the Supreme Court ruled, on supposed constitutional grounds, that the city of Pleasant Grove could refuse to install a monument from the Summum Church in a public park despite allowing other groups to install their monuments, including a statue of the Ten Commandments. The court ruled against Summum, unanimously I might add, on the grounds that the decision to allow memorials from some contributors, but not others, in a public space is an exercise of government free speech. Government free speech? Where in the Constitution does it say that a government has rights? Isn’t the government supposed to speak for all of the people? The Constitution does say a little something about equal protection under the law, but the Supreme Court sees no need to reference actual tenets of the Constitution when they can just make up their own off the top of their heads.
That this decisions was unanimous is not a good sign. It indicates that the so called “liberal” justices are not beneath a wink and a nod to the conservative agenda.
In fact, since I’m just going with the worst case scenario, I’ll even go so far as to say that the decision will be unanimous.
Good-bye ACA. We hardly knew ye
¹It’s no secret to my readers that I was not a supporter of the individual mandate and was bitterly disappointed in the Affordable Care Act.
So I decided to take this map of US counties experiencing DECREASING life expectancies
And overlay it with this map of Red and Blue states from 2010
I got this
I then did the same thing with this map of red and blue counties as of 2008. I couldn’t find one for 2010.
I got this. The dark blue areas are predominantly Democratic counties experiencing decreasing life expectancies. The dark red areas are the predominantly Republican counties experiencing the same decrease.
The fact that anywhere in the United States is experiencing decreased life expectancy should be a national disgrace. There’s more going on here than clear party lines, but the testimony of these graphs is clear.
“Budget Hawk” Republicans Will Raise the Deficit by Cutting Taxes and Repealing Health Care Reform
The new Republican House of Representatives is opened for business, and I do mean business.
Of course, we could start with the new rules imposed by the Republican majority. They’re starting off with their sincere pledge to reign in the deficit. Well, “reign” might not be exactly the word. How about reign in stuff the other guy wants to add to the deficit, not the Republican stuff. So the Republicans vote in rules that require any spending increase to be offset by cuts elsewhere. Cuts specifically. This is not pay-go. The new rules do not allow the House to raise revenue to offset spending. Only cuts will do for every spending increase.
Well, not every spending increase. Spending increases as a result of tax cuts is exempt. Imagine that. The costs associated with repealing “Obamacare” are also exempt.
Wait! I thought the Republican argument was that Obamacare was too expensive, that we had to repeal it to save the budget. If that is true why did they make it a point to exempt the “costs” of repeal? They did it because they know that they are scamming the American people.
Today, the Congressional Budget Office sent a letter to Speaker John Boehner with preliminary estimates¹ on the costs of repealing “Obamacare.” According to the CBO, “H.R. 2 would probably increase federal budget deficits over the 20122019 period by a total of roughly $145 billion.” Of course, Boehner must have suspected as much.
What’s more, the CBO estimates that H.R. 2 will leave 52 million Americans uninsured. But, hey! We have to tighten our belts. It’s all about austerity. Now let’s pass some tax breaks for the wealthy.
The CBO does estimate that premiums under H.R. 2 would be slightly lower than under Obamacare, but these costs would be offset by overall increases in the costs of health-care and the elimination of subsidies provided in the insurance exchanges that would disappear under Boehner’s beloved legislation. And if you happen to work for a large company, the CBO predicts that your premiums will go up.
So there we have it. The rules are rigged so that working people will get no help, at least not without losing help in another area. In the meantime, Republicans will raise the deficit with their ideological tunnel vision. Cut taxes and repeal Obamacare is the Republican mantra. A mantra that will cost us.
- Estimates in the CBO letter are general estimates as the CBO has not completed its full analysis. The figures will, most certainly, vary from those given here in the final analysis.
In his history defining and seminal work, Democracy in America, Alexis de Tocqueville explored the ins and outs of early nineteenth century American democracy. Of de Tocqueville’s concerns about American governance the most famous was a critique that has become known as the Tyranny of the Majority. According to Tocqueville, the majority in America is “omnipotent.” This omnipotence ultimately translates into oppression over the rights of the minority, blindness to ancilary issues not within the aegis of the majority and legislative instability. “Hence the majority in the United States enjoys immense actual power together with a power of opinion that is almost as great.”
