What If?: Even the Best Republicans or Democrats

When news broke about John McCain’s cancer, political leaders from both major parties weighed in with words of praise and support—even former president Obama.

But here is my first thought: McCain will receive world-class medical care without any real fear of financial ruin because of his health crisis, but this fact is because he is extremely wealthy (much of that accumulated while being a career politician), not because he is a veteran, not because he is an American.

When Al Franken spoke about his middle-class roots and his wife’s struggle to rise out of poverty, Democrats began to post and praise Franken as the Great Hope of the party.

But here are my first thoughts: Franken’s white nostalgia for the good old days erases the very harsh realities for blacks, who did not have the same hope and promises Franken’s family and his wife’s family did (similar to McCain’s current fortune). While the good old days noted by Franken did include some identifiable opportunities gone today, Franken’s and his wife’s stories are significantly buoyed by their white privilege (conveniently omitted in his oratory).

McCain and Franken, I believe, represent both the best each major party has to offer and everything that is wrong with political leaders in the U.S.

McCain has worked his entire political life as a Republican to maintain the inequities of class and race that now benefit him in a very public and tragic way. McCain, in fact, was to be a major piece of Republican efforts to dump people off health insurance and to reduce the tattered safety nets needed by children, the poor, the elderly, and his fellow veterans.

Franken is the classic white progressive Martin Luther King Jr. warned about during the Civil Rights era. He speaks to rugged individualism and glosses past race because both strategies bolster his political capital.

The public in the U.S. is left victim to a vapid and soulless political sparring match between Republicans and Democrats, although neither party really cares about providing for all Americans the sorts of essential promises that every person deserves.

As one volatile example, we remain trapped in the abortion debate—as if that debate is about abortion, which it isn’t.

Throughout the history of the U.S. wealthy women have always had access to safe abortions; and regardless of the law, wealthy women will always maintain access to reproductive rights, safe and world-class healthcare for them and their children.

Roe v. Wade was narrowly about abortion, but broadly about expanding to all women in the U.S. the same rights already afforded the wealthy—just as we are witnessing in McCain’s cancer challenge.

I struggle to have the sort of compassion for McCain and praise for Franken that others are expressing because, in context, these men are—even as the best of their parties—the problems, not the solutions, to a more equitable country.

What if each of these men extended their own great fortune, much not even earned, to all Americans simply for being human? What if both of these men had worked and would now work to insure that especially the most vulnerable among are extended the promise that their human dignity will be preserved against poverty, disaster, and failing health?

What if they admitted the American Dream has never yet been achieved, even in their narratives about the good old days? What if they honestly sought ways to make that dream a reality soon?

What if enough Americans stopped playing petty and self-defeating political games so that our leaders had no choice but to do the right thing?

Yes, what if?

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On Healthcare and Poverty: The Ill-informed and Heartless U.S.A.

The healthcare debate spurred by the election of Trump has overlapped with my own adventures with the healthcare system due to my accident at the end of 2016 and my parents’ serious and fatal health events throughout the summer of 2017.

As a result, I have witnessed vividly how ill-informed most people are—from the general public to healthcare providers of all types—along with how that overlaps with massive and heartless misconceptions about poverty in the U.S.

While the U.S. has a long and disgusting history of racism and demonizing people in poverty, the current failure to provide social safety nets for the struggling has roots in Ronald Reagan’s politics of hatred anchored by the false but effective “welfare queen” narrative.

However, even more significant, the erosion of social programs became standard policy under Bill Clinton’s tone-deaf and self-serving “get tough on welfare” policies in the 1990s.

A robust welfare system and universal healthcare driven by a single-payer system are not only morally imperative in the U.S., but also fiscally essential to provide the stability that would enhance the market and everyone’s ability to prosper.

Answering honestly key questions about the intersection of poverty and healthcare in the U.S. must be committed to facts and not ideology.

1. Who are the poor in the U.S.?

The poor in the U.S. are not a swarm of lazy able-bodied people drawn to free money and thus living off all the hardworking Americans who hate that laziness.

The facts, instead, show this:

First, you can see above that the non-student, non-disabled, non-working adult poor make up around 11% to 16% of the poor each year. This is a pretty small percentage….

As you can see, more than 80% of the officially poor are either children, elderly, disabled, students, or the involuntarily unemployed (while the majority of the remaining officially poor are carers or working people who didn’t face an unemployment spell). I bring up these 80%+ because these are the classic categories of people that are considered vulnerable populations in capitalist economies. These are the categories of people that all welfare states target resources to in one form or another, the good ones very heavily.

