I know this is a Democratic website, and we are in the habit of reinforcing anger at the other party, but this issue is too important, too dangerous to our civic society, our civil civic society, or what we have left of it.
We on this site are making a great error to believe that all of the anger and emotion shown at town halls is caused by the manipulation of political enemies. We focus on the extremes, the gullible who who believe the bill contained a "death panel," not attending to serious issues that are being raised.
Monday's N.Y. Times articledelicately dissects Obama's reassuring talking points such as "You can keep your existing doctor and insurer" and "medicare will not be diminished". It turns out those rabid right wing crazies, have some substance on their side.
We make an error if we believe all of the resistance is fueled by greed, racism, or ignorance. It is an error because by relegating it to these "evils" we fail to see the actual effect of any of the reform versions, and worse, we ignore the underlying pain and fear felt by those whom it will affect.
Fear of death is ubiquitous, as is aversion to suffering in ourselves and those we love. All societies from time immemorial have had ways to deal with this, from modern religion, shamanism to utopian visions that transcend our mortal existence. All of these also happen to entail a degree of acceptance, so that death is reinterpreted into something meaningful, transcendent, and as such acceptable.
Only in recent times has this been changed, so that death and debility is seen as preventable, or at least able to postponed until the distant future. We no longer believe in magic. We don't believe that a trip to the shrine of Lourds will allow the paralyzed to walk , the blind to see or cancer riven to be cured. We have not given up on faith, but rather changed its focus. We now believe in a new miracle, that a modern health system can save us.
This primal need, one that had been satisfied by mysticism, prayer and religion has now become merged into a high tech free market economy. Thus the violent, sometimes primal, reaction of so many at town halls. It is the shock of self realization, of how our faith has been transformed. It is not support of the medical status quo. It is rejection of pulling open the curtains, those hiding our society and our own psyches. The status quo is only acceptable, is comfortable because it goes largely unexamined.
The firestorm over Health Care Reform is being played out in the political realm. I maintain it goes beyond this. It is rooted in attempting to find a rational solution to something that can never be rationalized. A parent will sacrifice his life to save his or her child. We may be despondent over the death of a mother, even if she lived a long and full life. No matter how quantitatively literate, no one lives their lives based on risk-reward calculations.
The mechanisms to extend life, to end suffering and to make life fuller, have grown faster than our nations wealth. This is because discoveries in biology, chemistry and physics are reaching a point where they can be brought to bear on human disease. We may blame the high cost of maintaining health on greed, waste and inefficiencies, and certainly they exist; but it is primarily because of the success of research that now provides cures for what had been death sentences.
The ultra rich don't have a health care problem. Those in elite high paid professions don't have one either, as their health insurance can cost as much as $40,000 a year, all tax free. That should pay for every new treatment at the best of facilities. And up to now those over 65 have a pretty good deal in Medicare, but it is going broke. And Medicaid in most states provide bountiful services. In my state, California, the only group that can get any pharmaceutical with no questions asked. But this is being cut back rapidly.
The cut back in Medicaid, and the impending one in Medicare isn't done by legislation that limits coverage. It's done by cutting reimbursement, which causes providers, doctors and facilities to refuse this group, which makes for long delays if and when a provider can be found. And like in law, "Health care delayed is Health care denied"
Sadly, Obama talks about cutting waste in the general, but rarely in specifics, and when he does he obfuscates. His most repeated promise is "If you like your doctor or your insurer you can keep them." He does say that he will end subsidies to Medicare insurers, but very few seniors that I know, even those who are pretty informed, realizes it means that it is their medicare advantage program that will be eliminated.
He says that every American should be entitled to the same Medical care as United States Senators no matter what their income level. Will we all get VIP treatment at Walter Reed Medical Center as they do? And he will do this by cutting waste from Medicare. Except one persons waste is another's revenue that allows him to keep open the doors.
And his analogies get to be downright silly, such a saying that you wouldn't tolerate a garage that fixed your car and you had to have it fixed again in a week, so why tolerate a hospital where you have to keep coming back again and again. Cars compared to Human Beings. When a car gets to its maximum working life, oh say fifteen years and a hundred and fifty thousand miles, we just may decide that its systems are all going to go pretty soon and junk it. It's a really bad metaphor, and even if people don't pick up on it specifically, they just might understand that unlike cars, people may want to keep on trucking long after the expected life of their "components" have been exceeded.
So, yes, someone with multiple illnesses, could very well be treated one week, and given top care, yet the next week another system could fail, and they would come back again, and again, and again. This is the bind we have gotten ourselves in. It is easier to imagine that it is the fault of hospitals who are careless, then to acknowledge that the problem is the bind of trying to make the medical care myth work in reality.
Companies can make fortunes if they find a medicine that actually enhances one's health, but that's not actually a requirement. One that even gives the hope of this, the merest glimmer of temporary improvement, will be snapped up, with the public demanding it, at great profit to the provider. Aricept, the minimally useless drug for Alzheimer's is a good example.
While the term "Heath Care Reform" sounds like a perfectly rational endeavor to improve delivery of service, like perhaps transportation or education, it is of a different order of emotional magnitude. We miss the essence of the problem putting this in a partisan frame, or even an economic one, even though it has these aspects.
It has become our secular common faith that with enough "health care" we can live better, longer fuller lives. There are serious scholars who believe in the lifetime of those now being born, death itself can be defeated, as reflected in this segment of a White House Bioethics Report.
Attitudes toward Death and Mortality: An individual committed to the scientific struggle against aging and decline may be the least prepared for death, and the least willing to acknowledge its inevitability. Therefore, given that these technologies would not in fact achieve immortality, but only lengthen life, they would in effect make death even less bearable, and make their beneficiaries even more terrified of it and, in a sense, obsessed with it.
What connotations does the bloodless term "health care" take on when we are approaching deciding who shall be immortal and who shall face oblivion.
One response I often get here is that every other industrialized country has done it. But, that's really my point, they have done it; whatever the faults it is part of their civic culture. We are attempting to reconciliate two immiscible norms, that of egalitarianism and free enterprise. It's a problem our society faces every day, but never in such stark terms as this.
The present United States Health Care System is a Byzantine agglomeration of Public (Medicare, Medicaid, VA, Chips, Research Funding) Private (Insurers, Hospitals, Doctors, Drug Companies) with varying Federal or State Jurisdictions. Almost no lay people understand the complexity, other than their own circumstances, and I doubt many so called experts have a full perview of the vast landscape.
Because of this inscrutable complexity, we are forced into two camps. The first is those who not only trust Obama, but have confidence in his capability to make this work. The others are the mirror image, not only distrusting him, but despising him for threatening something that is precious for us all.
Actually, I feel that I have a perspective that is better than most. But this self bestowed perspicacity is useless, since it only makes me see the hopelessness of the endeavor. It is like seeing two trains coming towards each other on a single track, anticipating a collision, with no ability to do a thing about it.
Except to write essays, that go largely unread.