Corn Whiskey and Snake Liniment
There's so much white noise from all quarters around the Affordable Health Care Act that it's nigh on impossible to sort out signal from static. One thing is obvious, though: No matter who is blathering about it, whether from the left or the right, the health care system in this country doesn't work well. It needs to be repaired or perhaps replaced entirely.
I've seen the results of an increasingly dysfunctional health care system on friends and family. I've watched as a colleague of my husband's has struggled against cancer -- and, at the very same time, during a harrowing health crisis in which she should have been allowed to focus on getting treatment and getting better, she has also had to fight every step of the way against her insurance company, which keeps denying her claims. I mean... seriously? She has cancer. And they're trying to deny her claims? This outstrips the right-wing myth of "Death Panels."
In fact, it is a de facto Death Panel when an insurance company imperils treatment for a serious disease, but not one run by the government or staffed by caregivers. Those screaming about government interference in our health care decisions seemingly take no notice of corporate interference in our health care choices. This is curious, because it seems to me that when business -- which has a bottom line devoted to safeguarding profits, rather than human beings -- is in charge of deciding who gets treatment and who doesn't, and who lives and who dies... well, a definite chill enters the room.
In another case, a family member's hernia diagnosis -- called at the outset by the patient himself -- took nine months and numerous referrals to an array of health care providers to nail down the problem. In the meantime, the hernia sufferer had to endure unending delays and tests: Could it be gastroenteritis? Cancer? Muscle strain? "It's a hernia," he kept insisting, only to be shushed by specialists who then had nothing useful to say, and who simply sent him off to other specialists. When he finally, and almost by chance, got a referral to a surgeon -- let me more precise: The surgeon he had to see before getting a referral to the surgeon who finally did the repair job -- the guy took a glance at the problem and said, "Of course it's a hernia."
Of course. But if it was so simple, why was it so hard? Why so costly and time consuming and frustrating? Why was the patient passed around from doctor to doctor and specialist to specialist like an insurance dollar-sucking hot potato?
The example of the hernia stands in, I think, as good an illustration of the overall problem that has culminated in today's shutdown of the federal government -- and our imminent default on paying the nation's bills.
Bill Clinton took on the job of reforming health care, and he failed. Barack Obama got the job done, only for the Republican-dominated House of Representatives to vote to repeal the Affordable Health Care Act no less than forty times.
Forty! And the shutdown has long been presaged by threats from the GOP to let the government's funding run out, despite the impact this will have on our economy.
Obviously, the GOP has a passion about stopping Obama's signature accomplishment. But is it worth shutting down the government and risking an economic tailspin?
That's only one of a raft of questions that present themselves. The Republican mantra is that government should stay out of the business of health care and let market forces to their magic. But if there was magic to be done, where was it during George W. Bush's two terms in the Oval Office? If, after the Clinton years, the GOP really had a better idea, why wait until Barack Obama stepped up to do something about the problem? Why wait for a Democrat to come to presidential power to insist that there is a better way, if only GOP lawmakers would be allowed to pursue it? Weren't those eight years with Bush at the helm ample enough an opportunity?
However it happened, it's only been recently that House Republicans have presented us with their grand vision: The American Health Care Reform Act, which does provide for some pretty sensible solutions. A few I particularly like, drawn from the RSC website:
"Specifically, H.R. 3121, the RSC's American Health Care Reform Act:
"...Spurs competition to lower health care costs by allowing Americans to purchase health insurance across state lines and enabling small businesses to pool together and get the same buying power as large corporations...
"...Provides tax reform that allows families and individuals to deduct health care costs, just like companies, leveling the playing field and providing all Americans with a standard deduction for health insurance.
"Expands access to Health Savings Accounts (HSAs), increasing the amount of pre-tax dollars individuals can deposit into portable savings accounts to be used for health care expenses.
"Safeguards individuals with pre-existing conditions from being discriminated against purchasing health insurance by bolstering state-based high risk pools and extending HIPAA guaranteed availability protections."
But the question remains: Why only now? Why now, only after President Obama actually did something, flawed though it may be?
An answer might be found here, in another provision of the "American Health Care Reform Act: it "Protects the unborn by ensuring no federal funding of abortions."
That's terrible. Not because it refuses to support abortion -- I don't believe in abortion, either, though I would never tell a woman she has no right to exercise the option -- but because it drags an issue that's only indirectly related into the heart of the legislation. It's a poison pill, in other words, cynically thrown into a practical formula that would otherwise be geared toward some measure of palpable success. It's hard to look at this partisan punch thrown from the abortion wars and feel that this proposal has the best interests of Americans at heart. It smells like ideological opportunism.
