Now, in the fullness of time, we speak of what the relief of the Affordable Care Act means. For most of us with stories to tell, we had shouted ourselves hoarse when the injustice of the American system first struck us, individually, and in 2008 we voted, together. Many of us believed, during the summer of dreadful delay and interminable compromise, that we were seeing another deferral, another denial, another loss, another injustice, albeit one that came with excuses rather than accusations. Strangely, as the T.E.A. fools claimed both the stage and the Gadsden flag and the graves of our ancestors, we did not gather to tell our stories. I think we were in despair.
Today we feel as if the dreamer may safely awaken. We have had years enough to actually understand what is worth preserving and amending about the A.C.A. Unlike those for whom the A.C.A. is the death of “America” in some vague way, we who know the brutality of health care in America have been learning more all along about what the smoke of the back room obscured and the chattering bleached smiles of the news anchors of whose votes were up and whose down drowned out, and this act looks more and more like life to Americans.
I do not like autobiography. I find its subject matter boring. However, I know some people who should be honored. If you have patience, therefore, I would like to toss out a few of the conservative positions against health care reform and the single payer, and then, after our Kos Bump of Interest, I'll pay tribute to one of my friends whose life demonstrates the lies. I will then give a brief explanation of how nakedly partisan or willfully infantile a person must be to believe the anti-ACA arguments.
So, if we take the old conservative arguments – before they became incontinent under the pressure of Dick Armey's fist – and the new ones from after, we get something like this:
- People should save for these things/budget for them.
- The free market is doing a fine job already, and the real problem is that insurance companies have to pay too much due to law suits.
- If we had universal access, then poor people and stupid people would be encouraged to be poorer and stupider, and they would engage in riskier behaviors.
- Government is wasteful. It's way, way more wasteful than private industry. Just look at _, where people have to wait to get a __ and they go to ___ for it!
- NEW! The gummint can't tell me what to do! If they can tell me to get insurance, then they can tell me to eat brocoli!
- NEW! The Government wants to administer your health care so that they can control it and decide when you die, and this is an obvious path to the movie “Logan's Run” or the “Left Behind” (or “Right Behind”) books.
- Other things seem to be various yolps and screams, and I can't transcribe or transliterate them into propositions. Now, let me tell you about my dear friend Vicki.
I met Vicki at a small private college, where she was running the composition program in English. I was called to fill-in for her for a couple of weeks (while she, in her 30's, had an hysterectomy, though I didn't know that). I didn't mess up, so I later became an adjunct, then full time. The two of us would compete for the "work horse" title (most students per semester or for the year), and she usually won. For years, she and I were composition, for the most part.
She has a doctorate from Vanderbilt in Victorian British literature, but she only taught composition. She did not complain or try to leave, and she kept regular hours in her office from 9:00 to 5:00, as she was also the college's writing center. Her evaluations from students were high, and the grades she gave out were realistic (a C-average). This is praiseworthy in anyone, I think, but she was also very low paid, so she was good and a bargain.
It eats me alive that she could, did, and still does work harder than me, as she has more obstacles, more pain, than any of those around her. In her case, it is severe autoimmune conditions. Rheumatoid arthritis attacks hips, wrists, knees, and fingers. She also has a form of Tourette's Syndrome, and where I came into her story was at the point that she fought ovarian cancer and won. I just have osteoarthritis and congenital heart defects (which have been fixed now -- giving me Tietze's Syndrome) and stupid old metabolic syndrome (it was cooler when they called it Syndrome X). If work is a virtue, and if perseverance is a good, then she's a saint.
The small college had trouble making the interest payments on a loan it had taken out, and it bled people in layers. After cutting muscle, it began to cut bone. We found that the Board of Trustees would create a special panel that would cut faculty. Cuts were going to be made with one thing in mind only: cost versus benefit. The names of the trustees involved would be secret, and neither administration nor faculty would have input.
The result of the careful analysis was that the Division of Music was not cost effective, and several faculty members in assorted places were not needed enough.
Of the faculty who lost their positions outside of Music, almost all were women. This was curious, except that we heard that one of the Trustees felt strongly that Adam tills and Eve spins (lovely link). However, there was something. . . else.
Another of the cost hunters was a proven business expert, a veteran of budgets. His expertise was well known because he owned the health insurance company the school used. Strangely, all of the people outside of the eliminated division who lost their jobs had existing or recent serious medical diagnoses. One man had just gotten into his treatments for prostate cancer. One woman had just gotten her cervical cancer diagnosis. Another woman had a spinal problem that was freshly diagnosed. Vicki, who taught more students for less money than almost anyone, was let go.
Vicki was on unemployment for as long as it lasted. She sought teaching jobs, of course, but did not find one.
During economic prosperity, the job market for college teachers is like something dreamed up by The Joker in one of his more sadistic moments, but today it is simply an open insult to sense and sensibility. (Let's have a single conference, and have every hopeful attend it, at their expense. If the hopeful is favored, she will go meet a group of five professors who hate one another and are in competition to have the greatest number of pet words in answers. That's what it's like in the grand times. I came to believe that that conference was the only conceivable justification for land mines.)
Our state knows that Welfare Queens drive their Cadillacs to the Welfare office, so when she needed relief, they insisted that she spend all of her retirement funds, first. After, therefore, destroying all of the saving she had done to prepare for a catastrophe, she was able to get minimal support -- when it wasn't being cut off. She applied for Social Security Disability and was denied, twice, because, after all, she had just had a job.
Here's the thing, though. Her symptoms never relented. Arthritis pain too severe to sleep, treatments that are ruinously expensive for a rich person -- these do not care about one's job. That's the curiosity and inconvenience of illness and "pre-existing conditions": they afflict regardless of the government, the insurer, or the doctor.
