October 13th, 2012

feeling my oates

The American Way of Health

Of all the issues over which Republicans and Democrats have butted heads in recent elections, none have proven as shockingly polarizing as health care.  When President Obama managed to pass a health care reform bill, it so enraged the opposition — despite the fact that it was a monstrously compromised brand of ‘reform’ that still left the insurance companies in charge of nearly everything — that they have spent the intervening years trying to destroy it by any means possible.  They have challenged its legality in the courts; they have made overturning it a key plank of their platform; some Republican-dominated states (like Texas, where I live) have simply refused to implement it altogether.

The basic philosophical opposition to federalized health care is that it forces the taxpayer to fund what should be paid for by the individual.  This holds water only if you don’t take efficiency and cost savings into account.  Conservatives and libertarians talk a good game about how private beats public every time when it comes to efficiency and affordability, but this is pure snake oil when it comes to health care.  America’s health care system is the most expensive on the planet, and the least efficient; its profit considerations lead it to waste tens of billions of dollars on advertising, marketing, lobbying, and other wasted expenses that do nothing for the consumer.  As a moneymaker, it’s a hell of a racket, but in terms of displaying the efficiency and cost-effectiveness of private enterprise, it’s a dud.

More compelling is the question:  why on Earth would you want health care to be controlled by private insurers?  The utter dysfunctionality of the American health care system is as predictable as sunrise when you consider that we have placed it in the hand of people who stand to profit the most from not paying for medical treatments.  Our addiction to capitalism has served us well in a lot of areas, but it’s a bust at keeping people alive and healthy, particularly since living, healthy people are hardly scarce.  Worse still, we have made the absolutely mind-boggling move of tying health insurance to employment, paralyzing millions of middle-class workers and forcing them to stay in jobs that they might otherwise abandon for better prospects if they weren’t terrified of losing their health care benefits.  A cynical person might suggest that this was done with the express purpose of making the workforce more vulnerable, and thus pliable; thank goodness no such person can be found in these parts.

For an entertaining, but thankfully brief, while, the right attempted to make the argument that America’s health care system, far from being an overpriced slow-moving disaster, was in fact the finest imaginable, the envy of the world — so much so that people come from all over the globe to experience its wonders.  This turns out only to be true of the very rich, who are paying for their own health care and need not suffer from the endless delays, long waits, mindless bureaucracy and murderous expenses encountered by the rest of us.  Health care, you see, is a necessity for the human body, not a market commodity, and thus cannot be sold through the normal rules of the market like a track shoe or a fruit soda.  This is what people mean when they say health care is a right; it comes not from any sense of entitlement, but the simple recognition that everyone needs to be treated when they are sick, the poor in their millions no less so than the “job creators” in their mansions.  The result of a century of denial of this obvious fact is a health care system that is a complete joke everywhere but at home; if you don’t believe it, try explaining how our enviable system works to a European or a Canadian.

The ‘let ‘em die’ approach having largely failed to take root, it has proved necessary to take another tack, and the one ultimately decided upon was the ‘socialist takeover’ gag.  At first, it took the form of a warning against the creation of a massive and unwieldy government bureaucracy, but this didn’t go over particularly well; after all, the Republicans only recently created a massive and unwieldy government bureaucracy themselves, in the form of Homeland Security, and its only purpose seems to be to annoy, inconvenience, and worry everyone.  And having already justified the debasement of civil rights under the Patriot Act by claiming all other freedoms were useless if you get killed by some terrorist, they were left without a response to the question “What’s so great about free enterprise if I’m too dead to appreciate it?”, especially since most people are slightly more at risk of getting sick than of being murdered by a shrieking Islamist.  So the tactic switched to the horrors of European-style socialism, massive tax hikes, government death panels, and the like.  This one fared a bit better, since hatred of snobby Euros and residual commie-bashing are still powerful motivators in American politics.

If Obama gets his second term, and some of the key elements of his reform package, flawed as they are, are allowed to become law, even this resistance may fall away.  No country in the world with socialized medicine has ever given it up voluntarily; it is only through the enforcement of phony ‘austerity’ measures that some governments have tried to chip it away, which would be rather difficult to explain if it were truly as awful and unpopular as the parties of wealth always say it is.  Even here in the U.S., Republicans play with fire when they try to interfere with Medicare, currently the most extensive form of government-funded health care we have.  With Paul Ryan now a candidate for national leadership, the G.O.P. is trying to re-introduce Medicare ‘reform’ — that is to say, conversion of the system to a private insurance program — but organizations like the AARP are quick to bring the hammer down on such nonsense.

But when Republican policy and nonsense are found together — and honestly, when are they not? — it is usually in the company of men like Mitt Romney.  The man who would be President, and who has expressly made it a priority to uproot even the weak tendrils of health care reform Obama has managed to plant (or not, depending on who he’s pandering to that day), recently said on a campaign stop “We don’t have people that become ill, who die in their apartment because they don’t have insurance.”

