Gold-Plated Indifference

I failed to blog the last three days due to a debilitating case of cedar fever, Austin's tortuously special brand of hay fever where, according to my allergist, "pollen counts of cedar pollen in Central Texas are the highest know anywhere in the world, for any plant." But I have re-upped my prescription meds, with some low-dose steroids throw in for good measure, so I think I can get through this.

At least going to a medical specialist was an easy option for me: I get good coverage with a reasonable copay through my employer. Obviously this isn't true for millions of Americans, a fact that should chagrin and moritfy us all. Since Bush's proposed healthcare fix has come up in the comments of some of my recent SOTU posts, I thought I'd introduce my thoughts on the matter in an official post. For my money, the most au courant pundit writing about healthcare in America is Paul Krugman: 

"A Healthy New Year" (1 January)

 "First, Do Less Harm" (5 January)

"Golden State Gamble" (12 January)

"Gold-Plated Indifference" (22 January)

My own views tend to mirror Krugman's fairly closely, so, like him, I believe a single-payer system is the most efficient, effective method for providing sustainable healthcare to the majority of Americans. I appreciate, but do not share, the categorical imperative many conservatives feel towards decreasing taxes, but Bush's "standard tax deduction for health insurance" seems to fly in the face of the conservative call for smaller government, which, as I understand it, underwrites that imperative. With a single-payer system there is one moment of government 'intrusion,' namely the annual collection of each individual's share of the total cost.  Bush's plan requires continual and multiple levels of government oversight of taxpayers, healthcare providers, and medical insurers, not to mention his proposal to grant federal funds "to help the states that are coming up with innovative ways to cover the uninsured." Often, state's plans are as complicated as Bush's alleged tax break. For more on this, see Krugman's "Golden State Gamble." To their credit, however, state plans are generally more authentic attempts to help Americans than anything the Bush administration has concocted.

Because Bush's "standard tax deduction for health insurance" is also, to put it bluntly, illogical for the simple fact that people who have inadequate or immaterial healthcare are also unlikely to pay taxes. How can they, then, benefit from tax deductions? Plus, no amount of tax break increases access to information about the intentionally convoluted system of personal insurance. No amount of tax break will help you get accepted for coverage despite your pre-existing condition. And certainly no amount of tax break will decrease the substantive cost of unchecked insurance premiums. I think this is a textbook case of not getting blood from a turnip. A single-payer system, conversely, would indemnify those Americas unable to cover themselves (as well as the rest of us), and it does so in a fair and simple manner, using procedures that are wholly consistent with the market. Just because the demand-side has been collectivized doesn't mean that the supply-side has to be taken away from private providers. Think Canada's system, not the United Kingdom's.

Don't take my word for it: check out Krugman's "Gold-Plated Indifference," where he argues that, "Going without health insurance isn't like deciding to rent an apartment instead of buying a house. It's a terrifying experience, which most people endure only if they have no alternative. The uninsured don't need an 'incentive' to buy insurance; they need something that makes getting insurance possible." Krugman pointedly accuses Bush, "someone with no sense of what it's like to be uninsured," of misunderstanding and misrepresenting the causes and effects of America's healthcare crisis:

No economic analysis I'm aware of says that when Peter chooses a good health plan, he raises Paul's premiums. And look at the condescension. Will all those who think they have "gold plated" health coverage please raise their hands? According to press reports, the actual plan is to penalize workers with relatively generous insurance coverage. Just to be clear, we're not talking about the wealthy; we're talking about ordinary workers who have managed to negotiate better-than-average health plans. What's driving all this is the theory, popular in conservative circles but utterly at odds with the evidence, that the big problem with U.S. health care is that people have too much insurance - that there would be large cost savings if people were forced to pay more of their medical expenses out of pocket.

Krugman concludes that, "Mr. Bush. . .is still peddling the fantasy that the free market, with a little help from tax cuts, solves all problems." A statement with which I agree, and whose source, I believe, is rooted in what Krugman labels as Bush's "condescension." One of the principle delinquencies I see in conservative ideology is the scapegoating of the poor: the assumption that living in a democracy means the interminable and readily available actuality of options mixed with accusations that, because they make bad choices, it is their own fault for being poor. I'm not sure if these twin notions are grounded in an unshakeable, though not entirely wrongheaded, confidence in 'the American Dream' (you know, work hard, get ahead), but to my eye and ear they are largely unwarranted and spurious notions, the purpose of which is to make it easier to ignore America's deeprooted class crisis, and to accept our persistent failure to solve it.