De Tocqeville’s criticisms of American democracy are valid. Democracy in America should be required reading for all Americans. Most especially to one who studies the sociology of knowledge is the nineteenth century philosopher’s unwitting nod to postmodernism when he suggests that the tyranny of the majority can be even more oppressive than any monarchy by virtue of its ability to define the very ideas of the citizens.
“The most absolute sovereigns in Europe today are powerless to prevent certain thoughts hostile to their authority from silently circulating through their states and even within their courts. The same cannot be said of America: As long as the majority remains in doubt, people talk, but as soon as it makes up its mind once and for all, everyone falls silent…I know of no country where there is in general less independence of mind and true freedom of discussion than in America.”
In going back to the well thumbed pages of my volume of Democracy in America I am still humbled by de Tocqueville’s analysis. It’s no wonder that sociologists claim his as one of our own. However, I’m left to wonder just how de Tocqueville would analyze our current debate on health care reform.
No doubt de Toqueville would be confused. Throughout the health care debate poll after poll demonstrates that majority opinion supports the foundation of a public option to control costs by providing an alternative to private insurance. This, despite the negative PR blitz of this last summer and the veracity of a Tea Party movement venomously against health care reform or the prospect of even the slightest government interference in the free market. If ever a majority had made up its mind it is with regard to the public option.
Yet the fate of the public option is in peril? How could that be? How could de Tocqueville’s famous analysis be so far off in this (and many other matters, but that’s a different blog)?
Of course, we can’t be too hard on a nineteenth century social commentator. How could he have ever predicted the rise of what I now call Pathological Liebermanism or The Tyranny of the Lieberman. This is a phenomenon in which the processes of American democracy invests disproportionate power into the hands of one elected official (in this case “Droopy” Joe Lieberman, but also Ben Nelson). The majority of Americans support the public option. The majority of legislators support the public option. But majorities are not good enough. Individuals like Lieberman and Nelson can bring the “omnipotence of the majority” to flaccid humility.
We must remember that our founders and their immediate heirs had very little regard for the will of the majority. They established norms through which they could thwart “mob rule” in the chambers of congress. Among those rules was the filibuster. And the filibuster has become the weapon of choice for minority political parties. Now, to be honest, I’ve supported the filibuster when it was being used to protect the Arctic National Wildlife Reserve. On the other hand, the filibuster was also used to delay crucial civil rights legislation. It seems that we have a love/hate relationship with this particular Senate rule. In matters of health reform including a public option, an issue which I support, it is maddening to think that one senator, a Lieberaman or a Nelson, can stall the will of the majority of Americans.
It is equally maddening that such senators can, in essence, put their filibuster busting potential on the sale block. In Nelson’s case it was an agreement that the federal government would pick up the tab of health care reform for the citizens of Nebraska…and only Nebraska. Why should the people of Nebraska benefit at the expense of the rest of Americans who would have to pay more to make up for the absence of that state? Because Ben Nelson won’t shut up? In Lieberman’s case it was the elimination of popular reforms, the public option and the expansion of Medicare. Why should Lieberman, a man who himself enjoys the benefits of a single payer, government run health program, be able to deny the same for the rest of us all by himself?
Indeed, de Tocqueville would be obliged to add a chapter or at least a long addendum to his master work to address the Lieberman Syndrome (another cool name for what we are witnessing).
De Tocqueville was also not privy to the idea of modern lobbying and money politics. In almost every case the politician with the largest campaign coffers wins. De Tocqueville’s assertion that our legislators change rapidly, leading to instability in our houses of government has turned out to be false. Indeed, the majority of seats in congress are considered “safe” seats in which the sitting representative will almost certainly be re-elected. This fact, however, rather than stabilizing our legislature as one might predict using de Tocqueville’s reasoning, has lead to an entrenchment of ideas and ultimately to an institutional polarity that one might suggest is even more destabilizing in effect.
This polarity is linked to campaign contributions. Think about it. A two party system is much easier and cheaper to fund than one in which multiple parties and ideas are competing for recognition. As it stands, most corporations hedge their bets by donating large sums of money to both parties. Imagine if there were three or four or even five parties demanding such control!
