Obamacareless: Sickness Is the Health of the State

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by David Underhill
Guest Column

The racket about getting medical care to those without it isn’t really about that.

Keeping this in mind will make the shrillest weeks of the campaign season more bearable as elections approach. The coronation of Paul Ryan as veep on the Republican ticket made Medicare a loud topic because his crush on Ayn Rand demands it. In thrall to her, his career has been a crusade against the idea that access to health services should be a right, not a commodity.

The Supreme Court had already cranked up the decibel level when, to the dismay of the faithful, it gave Obamacare a reprieve from the anticipated death sentence—while granting states an apparent escape hatch from some provisions. And Alabama is especially clamorous because it’s holding a constitutional referendum (September 18) about tapping an emergency reserve fund to finance ordinary expenses. This arises from the legislature’s refusal to pass a balanced budget, thanks mainly to the newly Republican majority’s reluctance to fund health services, particularly Medicaid.

But despite all the noise around these medical matters, it isn’t truly about alternate ideas for the best methods of providing health care to the people. It is about wielding taxes and budgets as political weapons. Seeing this with a clear eye (and foggy conscience, as necessary) will make sense of otherwise baffling and irrational developments.

Biting the Feeding Hand

When the Supreme Court decided (meaning, when one person—the chief justice—switched sides by surprise) that Obamacare is legal, the justices also chiseled out a big loophole. By a 5-4 vote they forbade the feds from enforcing an expansion of Medicaid under the new law. It would have granted coverage to those not poor enough for Medicaid previously but not wealthy enough to afford even the subsidized private insurance Obamacare requires.

The states, which administer Medicare, must have the option of refusing to cover this group, said the court. This means that many millions nationwide might be left with prayer as their primary medical plan and harried interns as their primary physicians when untended conditions turn critical and the ER is the only recourse.

Immediately governors—especially Republicans, especially in the South—began declaring their refusal of the Medicaid expansion. Their stated reasons cited the usual suspects: federal meddling, states rights, bureaucratic hassles, unfunded mandates, etc.

These are flimsy excuses for spurning immense benefits in health care, not to mention money. Enlarging Medicaid would cost a lot, but DC would pay almost all of it. For the first three years the feds would finance everything. After that they would cover 90 percent of the bills. By paying 10 percent of the actual costs, states could provide medical services for citizens now scheduled to suffer and die from neglect.

Yet several governors said outright “No!” Others have dodged and shuffled during the couple months since the Supreme Court’s ruling. Recently the governors of Florida and Texas repeated their refusal of the nearly free Medicaid expansion.

Ignoring the needs of the poorest social layers is routine. But medical providers, particularly in small towns and rural areas, have been complaining. They rely on Medicaid to keep their services financially alive. And the governors have ignored even these doctors and hospitals, so far.

Sick, Sick, Sick?

Yes, this seems baffling and irrational—at best. Digby, a leading liberal blogger on the Hullabaloo site found it starkly pathological. Introducing a linked article about the “Tea-Party backed” South Carolina governor’s rejection of expanded Medicaid, she said: “This is a sick story about sick people from a sick state in a sick country.”

No, it isn’t. It’s mean, petty, cruel, heartless, brutal and inhuman only if you believe the government should help those in need. But if you’re a libertarian, refusing to help the sick isn’t sick. Instead, it’s adherence to the healthy principle that government should concentrate on protecting property rights and leave other matters to the magical market. And if you’re conservative, denying government-funded health care to the ill promotes the longevity of the existing order, which is precisely what you strive to conserve.

The ailing don’t agitate. Neither do the broke. Poor, sick folks devote themselves to just getting from one day to the next, financially and medically. Trouble bubbles from the somewhat healthy and slightly secure, who have the capacity to act without having the restraint of great privileges to lose.

So defenders of the prevailing system will welcome the chance to promote policies that keep the ailing chronically feeble and bedeviled with debt. Nobody will say this frankly. It sounds too hideous and too contrary to the American myth of equal opportunity for all.

But silence doesn’t alter the fact: If there were no desire that illness and poverty assist in keeping those afflicted with these conditions fastened in their social place, then the revenue and policy choices that have such consequences would not persist.

It’s not only permissible, it’s almost mandatory for politicians to proclaim their allegiance to various incentives designed to boost the interests of businesses. This is a common, explicit use of government policy for the benefit of some and not of others. Its effectiveness is occasionally debated but its legitimacy rarely is.

Then why would it be strange or outrageous to assert that taxes and budgets can also serve as weapons to hobble and damage some and not others?

Now, Tomorrow, Forever

In more honest—or at least more raw and blunt—times than the present, such motives didn’t need to hide behind masks and hypocrisies. Youngsters versed in history will have read and seniors will remember when Alabama’s governor George Wallace stood on the capitol steps at his inauguration and proudly, plainly announced his intentions: “Segregation now, segregation tomorrow, segregation forever!”

When a governor attracts loud, ecstatic cheers for such declarations, the reception shows what else is allowed. This was also the era of president Lyndon Johnson’s War on Poverty. It included numerous federally funded efforts to assist the poor with housing, education, health and nutrition, among other things. In deference to local authorities these programs were not entirely imposed and administered from Washington. The state or municipal role was sometimes just ritual, requiring little or no money. Local officials merely had to formally request a particular program.

And many of them would not do it. They refused the assistance because they realized it would bolster a movement they despised. Federal money for anti-poverty activities in their communities would provide jobs, security, stability and energy for individuals and groups agitating about civil rights. In hopes of suppressing that now, tomorrow and forever, these local officials spurned the aid, which meant denying the benefits to white citizens along with black.

Remembering this confers a warped, regressive logic upon current behavior that seems at a glance baffling and irrational. Refusing the virtually free Medicaid expansion reminds everybody of who occupies what place in the reigning order and of the expectation that all should stay in their place.

Govs and Banksters

That is neither especially sick nor especially Southern. Imagine the feds proposing a policy that would shower big financial prizes—money, jobs, contracts, whatever—on states that recast their corporate regulations in certain ways. For instance, by requiring that the boards of directors of banks be elected not by stockholders but by stakeholders, defined as everybody directly affected by the banks’ operations. This is a reasonable, prudent, modest reform. Why shouldn’t institutions with such huge influence over the lives of people around them be guided by those affected rather than by those who happen to own the most shares and who may live somewhere across the oceans?

Such a plan would attract considerable support in Alabama and throughout the South — and a lot less in the southern end of Manhattan. There it would be recognized as an assault on the established order, and the feds would be vividly instructed about where they should put their offered aid.

At the moment this can only be imagined. There’s no organized demand for democratic banks. There is, however, swelling support for curbing the costs and spreading the access to health. Obamacare and the expansion of Medicaid attempt to address this urge.

If it succeeds, that could inspire movement in other realms now imaginary only. Fierce opposition would arise. The bankers might be driven into a mutual defense pact with the governors seeking to strangle Medicaid before it can grow.

They deserve each other.

© 2012, Glynn Wilson. All rights reserved.

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