Now, I’ve talked before, as has every other even vaguely left-leaning blog on the internet, about how ol’ Willard has the habit of coming across as the ultimate privileged rich white guy, possibly on account of his being so privileged, rich and white.  But this one takes the cake, eats the cake, shits the cake out on the middle of a banquet table, and orders a minimum-wage-earning black maid to clean up the cake shit while you tell her how delicious the cake was.  Perhaps this just seems exceptionally gross to me because of my own recent health scare, but we absolutely have people who die because they don’t have insurance.  Over 40,000 people a year, in fact, according to the Harvard Medical School; amongst the under-64 cohort — that is, people who do not qualify for Medicare, America’s only guaranteed government health care program — mortality rates are 40% higher among the uninsured.

The reasons for this are as many as they are obvious to anyone who, unlike Mitt Romney and everyone he knows, is not wealthy enough to afford any kind of medical treatment they care to have.  Thanks to the built-in costs of privatization and competition referred to earlier, health care in this country is absurdly overpriced.  For the uninsured, simply visiting a doctor or dentist — merely stepping into the office — costs over a hundred dollars, a significant amount when you’re making subsistence wages. Seeking actual treatment is so cost-prohibitive that it’s hard for many people to even imagine; a brain-crushing 62% of bankruptcies are caused by medical expenses.  This means that one single industry is responsible for over two-thirds of the cases of people whose incomes have been destroyed — worse than unemployment, sudden death, drug addiction, habitual gambling, or even banks.  Lower-cost options are available to some — usually only couples with children, and even Medicaid is not available to many people living in poverty — but information about them is often difficult to come by (and not always unintentionally).  The result of all this is that the majority of the uninsured simply do not ever visit the doctor or dentist unless they are simply unable to avoid doing so — until, in other words, they are so sick that irreparable damage has already been done.  They are so understandably afraid of the cost of a medical visit that they allow medical problems to fester and worsen until the illness becomes chronic — and the costs become even more unaffordable.  (All this is not even to mention the parallel crisis of mental health care, which has the added malignancy of destroying the lives of other people.)

Everyone knows from endless PSA repetition that the preventive approach to health care is the best.  Regular medical visits result in catching problems before they start, thus lengthening the patient’s life and lowering the overall cost of care.  The problem is that while for people with insurance, a regular doctor’s visit is no more invasive than getting one’s oil changed, for the uninsured, it is the beginning of a downward spiral that may never end.  The initial visit costs a few hundred dollars for the visit and the checkup; any tests — x-rays, blood work, EKGs, or anything from which useful information may be gained — costs hundreds or even thousands more.  Medication can cost hundreds of dollars, none of which is reimbursable for the uninsured.  Prevention ceases to be an efficient and sensible approach to health care, and becomes just another luxury one can’t afford, until, eventually, disaster strikes and all those expenses hit you anyway, along with the insanely high cost of ambulance services, surgery, meals, overnight stays, and the rest.

Concomitant with the idea that no one dies because of lack of insurance is the nonsense — repeated by Romney in the very same speech — that anyone can get medical care simply by going to an ER and having the necessary treatment.  Leaving aside the fact that someone still has to pay for it, this is true only of the kind of care given by emergency rooms.  It’s fine if what you need treated is a gunshot wound, a broken leg, or a bad case of the flu, but the vast majority of health problems in America are chronic.  They are conditions that require long-term or lifetime treatment, for which an ER is less than useless.  Walk into an emergency room and ask them what they can do about arthritis, diabetes, hypertension, sleep apnea, anemia, asthma, epilepsy, or osteoporosis, among many others:  they can do nothing.  All these are treatable, but they require frequent medical checkups and constant medication, which, for the uninsured, makes them prohibitively expensive.  So, once again, unable to afford the necessary treatment, the poor simply ignore the problem, meaning it gets worse and worse, and the end result is a life cut short by decades.  This is not an abstraction to me:  this is very likely how I will die.  For me and tens of millions of uninsured people, our lives will literally end much sooner than necessary because we simply cannot afford to pay for even the diagnosis of chronic conditions, let alone the means of combating them.

This is the broken system we have, and the one attempt, feeble as it is, to make it work slightly better, is what Mitt Romney’s party is frothing at the mouth to dismantle.  In terms of alternatives, all they have offered is their usual roster of deregulation and privatization, which, in this case, is saying they want to give the foxes easier access to the henhouse.  Public health care is one of the most obvious examples of why it isn’t always the best idea to put private enterprise in charge of everything; it’s a truth that’s been recognized by nearly every country on Earth.  But here in America, we are still frustratingly vulnerable to the dog-whistle of socialism.  If there are two aspects of life that should be free from any kind of a profit motive, they’re education and health care, and yet we continue to insist that whether or not you get a decent education depends on how much money your parents have, and whether you live or die depends on who you work for.  If we can’t get past those dehumanizing pillars of bullshit, nothing much else in politics matters.