The polarity between liberal and conservative is also fed by campaign contributors. In the health care debate The Center for Responsive Politics has done interesting research on campaign contributions and position in health care reform. They created a ratio between contributions from labor organizations and contributions from health care corporations and compared this ratio to the voting records of our senators. Those senators with higher ratios, thus higher comparable contributions from labor, were more likely to vote yes to the Senate bill. Of course, they were also more likely to be Democrat, indicating a traditional tendency for labor unions to contribute to this party. Those who voted against the bill were more likely to have received larger contributions from the health industry. It is important to understand, however, both health and labor organizations are sure to hedge their bets by contributing large sums to both parties. It is also paramount that the money does not necessarily represent a “majority” view. (1)
When it comes to money and health care those who are least satisfied with the status quo are almost certainly the least likely to contribute large sums to politicians. Labor organizations such as unions may have larger coffers to represent the interests of working people, but this is only a segment of the population so affected. Obviously the tyranny of the majority is not driving this debate, nor is the majority in any way “omnipotent” in the de Tocquevillian understanding of the term.
The health care debate might help us define American politics in a post de Tocquevillian way. It is the Lieberman Doctrine (Yes, coining terms is my new hobby!) that seems to be the new “omnipotent tyranny” influencing contemporary American democracy.
Now this post is not a condemnation of the filibuster, nor is it a confirmation of the legitimacy of majority rule. In this matter I happen to have the comfort of speaking with the majority. That is not always the case. When I do represent the minority opinion I want to have processes in place, like the filibuster, to protect my interests. I also recognize the reality that the majority is not always right. But certainly these ideas must be revisited.
It is the contention of the Journal of a Mad Sociologist that any great disparity in power, regardless of the holder[s] of such power, is a danger to democracy and humanity. The concentration of power in the hands of the majority has the potential to be just as oppressive as the concentration of power in the hands of Joe Lieberman. Neither should have the power to over-ride what this outlet has defined as a human right, the right to health care.
(1) In most cases this moneyed politics tends to limit the differences between parties. In health care, however, polarization is the result as a conflict between funding sources emerges to define the debate.
Above is Howard Dean on the Rachel Maddow show defending the Senate Health Reform bill he early suggested killing.
(Click the logo above for a PDF version of this blog)
Theres a fundamental argument in the health care debate that has yet to be truly elaborated. The central question is, does our society recognize access to health care as a right or as a privilege? That this question has not been explicitly defined is intriguing as it could very well change the direction of the discourse into a more humanistic direction. That might be the very reason for not framing the health care debate in such a way. After all, rights are very popular, but frowned upon by the power elite as being an undue burden in their quest for a wider profit margin.
As it stands, it looks as though the meritocratic bias of our society predefines access to health care as a privilege. One of my students, echoing the capitalist paradigm, defined health care as a commodity. Like all commodities, health care is subject to supply and demand curves and scarcity. Indeed, this is a strong argument from the perspective of those providing health care and health insurance while trying to secure a profit for themselves and their shareholders. After all, sick people are expensive.
That health care is a commodity is a great descriptor of our current situation. In a health care market the goal is to maximize profits. This is done by cutting the costs of health care providers while at the same time steering health care consumers to the most expensive products. So the people who really need health insurance are more likely to be dropped, denied or subject to exorbitant costs. Those who can afford access to health care are often subject to the most expensive procedures, such as surgery over therapy. This leaves millions of Americans who can only access health services in the emergency room, publicly funded clinics or the extraordinary efforts of charitable organizations. In these instances the costs are passed on to consumers.
If health care is framed as a basic human right, however, then profit motive must take a back seat to universal access, as making the claim that some people have more rights than others is culturally awkward. It is also subject to a different social process, as rights are socially and historically contingent. The founding fathers had no need to elaborate a right to health care. For them, access to health care was almost universal, and quality of care was comparably equitable regardless of class. Its likely that the health care that George Washington received was not much better than that received by anyone else.
But that was before the advent of modern medicine. The medical field has since evolved from an exercise of natural philosophy to a specialized profession of scientific and technological innovation. The miracle of modern medicine has improved the quality of life, but has also contributed increased costs of care. The resulting health care industry can be described as a typology along a horizontal axis of cost and a vertical axis of quality. In such a system some are bound to be left out while others will be privileged.
For a long time this typology was not so pronounced as to inspire the scrutiny of society as a whole. The miracle of modern medicine allowed more people to survive infancy and live into old age. We have since taken it for granted that our children will survive and that we will grow old. However, the cost of this historical revolution is the shift in medical needs from the treatment of infectious disease and injury to the much more expensive chronic diseases that correlate to old age and the limits of medical science.