2. Why do many in the U.S. believe the poor are primarily lazy, responsible for their own poverty—ignoring how poverty is mostly a lived condition of the vulnerable?

Maria Szalavitz explains in Why do we think poor people are poor because of their own bad choices?:

It all starts with the psychology concept known as the “fundamental attribution error”. This is a natural tendency to see the behavior of others as being determined by their character – while excusing our own behavior based on circumstances.

For example, if an unexpected medical emergency bankrupts you, you view yourself as a victim of bad fortune – while seeing other bankruptcy court clients as spendthrifts who carelessly had too many lattes. Or, if you’re unemployed, you recognize the hard effort you put into seeking work – but view others in the same situation as useless slackers. Their history and circumstances are invisible from your perspective….

A great example of what the fundamental attribution error looks like in real life can be found in the bestseller Hillbilly Elegy. JD Vance writes of seething with resentment as he worked as a teen cashier, watching people commit fraud with food stamps and talking on cellphones that he could only “dream about” being able to afford.

From his perspective, the food-stamp recipients were lazy and enjoyed selling food to support addictions rather than working honestly. But he had little idea how they saw it from within – whether they were using illicitly purchased alcohol to soothe grief, pain and trauma; whether they were buying something special to celebrate a child’s birthday; whether the hard life that he had been able to manage had just gotten the better of others who were born wired differently or who didn’t have any supportive family members, as he did with his beloved grandmother.

3. But the Affordable Care Act (ACA)—known as Obamacare and mistakenly by many Trump supporters thought to be two different programs—is a healthcare disaster?

The greatest charge against the ACA should be that it failed to go far enough in terms of moving the U.S. to universal single-payer healthcare, but the ACA did achieve greater coverage for more people, especially the vulnerable.

What many who blame the ACA for healthcare problems fail to acknowledge is that Republican-led states have purposeful worked to sabotage the ACA:

While the ACA improved access to health care for millions of Americans, it also amplified existing inequities in how states are treated by the federal government. Unfortunately, the Better Care Reconciliation Act (BCRA) proposed in the U.S. Senate not only fails to fix this problem — it essentially locks it in forever. States like Massachusetts and New York spend about twice as much money per Medicaid enrollee as South Carolina. By capping allowable increases in Medicaid spending, BCRA would let northeastern states keep benefitting from more federal funding than states like ours.

This is further exacerbated by the fact that some states expanded Medicaid under the ACA and tapped in to billions of dollars to improve health coverage, while others like South Carolina rejected expansion. Even though BCRA would phase out the Medicaid expansion over several years, expansion states would still collect billions more during that period, while non-expansion states would receive token allocations. There’s something inherently unfair about this — especially since this punishes the states that opposed Obamacare.

4. Isn’t the real solution to better healthcare the free market and not more government?

As J.B. Silvers explains:

This foundational belief rests on general experience in markets for most goods, and it has led to Republican support for Health Savings Accounts (HSAs), in which people set aside their own money to pay for their health care costs.

Landmark research showed that this approach could work – but under special conditions. The RAND Health Insurance Experiment is the basis for current HSAs. It demonstrated that people could save money – with no worsening of their health – if the cost sharing (deductibles and co-pays) was completely pre-funded in individual HSAs. The only major exceptions were for kids and some chronic conditions.

But current proposals have extended this logic to populations, such as those with low incomes and few assets, where these findings are not applicable. Furthermore, HSAs generally are not fully funded to the levels used in the RAND research.

Yet, the Better Care Reconciliation Act, as the current Senate bill is officially called, adds a substantial boost to HSAs, and most state-level Medicaid proposals include a modestly funded health savings account. The problem with this Republican approach is that poor people don’t have any money to begin with and typically can’t afford to buy insurance or pay deductibles.

Silvers also discredits the “let them work” argument:

While the Medicaid expansion enrollees are working already (by definition, they have income above the poverty line), their job prospects and history are marginal. The 30,000 Medicaid recipients in the health insurance plan that I ran as CEO, for example, had about nine months of Medicaid eligibility before they got a job and lost coverage.

But the myth persists that Medicaid is loaded with moochers who simply do not choose to work and won’t pay for coverage anyway.

The fact is that very few fall in this category. Work requirements and required premiums may be simply a way to reduce Medicaid rolls using a faulty assumption.

I have watched and am watching my own hard-working parents suffer dramatic and personal negative consequences of being ill-informed and then participating politically on those calloused beliefs.