Still, hearing over and over again that "Obamacare" would be too expensive and deny people the freedom of choice, I sought out a brief explanation from Jimmy LaSalvia of GOProud. I asked him whether this fight really was worth shutting down the government. I was thinking about 1995, when Newt Gingrich and Clinton went head to head and the government shut down for three weeks. In the end, both sides took a hit in the public relations arena, but the GOP got hit worse. (The current received wisdom is that the shutdown helped Clinton win a second term the following year. As an article from the Washington Post put it earlier this year, that showdown between Gingrich and Clinton spelled the end of the "Republican Revolution.") I wondered whether the GOP risked tarnishing its brand by reacting, or overreacting, in such an extreme manner.
LaSalvia didn't seem to think the current situation was especially prone to comparison to what happened back then.
"Look," LaSalvia wrote me in an email. "The Senate hasn't passed a budget for several years. That's why there is even the deadline for a government shutdown.
"Seems to me that the House has twice sent the Senate a CR, and a budget has been sent over multiple times, so the Senate is [to] blame here. It's controlled by Democrats. So, I don't understand your question. Why would the GOP brand be tarnished?"
His email arrived even as the blogosphere was blowing up with comments to the effect that house Republicans were being "stupid" and "petulant," and a commentator on TV was comparing the shutdown to a child's temper tantrum. Obama himself, in a speech a little earlier, called the GOP's actions a matter of "demanding ransom," with the economy, and the fortunes of Americans, as the hostages. If politics is anything, it's perception -- and at least half the country has the definite perception that the Republicans have driven us right over a cliff for no good reason. There's also a feeling that the GOP has been hijacked by an extremist element that makes the Republicans as a whole reckless and unreliable -- unfit, in other words, to govern.
But there's half the country that might well approve of these extreme measures.
I asked LaSalvia to address other points that the GOP hammer at: That Obamacare will cost too much, that it will restrict freedoms to choose (abortion not being a restriction of the freedom to choose that the GOP seems to worry about), etc.
LaSalvia agreed that the new health law will simply be too expensive.
"It's not just small businesses and corporations that will have to pay more," he told me. "It's self-employed people who buy individual policies who will be hit the hardest. I know a lot of self-employed gay people, like me, who trying to make it in this economy and they don't know how they are going to afford the increase.
"The economic impact is expected to be so severe that the Administration is delaying the corporate mandate for a year because we just can't handle the job losses that are anticipated because of the increase costs," LaSalvia added.
For a wider perspective on this point, I sought out the input of the founder of a social media software company in the D.C. area, a man who identifies as fiscally conservative. He declined to be named in this column, so I will just call him Fred. As a small businessman looking at potential for expansion, Fred had more to say on this subject.
"There are certain benefits for small businesses, dependent upon how many employees they have," Fred explained. "Right now we are less than 25 [employees] -- so as of [Oct. 1] we technically [will] be able to shop for competitive coverage and apparently get lower rates -- I will believe that when I see it... and i hope it is true -- our rates have risen over the past two years by almost 33%."
Of course, with his company picking up steam all the time, the prospect of getting big -- maybe really big -- poses additional anxieties around the issue of how much it's going to cost to comply with the law.
Once a company has 50 or more employees, Fred told me, "you lose the ability to shop around for competitive coverage...and are forced to pay for coverage for the employee and their family.
"I think this has potential to be very damaging to small businesses.... I have spoken to companies that are laying off people just to get under 50 so they can get the competitive prices." On a national, systematic scale, layoffs or delayed hiring due to the health care law "will affect the unemployment rate...which is a huge economic indicator.
"Now... having said all of that I will say I think it is a great idea to make for a competitive market on healthcare coverage," Fred added. "It is smart to have insurance work to get your business. Before, it was too easy, and to make them compete is good."
It's refreshing to get out of one's own echo chamber for a while and hear what people from all across the political spectrum have to say. The health care crisis is also far too big to allow it be reduced to an ideological struggle -- too many people are affected and too many sectors of our national life overall are affected.
In that way, the Republican Party has exhibited a complete failure of leadership. Only lawmakers who devoutly believe that their mission as government officials is to destroy the government could pursue the tactics that Boehner has allowed himself to be forced into adopting.
But it takes two to dance, just as it takes two to engage in mutual recrimination. The Democrats, so often lacking in spine and discipline, chose a good moment and a good cause to exhibit some strength of character. But did they go about it the right way?
Well, here we are. Only time will tell how much good the Affordable Health Care Acts will really do us, and how badly the plunge into this latest government shutdown will harm us.
One office colleague commented that if the men and women in office saw their own paychecks stop with a shutdown like this, it would never happen. I think that's true, but I think there's a larger principle than money that is also in play here. I think it might do a world of good for our elected officials to take a politician's version of the Hippocratic Oath. I'd like to see lawmakers in both parties take a vow to "do no harm," instead of seizing license to inflict as much hardship as they think they can manage to blame on the other guy.
Meantime, I am going to stick to the only medicine I know truly does work: Corn whiskey and snake liniment. Ain't nothin' wrong with me that a visit to the curandera wouldn't fix.