Large corporations developed to fill the market demand for medical access. These corporations were not motivated by the desire to do well by their fellow man, but rather to turn a profit. In an exercise of free market principles at their best, health insurance companies thrived by guaranteeing access to care for a price. Meanwhile, public clinics and government programs such as Medicare and Medicaid picked up most of the slack among unmarketable old and poor people. This system lasted long enough for insurance companies to become entrenched stakeholders in the medical system, earning them a place at the discussion table for a crisis in which they themselves are complicit.
Now we face a culmination of these dynamics. As usual, the realities do not break down along clear lines of right and wrong. Most people would agree to the simple statement that everyone (except illegal immigrants, but thats another essay) deserves access to health care. The question becomes more complicated when we add factors such as how much access and to which technologiesand who pays for it, the consumer or the tax payer? The fact that there exists an established institutional framework and its requisite capitalist paradigms that wields significant wealth and power is yet another obstacle to meaningful reform and a discursive restraint on radical debate.
Privelege vs. Right
The claim that health care is a commodity is a paradigm of privilege that denies the concept of an individual right to health care. After all, individual rights are not for sale. This constraint predetermines the direction of the debate and ultimately the outcome of reform.
A privilege is, by definition, something that is bestowed upon individuals through some social process. The sociology of privilege is based either on merit or inheritance and is a defining feature of status. Achieved status, or status based on presumed merit, is the default discursive formation in American society. Being of high status is assumed to be based on some individual quality, work ethic, drive or competence. Therefore, any privileges corresponding to status is deserved. Those who do not have such privileges may be offered some charitable entitlement, or they may simply be written off as undeserving.
Yet status is also ascribed, or inherited based on factors such as the socio-economic position of ones parents, ones race or gender, ones biological contingencies or limitations. Being born without a congenital health defect privileges one to easier access to health care just as being born to wealthy parents does.
Rights, on the other hand, are much trickier matters. By virtue of Americas cultural canon, such as the Declaration of Independence, the Federalist Papers and the Constitution human rights are inherent just by virtue of being American (or as some might suggest, human). As such, human rights cannot be denied an individual based on status without some established and limited system of due process.
In the United States the claim to rights is easy to postulate when those rights can be identified in personal terms. The right of the individual to speak or to worship, or even to gather with other individuals is easily defensible. Such rights do not require an investment on the part of others for exercise. The right to free speech does not have attached to it a corresponding right to be listened to, in other words.
Other rights, however, require a commitment on the part of others if the individual is to exercise them. The right to due process including a jury of ones peers, for instance, requires others to take on the responsibility of serving for jury duty. The right to privacy infers a responsibility to keep out of other peoples affairs. A more abstract right that most of us would recognize is the right to an education. But in order to exercise that right a sacrifice (one might argue a responsibility) must be made on the part of the community in the form of taxes, land acquisition and the childs time spent away from parents and out of the marketplace. Such rights, however, often come with a certain amount of contention as we debate just how much the community is to sacrifice as compared to what the community can expect to get in return.
Thomas Jefferson did us no favors in defining these inalienable rights so eloquently as life, liberty and the pursuit of happiness. All three such rights require some expense on the part of the community if they are to be manifest in the individual. For instance, it could be argued that one must have access to meaningful work at a living wage to enjoy life, real freedom and the opportunity to happiness. However, what is the responsibility of the community, of the society, of government, in assuring such access?
Health care fits nicely into this paradigm. Inequalities in access to health care certainly correlate to inequalities in life expectations, the liberty that comes with good health and unfettered ability to pursue ones own ends. Those with enough resources have a privileged advantage to these rights. However, rights should not be subject to ones socio-economic status. Rights are inherent in the individual, not in their social position.
Toward a Right of Health Care
Health care was not an issue for our founding fathers. Before the advent of a germ theory there was not much polarity in access to this right as there was for other matters addressed by the founders, such as speech, assembly, privacy. Consequently, health care is not neatly defined in our 220 year old Constitution. The founders recognized, however, that as times change so does our concept of rights. Thats why our Bill of Rights included the 9th Amendment, which ensured that the rights listed in the Constitution are not the beginning or the end of the story?
Since the advent of modern medicine, contemporary statesmen have come to recognize the importance of health care to the satisfaction of individual rights. Many governments and charters formally recognize access to health care as a human right. Not the least of these charters is the Universal Declaration of Human Rights, Article 25. As a signatory to the UN Charter the United States is bound by our own Constitution to recognize the right to health care.
