Health Care and Someone Else's Child

In a previous post [1], I wrote that Mitt Romney was booed at the NAACP convention when he reiterated his support for repealing health care reform was because,  what health care reform means for African Americans [2]. Many people in the audience probably knew what health care reform means for them, their families, and the communities.

Romney offered the standard conservative "one-size-fits-all" solution for health care.

Free enterprise is still the greatest force for upward mobility, economic security, and the expansion of the middle class. We have seen in recent years what it’s like to have less free enterprise. As President, I will show the good things that can happen when we have more – more business activity, more jobs, more opportunity, more paychecks, more savings accounts.

Romney either ignored or failed to grasp that his experience with the free market is very different from the experiences of many people in the NAACP audience.

Judging from their booing and the looks on their faces [3], the folks in the audience for Mitt's speech probably know only too well  that conservatives have no alternative health care solutions to offer [4], and no intent of offering any meaningful solution for the health care concerns of African American families and communities. 

Mitt Romney's solution is "the free market," but many people in the NAACP audience for Mitt's speech could probably have borrowed an old blues lyric to sum up their experience: "Your Free Market Ain't Like Mine." [5]

For him, free enterprise is the answer to all of America’s problems. By free enterprise, he means de-regulation and low taxes for the rich corporations and people. He means trickle down economics. Those policies are not the solution. They are the problem. Those failed policies gave us the mortgage foreclosure crisis and soaring unemployment. Those policies gave us the recession.

Their free market certainly isn't much like Romney's free market.

There were probably people in that audience who knew what kind of solutions the "free market" tends to offer them [6].

That’s the problem with applying a "market-based solution" to a problem like health care. I can’t explain it any better than Republican Senator Chuck Grassley.

But Sen. Charles Grassley, a Republican from Iowa, questions whether dentists at corporate dental chains are free from corporate pressures to maximize profits. Grassley, the ranking member of the Senate Finance Committee, wouldn’t speak about Aspen Dental specifically, but he’s had committee investigators looking into the company and other private-equity-owned chains for months.

"Because when private equity firms get involved," Grassley explained, "you got to understand that their motivation is to make money. And they are not dentists. And dentists ought to make the determination ’ of what is good for the teeth.’ Not some private equity manager in Wall Street."

The problem is that there are populations that need services, but there’s no profit to be made in serving them. There are services that we as a country, at least until recently, have agreed that people should receive whether there’s a profit to be made or not. Health care is one of them. "Market-based" solutions require profit, and the only way to make a profit serving these populations is to overcharge, under-serve, or both.

It's no coincidence that Deamonte Driver's death for lack of a dentist [7] became symbolic of the need for health care reform. Nor was it a coincidence that Marcellas Owens [8], whose mother died when he was just eight years old, after losing her job caused her to lose her health insurance, and her previous salary disqualified her from receiving Medicaid.

In times of crisis, "who the hell we are," is defined by what we do together — and what we agree we should do together — for "someone else's child."  As Ezra Klein explained a couple of months ago, health care is still something we still agree that we should do together [9]. 

Health-care and higher education are similar in another way, too: People don’t think they can responsibly say no to either expense. Families take out hundreds of thousands of dollars of debt to pay medical bills and tuition costs. The only other cost that’s anything like that is housing — and it’s a much more optional expense. You can buy a house on your schedule. Health-care costs and your child’s 18th birthday tend to be somewhat less cooperative.

This inability to say no removes the ultimate form of market discipline: the consumer’s ability to simply walk out of the store. Oh, you can, at times, walk over to another store and try your luck there — though that’s not true if you’ve been brought into the ER in an ambulance, and it’s not true if your son only got into one decent college — but it tilts the power towards the sellers and away from the buyers.

There’s certainly more we could do to bring market pressures into play in both sectors, but the reason the government ends up involved in health care and education is that a real market would require us telling more people than we’re comfortable with that they can’t have the medical care or education that they need.

One thing we have so far agreed we should do together is to make up the difference, when the medical care someone can afford falls far short of the medical care they need. Many people in the audience for  NAACP could look at "someone else's child," like Deamonte or Marcellas, and see their own child, or a child from their community, and want the same for "someone else's child" that they'd want for their own — to get the medical care they need.

Given the amount of right-wing propaganda thrown at health care reform, it's a small wonder that the majority of Americans are are not comfortable telling people they can't have the medical care they need: support for health care reform spiked after the Supreme Court upheld the law [10]. Even before the Court ruled, most Americans said they wanted to keep health care reform [11], in one form or another. And now that the Court has ruled on health care reform, the majority of Americans want Republicans to just move on already [12].

On health care, Biden compared what the Obama administration accomplished with health care reform, and the old status quo Republicans are determined to return us to.

“Health care. We see a future where everyone has access to affordable health care…

[Applause]

“Where seniors have access to prescription drugs at a lower cost, where they have access to preventive care – making their lives more livable and reducing costs, where insurance companies cannot deny coverage because of a pre-existing condition, where there are no limits on insurance policies, where children can stay with their parents on their policy until they’re 26, where Medicare is guaranteed and Medicaid is expanded.

[Applause, cheers]

“Where no American faces the prospect of a bankruptcy just because they get sick.

[Applause]

“Romney and his allies see health care a different way – controlled by the insurance companies – where pregnancy is a pre-existing condition, where coverage can be taken away if you get sick or hit your limit, where Medicare is voucherized,19 million people cut off of Medicaid, where 30 million Americans will have to wait for another generation before they have a chance for affordable decent health care.