Understanding poverty, who the poor are, and how universal single-payer healthcare—these are foundational for the prosperity of all Americans, who must set aside lazy and unwarranted beliefs grounded in disdain for a poor class of citizens who do not exist.

All of us are are will be among the vulnerable categories who suffer the most in the U.S.—children, the elderly, the disabled, carers, the working poor, students.

A final important question we must all answer: Should we all reject being ill-informed and heartless?

Freedom, Choice, and the Death of Us

“they did not stop to think they died instead”

“‘next to of course god america i,'” e.e. cummings

Over the course of a couple hours after my mother was discovered comatose, the ER doctor offered us a choice: airlift my mother to a larger hospital for surgery to remove the clot in her brain that caused her stroke or leave her comatose, each moment destroying more of her brain.

Just twelve days later, in front of my mother then in a rehabilitation facility after responding well to the high-risk surgery,  my father became unresponsive; the EMS team summoned by a 911 call were frantically trying to resuscitate my father, kept alive by his pacemaker/defibrillator. Since my father had resisted switching off the defibrillator and choosing a do-not-resuscitate (DNR) order, the lead EMS responder asked me where I wanted him to be transported.

Because of the proceeding days when we all scrambled against my parents’ health insurance, my first thought was how was I to know where his insurance would cover this event (ultimately the last moments of his life).

While cycling on the local rail trail near my university and where my mother now remains in a single room—the building in which she witnessed my father’s death—a friend and I pedaled up to a road crossing where a father sat on his bicycle with a trailer attached for children to ride along.

This intersection has decorative circles of brickwork on each side of the road. As this man crossed, he steered poorly around the brickwork—the cart left wheel rolling up onto the brick, tipping the cart and his two sons over onto the side of the trail and jerking the bicycle out from under the father.

These are all complicated and difficult stories about choice and freedom in the U.S.

The U.S. is a cruel and calloused culture that values a false narrative about freedom and choice, an idealized version of freedom and choice as concepts that trump all else.

Even human dignity.

Even life.

Especially in healthcare, education, and providing social support for the poor, the guiding principle is giving people choice, believing that individual responsibility is the root cause of poor health, failing students and schools, and finding oneself in poverty.

The meritocracy and rugged individualism myths are so powerful in the U.S. that winners and losers both cling to them even when the game is revealed to be fatally rigged. As Tim Maly explains:

So there are people who can be so wrapped up in a certain worldview that even in the face of serious evidence that they have been taken in, and despite many warnings from the rest of the world, they persist. Indeed, warnings from the rest of the world seem to serve only to entrench them in their position. With some of them, it’s as if they end up making bad choices specifically to spite the people warning them.

The U.S. has instilled a tremendous amount of self-loathing, in fact, among marginalized groups (blacks, English language learners, women) who feel compelled to embrace the bitter American Dream in order to be American—even as each of them could utter as Langston Hughes wrote:

Let America be America again.
Let it be the dream it used to be.
Let it be the pioneer on the plain
Seeking a home where he himself is free.

(America never was America to me.)

The parent cycling with his children in tow was free to choose placing those boys in the trailer, free to choose to pedal along the trail and then to send them tumbling.

And there we must admit, parental choice is not universally a good thing, and we must also confront that anyone’s choice necessarily encroaches on the freedom of others: children routinely suffer the consequences of their parents’ choices.

The children were fine, however, but my mother and father—along with our family—have been navigating a hellscape of healthcare dictated by patient choice and freedom, jumbled with a nightmare of bureaucracy in which mandated and bounded choices are not really choices at all.

In the U.S., we celebrate the choice between a Toyota Camry and Honda Accord (essentially the same car with the free market promise of competitive prices in your local market!), but few people are afforded the freedom of not buying a car at all—and no one is allowed the freedom from sales and property taxes or freedom from insurance and liability for all that driving.

Freedom and choice are in fact a nasty shell game used to keep the masses occupied so that they do not realize only the few have some sort of economic freedom and choice because of the labor of those masses, those people drawn to the myths like moths to a flame but never allowed to survive the allure.

It’s July 4th, a patriotic orgy in the U.S. that is as shallow and materialistic as the country we celebrate.

A people truly committed to equity and our moral obligations as humans would recognize that sometimes, maybe even often, choice and freedom are not as important as insuring that no one needs to choose because essentials are collectively provided for everyone to insure the dignity of simply being a human.

No child left to the lottery draw of their parents, no sick person tossed into the meat grinder of market-based healthcare, no elderly cast into the dark well of individual responsibility.