I would not tell you this story if I could not provide at least the illusion of an happy prospect. There are two. The first is that she got hired by one, then a second, then a third, and then a fourth online for-profit college. (Yes, grumble grumble ethics of the for-profit colleges.) One of them offered her a real, flesh and blood campus position, but the others were for online education only. Without prejudice, when bosses saw her teaching, her counseling, and her course design, they were ecstatic. One college promoted her, then promoted her to teaching graduate school, then promoted her again. She is working seven days a week, making only slightly more than she did at a poorly paying college job, and she has to face a 1099 tax form, but her rise will likely continue. Anyone who teaches can tell you that being able to teach what one trained in is a benefit almost as sweet as pay.
The real happy ending? The Affordable Care Act will mean that she will soon have affordable health insurance. It's a year and a half away, of course, but it is coming. When it comes, there will be no pre-existing condition exclusion and no cap. There will be no sneaking around -- jacking up the premiums and communicating with the employer. It's even imaginable that she might get to start rebuilding her TIAA-Cref.
Why there is no argument against the ACA, only a lie and a fantasy
If we look back at the old conservative arguments, we can derive two real proposed positions and objections.
1. Moral arguments: "Individuals should save (and the government should facilitate by individual savings accounts, etc.)," "universal access encourages frivolous use of health care," "Government has waste, as seen in _" are all effectively moral arguments. The "should save by a medical account" claims that those who presently cannot pay medical bills can face any medical expense, regardless, with proper financial planning. The uninsured, this argument posits, lack prudence. Furthermore, the person who makes this argument gets to compliment himself and his class by implying that he does have prudence and can "manage" money.
The argument that universal coverage would lead to a slippery slope of blocked up clinics with stupid people milling about is an encoded race and class fear, but it also implies that the people who now have no insurance and cannot pay are not in need and would stand in the way. This implication has to be present, by the way. If these imagined brown hordes are going to "waste" the medical office's time, then they can only do so by not being sick. Thus, this argument is tantamount to saying, "The people who want insurance don't need it." Since the "they" is almost always undefined ("old people," "crazy people," and "poor people" are meaningless terms), it's a way of saying, "I don't want to see anyone else at my doctor's office."
2. Begging the question: You waste, I profit
The "Government wastes, and you can see because of -Agency- and -Anecdote-" argument deserves special treatment. What is waste? The very selection of the term (not even mentioning that the person will argue from anecdotal evidence and cherry picked evidence) is begging the question. It is waste because waste is what is called waste.
Is it waste, when a crutch is sold at Rite Aid for $17.00 and costs $89.00 when provided by a hospital? Is it waste if a 400 bed hospital spends >$2,180,000 a year on advertising? Is it waste if a company knowingly ships a dangerous product, planning on paying the fine, when necessary, and then has a fine that almost destroys the enterprise? In each of these cases, one ideological camp calls it "business," and the other calls it "exploitation," but no one calls it waste. "Waste" is only something government does, a priori. This is because "waste" is a special term, it means "excess labor cost," and never "excess profit taking" or "inefficient administration" or "excess management."
Making this argument does two things: First, because it uses a licensed premise (waste is only ever excess labor and not excess greed), it tells the speaker and audience that the investor's model of management is the only scale of virtue. Second, it defines good as profit. It's this that's most important.
No one can say, "Government wastes money, so we should have free market insurance" as a proof without having determined that the social duty of government is saving money. Instead of asking about right and wrong, it asks what's cheap. It's government by Wal-Mart shopper. The "government wastes money, so private insurance is best" argument depends upon rewriting the U.S. Constitution so that the government does not provide for the general welfare, but only for the general wealth (and that only in aggregate).
It's not surprising, then that the other arguments all have in common a precondition that there is this thing called The Government that is a foreign entity. The "government gets to control you" is predicated on the idea that this thing -- "government" -- must be hostile and impenetrable. You only fear "the government will control you" if you believe that you have no influence on the government.
If you don't believe in, or want to quit, or you don't think voting matters, then the government can be Government. Otherwise, people who believe in participatory democracy believe that they can change the government. To see government as an inveterate enemy force in a political, cultural, and personal sense requires much, much more than the businessman's creed that regulation is burden: it requires a divorce from democracy.
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Q.V. Truth= = =
Far from the slovenly, confused, gleeful hordes of emergency room blocking minorities, the uninsured have been and are as frequently employed as unemployed, educated as uneducated, vigorous as weak. "Uninsurable" is a designation thrown down from the Olympus of the Blue Aegis, the heaven of HMO's, falling on the just and unjust alike. It comprises people who are ill, not people who are bad. The demographics of the uninsurable are the demographics of illness, and disease has no respect for skin, education, or ethics.
My friend Vicki's character should frighten a Republican fear-monger. She worked her way up, paid her own way, came from disadvantage, got a Ph.D., payed off her loans, built up retirement, and has poured hours into labor. Her only failure has been marked upon her by birth and bad luck, and for that, the world would be robbed of her work. For that, students would be denied. For that, she would be dismissed out of hand by someone lucky as undeserving?
I did nothing to gain my birth defects, either. However, no one "deserves" disease -- not the person engaged in risky behavior more than the child born to a dangerous environment. Once we make the cognitive advance, once we realize that no one earns an illness, then we can come to the final realization that therefore all deserve care. Otherwise, the ones who natter on about the morality of health are the people who are healthy, wealthy, and unwise.
It may be that our whole GDP would not get the health care we deserve it may be that healthcare for all is impossible, but let no one say that it is "waste" or impugn moral stances.
As for the government's death panels, perhaps the Freepdom loving could come up with a private, secret underground gurney track, where they can provide a safe haven in Canada for wealthy Americans who can no longer breathe freep. The first day that their flights to the Caymans are cancelled, the freep peoples will slither into action.