We can only assume that the GOP would return us what used to be the status quo on health care, because Mitt Romney has no health care plan [13] and the Republican's have offered no alternatives to the health care reform bill [14]. The House GOP has voted 33 times to repeal health care reform [15], but haven't bothered to come up with anything to "replace" it that would accomplish the same things that health care reform has and will accomplish [16], and probably never intended to in the first place [12].

Ezra Klein wrote that in the old days, Democrats and Republicans used to argue over how best to accomplish universal coverage [17], but at least agreed that every American should have access to health care. That debate is over, mainly because today's conservatives believe there's nothing to reform [18], because there was nothing wrong to with the way things were [19].

The reality is that not all Democrats are progressive. The health care reform debate is illustrative of this divide, and the challenge progressives face with this political reality.

The difference depends on what you believe concerning health care. Is it an injustice that millions of Americans have little or no access to quality, affordable health care? Or is it merely unfortunate?

It depends on whether you believe health care is a right. It's a generalization, but not too much of one, to say that progressives — many or most — believe that health care is a right; or, more specifically, that access to quality, affordable health care is a right. This makes health care a human rights or civil rights issue. It means that a system in which millions are without access to care is an unjust system.

What if you don't believe that health care is a right? If you don't believe that health care is a right, then it is not a human rights or civil rights issue. It means that millions of Americans being without health care is not an injustice. It may be unfortunate, but it's not an injustice.

What does this matter? It matters, because an injustice and a merely unfortunate circumstance add up to to different levels of urgency. An injustice, to many people, is intolerable, and thus so is any delay in delivering justice.

That why Mitt Romney's health reform plan is non-existent. That's why Republicans like David Drier can say they don't necessarily believe that expensive medical care should be provided to people with pre-existing conditions [20].

And he's supposed to be one of the reasonable ones:

Rep. David Dreier (R-Calif.) said on Monday evening that he didn't believe highly expensive health care should be provided to uninsured patients with pre-existing conditions...

"While I don't think that someone who is diagnosed with a massive tumor should the next day be able to have millions and millions and millions of dollars of health care provided, I do believe there can be a structure to deal with the issue of pre-existing conditions," Dreier said.

What do you suppose he thinks should happen to this person? Does he think there should be some sort of ....death panel that decides whether he lives or dies? Or should we just assume that anyone with a deadly illness who doesn't have enough insurance to pay for "millions and millions and millions" of dollars of health care should just be euthanized on the spot? Or perhaps they should be made to suffer. After all they failed to get rich enough or lucky enough to have adequate funds to pay for their needs so maybe it would be best to use some of these sickly parasites as cautionary tales.

That's why conservatives who don't have the burden of eventually running for re-election can stay more bluntly what they believe about access to health care [21].

Breathe deeply and try to summon your inner peace before reading this description, from economist Tyler Cowen, of what conservatives and libertarians should put in health care policy. You're going to need every drop of calm and sanity you can muster.

2. A rejection of health care egalitarianism, namely a recognition that the wealthy will purchase more and better health care than the poor. Trying to equalize health care consumption hurts the poor, since most feasible policies to do this take away cash from the poor, either directly or through the operation of tax incidence. We need to accept the principle that sometimes poor people will die just because they are poor. Some of you don’t like the sound of that, but we already let the wealthy enjoy all sorts of other goods — most importantly status — which lengthen their lives and which the poor enjoy to a much lesser degree. We shouldn’t screw up our health care institutions by being determined to fight inegalitarian principles for one very select set of factors which determine health care outcomes.

I'm going to repeat that: "We need to accept the principle that sometimes poor people will die just because they are poor."

There's some little danger in addressing this kind of "pure, sociopathic callousness," as Freddie deBoer describes it.

The "principle that sometimes poor people will die just because the are poor," is the principle of of what Deepak Bhargava called "America's Health Apartheid." [22]

History tells us that ignoring inequality tends to further entrench its insidious causes. It's imperative that we begin an honest debate about the fundamental reality that health care access and outcomes in America are radically unequal.

Consider these facts:

• Hispanics are twice as likely to die from diabetes. Tuberculosis strikes Asian Americans at 16 times the rate of whites. Cancer kills 35 percent more African-Americans than whites.
• If two patients have similar heart disease, a black patient is one-third less likely to undergo life saving bypass surgery than a white patient.
• Among preschool children hospitalized for asthma, only 7 percent of black and 2 percent of Hispanic children, compared with 21 percent of white children, are prescribed routine medications to prevent future asthma-related hospitalizations.
• One of the most dramatic predictors of health is access to insurance and while 11 percent of whites are uninsured, about 32 percent of Latinos, 20 percent of blacks and 17 percent of Asian Americans have no health coverage.

This is the principle that played out in the lives of Deamonte Driver and Marcellas Owens, and one that many in the audience for Romney's NAACP speech have seen play out in their families and communities. When Wolf Blitzer queried Ron Paul about a hypothetical uninsured may will terminal illness,  "But Congressman, are you saying that society should just let him die?," [23] this is the principle that led  one audience member to shout "Yes!", and several more to cheer his answer. This is the principle that led Republican governors to say "Drop dead, to the uninsured [24], as they reject the Medicaid expansion in health care reform [25] in their rush to abandon the poor [26] in their states — some of which, by the way, have the worst records on health care in the country.

This is the difference between conservatives and progressives on health care. For progressives, that "sometimes poor people will die just because they are poor" is a problem -- one we can, and should, solve together. For conservatives, that "sometimes poor people will die just because they are poor" is a principle that be accepted.