Although the government shutdown is over for at least a few
months until the next crisis, Republicans still will not concede that the fight
over “Obamacare” is over. It is so like this country—which prefers to “react”
to problems rather than anticipate them—that the only major attempt to address
a vital domestic problem before it becomes a catastrophe is under assault for (let’s
face it) partisan political reasons. We’ve all heard the Republican talk about “fiscal
responsibility” before, thank you not very much. Remember how those tax cuts
for the wealthy was supposed to create jobs and boost the economy? Instead,
those wealthy pocketed their extra cash or shipped in overseas, and this
country lost 3 million manufacturing jobs during the Bush presidency; we would
have lost many more without the auto industry “bailout”—under Obama. There is
nothing “patriotic” about greed.
Before the Affordable Care Act was even discussed, at least
some people were concerned about a health care industry that was just 5 percent of GDP in 1960 but leaped to 18 percent
today. Complaints that government programs like Medicare and Medicaid will rise
from 6 percent of GDP today to 15 percent in 2040 conveniently ignores the fact
that at that rate, the far more undisciplined private sector spending will
likely bring health care expenditures to at least 40 percent—and more likely 50
percent—of GDP by 2040 without any “interference.” Without the ACA, it is
likely that those who cannot afford health care in the pre-Obamacare “system,” will
rise to a 100 million or more uninsured Americans—meaning that a significant
minority of people will not have access to preventative care, meaning that the
cost of serious illnesses that could have been prevented will only be delayed
down the road, especially as the population grows older.
Knowing that hasn’t prevented stupidity from “informing” the
debate, of course. Remember when there was no “Obamacare” around to bash when
your premiums were doubling every year when Bush started his deregulation-out-of-control
business? A recent story on CNN’s website invited the following commentary from
a blonde named “Linda,” who merely confirmed Rachel Jeantel’s “new
school” attitude toward women with blonde hair:
“Please give me free ice cream, lots of time off, and a
worry-free life - it's my birthright and the taxpayers owe it to me.”
This provoked the response “It takes a wingnut to equate
healthcare with ice cream,” to which “Linda” retorted “It takes a wingnut to
force others to pay for their health care. I want freedom - you and your kind
are robbing me of my freedom and my money - I will fight your forever. I will
never give up.”
This is, of course, prime Tea Party” philosophy,” one this
country cannot afford. It takes a
bigoted “wingnut” not to realize that unless you are one of the super-rich who can afford to pay for their own health
care—and even they likely prefer the
insurance option—everyone pays one way or the other, either with money, productive
hours, or their life. “Linda” here shares the stereotypical belief of many that
those without health insurance because of poverty wages or have substandard
employer insurance are all really just lazy welfare bums looking for a handout.
In actuality, everyone is a taxpayer—especially low-income people who pay the
highest percentage of taxes in states dependent on sales taxes. The benefitless
low-income and underpaid are just as likely to think that greedy bastards like “Linda”
are the ones who are really doing all the “robbing.”
When attitudes like this may fuel one side of the debate, it
is unlikely that issues can be rationally discussed. Anti-tax fanatics are one
thing; those who preach “free market” solutions to “fix” the health care
industry pose another propaganda threat.
Steven Brill wrote in TIME that
“There is no such thing as a free market in healthcare, if one defines a free
market as a place where there is some balance of power between the buyer and
the seller. Instead, healthcare is – except when Medicare is the buyer – a
lopsided seller’s market.”
This isn’t “news.” Way back in 1963 Kenneth J. Arrow wrote in
the December issue of The American
Economic Review that the health care industry was particular immune to the
effects of market philosophy. Arrow observed the nature of demand in the health
care industry was “irregular and unpredictable”; that the behavior of
physicians is unpredictable, and that they are not “salesmen”; that consumer
cannot “test” a product before consuming it; that there is uncertainty if a product
will work; that there are supply uncertainties; that there is a wild range of
costs for services, particularly due to over-billing and hyper-inflation; that
higher incomes of doctors have led to a deliberate restriction in the number of
doctors, employing licensing restraints to keep out the “competition”—doctors act
as a de facto monopoly.
Because the medical care industry lacks “competitive
preconditions” and “when the market fails to achieve an optimal state, society
will, to some extent at least, recognize the gap, and nonmarket social
institutions will arise to attempt to bridge it…it is contended here that the
special structural characteristics of the medical care market are largely
attempts to overcome the lack of optimality due to the nonmarketability of
information..profit motives largely explain the observed noncompetitive
behavior of the medical care market, behavior which, in itself, interferes with
optimality.”
Arrow was suggesting here that since the health care
industry is immune from market forces and cannot self-regulate its costs—save for
the ethically and morally unacceptable recourse of denial of care, “social
institutions”—meaning governments—have the capacity and responsibility to “bridge
the gap” between the profit behavior and moral accountability.
There is nothing “moral” or “ethical” in the effort to “kill”
the Affordable Care Act before it even has a chance to succeed. In fact, that
is perhaps the greatest fear of the Republicans—that at least the insurance
exchange program of “Obamacare” not only will succeed, but will stand as one of
the landmark domestic accomplishments in this country’s history, something that
Republicans and their Tea Party thugs chose to be on the wrong side of history
of.
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