Yet this does not stop others, like Theodore Dalrymple, to suggest that there is no such right. In his Wall Street Journal editorial Dalrymple, a pseudonym for British physician Dr. Anthony Daniels, states:
Whenever I deny the existence of a right to health care to a Briton who asserts it, he replies, So
you think it is all right for people to be left to die in the street? When I then ask my interlocutor whether he can think of any reason why people should not be left to die in the street, other than that they have a right to health care, he is generally reduced to silence. He cannot think of one.
I have one! How about the Hippocratic Oath: I will treat without exception all who seek my ministrations. Or how about this version of the Oath, I will remember that I remain a member of society, with special obligations to all my fell human beings Shouldnt we expect a physician to accept an oath taken in their profession as binding? Perhaps Im asking too much from Dr. Daniels.
How about the story of the Good Samaritan? Well, Im sure Dr. Daniels doesnt wear a WWJD bracelet.
How about the fact that it is universally, morally repugnant to allow the sick to suffer and die without giving whatever succor and aid at our disposal? According to the American Journal of Public health an estimated 45,000 deaths a year are associated with lack of health insurance. The study found that those who do not have insurance are 40% more likely to die from their illnesses than those who are insured. This study offers the moral equivalent to Dr. Daniels people dying in the street.
Jefferson declared that human rights are self-evident, endowed by our creator, that they are inalienable. This was nice rhetoric, but Jefferson was wrong. Rights are a social process of the people demanding that those in power treat them with dignity, and asserting such through whatever means available. As the chronicle of human history demonstrates, the struggle for human rights is ongoing and expanding. It is time to assert a basic and fundamental right to health care.
Are you, like Rachel Maddow, wondering what is motivating Joe Lieberaman’s threats to support a filibuster against the public option? The ongoing mission of the Journal of a Mad Sociologist to follow the money unearthed these little tidbits from opensecrets.org
$427,000 collected from the insurance industry for the 2010 cycle so far…and don’t forget, Joe isn’t even up for re-election until 2012!
Over $1 million collected from the insurance industry during his career. Lieberman has also collected over a million dollars from health professionals and over $600,000 from pharmaceuticals. Aetna alone has contributed over $100,000 during his career.
It’s clear where Joe’s loyalties lie. It’s time to show him where our loyalties lie.
In our culture we tend to look at addiction as a moral failing or a character fault, despite the volumes of evidence of profound biological variables. We know that addiction is a physiological response to intoxication. Yes, there are social and psychological factors that are important, but by the time we get to the point of full blown addiction, it’s the physiological dependency that plays the leading roll. We also know that some people are more prone to addiction than others, and some people become more physically dependent upon certain drugs than are others.
Despite this knowledge, we still hold the the archaic social constructs of moral failing with regard to addiction. And the cure for this moral failing is purging (purgatory). To redeem oneself from moral failing one is expect to pass through a trial of purgatory, to cleans oneself. Hence we possess a certain admiration for erstwhile addicts recounting their stalwart determination against the torment of withdrawals only to emerge from this suffering clean and cured. Twelve step programs are designed to lead people through a process of purgatory that is defined as a daily struggle. Purgatory becomes an expected and accepted paradigm for stories of overcoming addiction.
And the approved course of action for dealing with addiction is cold turkey. Even using progressive treatments such as the nicotine patch or gum has the perceived value of quitting cold turkey when, in fact, one is merely diminishing their addiction in stages. We must also remember that, according to prevailing paradigms, once we are addicted, we are always addicts subject to a fall from grace.
So now we are faced with this story from the New York Times about using controlled doses of heroin to treat heroin addiction. A study printed in the New England Journal of Medicine suggests that the use of diacetylmorphine, the active ingredient in heroin, produces better results than methadone for heroin addicts who have already failed other treatments. Heroin addicts were more likely to continue treatment using the diacetylmorphine than the methadone. Of course, methadone has the benefit of mimicking the chemical interactions of heroin without producing the high. Hence, it’s a great “cold turkey” solution that reduces the purgatorial horrors of heroin withdrawal.
Using heroin, on the other hand, offers no such approved means of resocialization in our culture. There’s no purgatory. There’s no cold turkey. There may even still be a “high” involved. And getting high is just not approved (getting drunk is okay, but getting high will not be tolerated in polite company).