Because, rhetorically speaking, scapegoating, as Kenneth Burke put it, is "the use of a sacrificial receptacle for the ritual unburdening of one's sins." In my formulation, and I think Krugman would agree, Bush, as an avatar of conservative thought, wants to intimate that it is poor people's own fault, because of their bad decision making, for not having proper healthcare coverage instead of placing the blame where it belongs: bloated insurance premiums, non-negotiated pharmaceutical formularies, reliance on emergency care, and a paucity of preventative care, all feeding off of governmental ignorance and neglect. And if it's their fault, we don't have to feel guilty and/or responsible for their conditions. "The stuff about providing "incentives" to buy insurance, the sneering description of good coverage as 'gold plated,'" Krugman coolly concludes, "is right-wing think-tank jargon. In the past Mr. Bush's speechwriters might have found less offensive language; now, they're not even trying to hide his fundamental indifference to the plight of less-fortunate Americans."

As with so many issues facing us, globally and locally, this one requires a paradigm shift, a change in perception towards what is the actual problem, and what is required to actually solve it. The first step is to recognize that poverty is a social disease, not a personal one. The reality is that, for all its metaphoric power, 'the American Dream' is often damaged, and sometimes flatout erroneous. But as a country, we have to stop unloading our dissatisfaction about that fact onto the most disenfranchised segments of our society. Reaganite 'welfare queens' no longer exist (and it was Clinton's 'welfare reform' that killed them). Mexican immigrants are not stealing our jobs and milking our social programs. And poor people are not bringing us down. But we are failing to bring them up. Shame.

Comments

[Mark]

My only problem is wanting to emulate Canada's system. I represented a couple of Canadian immigrants who complained heartily about how Canada's system allocates healthcare. One of the client's relayed a story of a injured knee playing soccer and a resulting 8 week wait for an MRI. Because he made pretty good money he drove to Detroit to pay cash for one. He said the most basic stuff resulted in a moderate wait while stuff like an MRI or even appendix surgery caused unbearable waits. The upper middle class and rich in Canada get what they need the regular middle class and poor get healthcare when the single-payer gets around to getting to them.

[Tim]

You can also check out this link to a column by one of the people I work with... and this is also from a so-called "best case scenario". http://www.courant.com/news/local/hc-colin0128.artjan28,0,4073614.column

He does have insurance and everything else, just the system currently has so many holes in it it's ridiculous. That's why I just plan to keep going until I drop. I figure if I make it to 40, I'll likely be one of those people that live until he's about 103 with nary a health problem. Otherwise, it'll all fall apart in about 30 seconds when I'm 38, like a newspaper in the washing machine.

[Marco]

Many years ago (I believe this was during the Clintons ill-fated attempt to push health care reform) I saw William F. Buckley being interviewed on TV and was flabbergasted when he said that not only do most poor Americans not have access to health care, "they don't want it."

They don't want it? I can't tell you how many people I've known who are stuck in jobs they find neither emotionally or fiscally rewarding, but they put up with it for fear of losing access to what health care they have. And they consider themselves lucky.

Those who don't have insurance (whether they are gainfully employed or not) either ignore medical problems or rely on emergency rooms and clinics for the underprivileged. Most of those places are understaffed, overworked, and are not set up to offer proper care. I have one family member whose condition worsened after going to one of those places. Later, when she got a job that offered health insurance, she was able to see a specialist. The doctor was shocked to find out what the clinic had been prescribing to her and told her to immediately stop taking the medication. By that point, the damage was already done and she had suffered significant loss in bone density.

To be fair, examples such as this are the most compelling argument against universal health care. The nightmare scenario is that most hospitals will wind up looking a lot like emergency rooms and welfare clinics. Still, I was stunned by Buckley's comment. That goes beyond idealogic or economic differences of opinion. It demonstrates a fundamental ignorance of the issues facing middle and lower class people in this country today.