The Journal of a Mad Sociologist is dedicated to revealing what I call social schizophrenia. It’s my contention that social schizophrenia results when contemporary knowledge is influenced by outdated social constructs. Our contemporary knowledge of addiction is still mandated by often medieval concepts of personal character and failing, purging and self control. Progress in knowledge, ergo progress toward freedom and justice, occurs when we liberate ourselves from the social constructs, formulate relevant constructs and institutions to put those constructs into action.
For a few years now I’ve suggested changing track when it comes to the hydrocarbon debates. It’s not that I’ve changed my mind about Global Warming. Global Warming is very much a reality and may be happening even faster than experts have predicted. When it comes to the discourse, however, the lines are pretty well drawn. Those who do not accept the validity of Global Warming, for whatever reason, are unlikely to change their minds. That does not mean that such people cannot be brought into the movement for change that can perpetuate global warming policy.
The fact is that the same chemicals contributing to global warming are also contributing to other negative consequences for our society. Such consequences include the destruction of our future, not through cataclysmic climate change, but equally cataclysmic destruction of the intellectual capacity of our future.
According to research done by the Columbia University Mailman School of Public Health, pre-natal exposure to high concentrations of air polution can result in a five point IQ deficit. Now, I’m not sure of the predictive value of a five point IQ deficit, but the fact that air pollution can have such effects bares consideration.
Controlling carbon emissions is not just about keeping the earth from heating up, but also about keeping the brains of our children from cooling down.
This is a very important and divisive issue. It is crucial that we hear stories of all involved. Unfortunately it seems that those who have abortions remain silent about their experiences and motivations. This is a very deliberate process of stigmatizing and shaming women into not sharing their experiences and thereby limiting the discourse.
Read the article below by Cecilly Kellog, a very brave woman for challenging the prevailing stigmas. The comments are also interesting.
Read these health care stories. If you don’t believe there’s a health care crisis in this country after you read these you have no heart. What gets me is the number of people who have commented who have insurance. We are so concerned about the uninsured, but even those who have insurance still can’t afford health care, or have critical health care denied them by their corporate insurance.
After reading some of these stories, my gut instinct is to place the Insurance Industry on the terrorist watch list, not condone the actions of their lobbyists!
Health Care Horror Stories: Click Here
The free market yahoos keep at it. They insist on maintaining the status quo of American health care by scaring us with horror stories about how a government run health care system would deprive citizens of making market choices in their best interests. This plays into the American Cultural Legacy of individualism. It is also a lie.
First, the Obama plan (though it is, in my opinion, not the best possible option, it may be the most politic) does not constitute government run health care. It offers a choice for people to participate in a government single payer plan. If they are satisfied with their private health care, they can keep it. In essence, the government is entering the health market. If the free market is based on competition, then why can’t the US government, representing the tax payers, go into business? And if the private sector can do everything better and cheaper than the private sector, why should insurance corporations quake when faced with the prospects of competing with a public sector program.
In fact, they know that they can’t compete. They can’t do a better job cheaper. This has been demonstrated time and again. Administrative costs for Medicare, a single payer government program, doesn’t come anywhere close to the same costs for private insurance (even after the catastrophy that was Bush Medicare reform). Privatized programs contracted for the VA were a train wreck that denied adequate health care for our combat vets, yet failed to compensate taxpayers with cheaper, more efficient services.
Secondly, when was the last time you “chose” health insurance coverage? In most cases your health insurance is chosen for you by your employer. And when your employer chooses to change coverage (in their own best interest, not yours) you have nothing to say about it. Yes, you can drop your coverage and try to find something comparable, but often you as an individual are unable to negotiate the kind of benefits that a larger employer can when they settle upon a benefits package. So, in reality, most of us have very little to know choice in health insurance providers.
Nor do we have a choice in health insurance quality. Most major health insurance companies offer very similar benefit packages, all of which come with byzantine rules and regulations that cost you money and save the bottom line of insurance companies. Again, you have no choice if all of the selections are the same. It’s like being offered ham and eggs or eggs and ham.
So, with the prospect of being able to ditch my employer chosen insurance, or a single payer plan from the government, I end up with more choices than that given by a pure, free market system. If it turns out that the detractors are correct, that government health care is more expensive and less effective, then I can “choose” to say no. Right now, I have no choice.