As we wave tiny plastic flags today, swill (mostly) cheap beer while overeating from our decadent grills, let us roast in the sun and the recognition that we actually have freedom and choice—and this heartless and selfish country is what we have chosen.

For Further Reading

Why poverty is not a personal choice, but a reflection of society, Shervin Assari

‘What to the Slave Is the Fourth of July?’ by Frederick Douglass

Healthcare? We Do Not Care: Blood from a Turnip

Over the past two weeks, my mother had a stroke and resides now in a rehabilitation facility, and my father died sitting beside her over this weekend, after deteriorating for months because of a failing heart.

My family has been experiencing the nightmare that is the consequence of living in a nation that worships money above all else: being sick and dying in the U.S. remains a financial disaster.

We in the U.S. have purposefully and willfully monetized illness and death.

While my mother was in the hospital, she needed her IV changed, but the floor nurse on duty was having trouble with the new placement. She called in the head nurse, who asked me about the care my mother was receiving at the hospital.

I eagerly praised the nurses, doctors, and staff—all of whom had been wonderful, and it is no hyperbole, they literally saved my mother’s life.

I explained, however, that this recent experience combined with my own accident on Christmas eve had reinforced how senseless the healthcare and insurance systems in the U.S. are.

She was quick to concur, noting how often the insurance representatives dictated what doctors have traditionally decided was best for patients.

My mother’s insurance was not a provider for the hospital where they saved her life; that same insurance made placing her in a rehabilitation facility a week-long waste of time, including rejecting her being in a higher care facility recommended by the doctors.

Today, we head to the mortuary with the blunt awareness that my working class parents have only a small balance in my father’s check book—accounts we may not be able to access due to my mother’s condition—and only their insurance and Social Security to sustain them.

As millions of people have done and are doing, we are navigating how inexpensively we can bury my father while also balancing how to provide my mother the care she needs to recover her life, again as inexpensively as possible,

I am a son of the South, just as I am of my parents, and I cannot push from my mind “You can’t get blood from a turnip.”

How did we allow this? How do we sit idly by and cheer on the soulless political leadership that manufactured this disaster and works now to make it even worse?

Insurance companies, pharmaceutical companies, and lawyers are feeding on us; our healthcare system is a real-life reveal like Soylent Green.

The wealthiest and most powerful country in human history could easily provide humanely for the health and death of every person who lives in the U.S. And as a people who rush to wave our flag and shout about being a Christian nation, we have the capacity to put our actions behind our words.

Other countries do because the people expect this basic human dignity.

But we do not care. We are an awful people.

For the love of money is a root of all kinds of evil. Some people, eager for money, have wandered from the faith and pierced themselves with many griefs. (1 Timothy 6:10, NIV)

The rich rule over the poor, and the borrower is slave to the lender. (Proverbs 22:7, NIV)

“Again I tell you, it is easier for a camel to go through the eye of a needle than for someone who is rich to enter the kingdom of God.” (Matthew 19:24, NIV)

If you are so inclined to evoke God, claim to know the wishes of God, we must admit there is no act of a god greater than the will of a people to put children, the elderly, the sick, and the dying before all else.

Instead, we have cast them all into the Terrible Churn that is our glorious Free Market.

Damning them, damning ourselves.


For Further Reading

Health Insurance Coverage and Health — What the Recent Evidence Tells Us, Benjamin D. Sommers, M.D., Ph.D.; Atul A. Gawande, M.D., M.P.H.; and Katherine Baicker, Ph.D.

Are the benefits of publicly subsidized coverage worth the cost? An analysis of mortality changes after Medicaid expansion suggests that expanding Medicaid saves lives at a societal cost of $327,000 to $867,000 per life saved.29 By comparison, other public policies that reduce mortality have been found to average $7.6 million per life saved, suggesting that expanding health insurance is a more cost-effective investment than many others we currently make in areas such as workplace safety and environmental protections. Factoring in enhanced well-being, mental health, and other outcomes would only further improve the cost–benefit ratio. But ultimately, policymakers and other stakeholders must decide how much they value these improvements in health, relative to other uses of public resources — from spending them on education and other social services to reducing taxes [emphasis added].

The Hollow Nation

Shape without form, shade without colour,
Paralysed force, gesture without motion…

“The Hollow Men,” T.S. Eliot

My name is Kathy H. I’m thirty-one years old, and I’ve been a carer now for eleven years….Carers aren’t machines.

Never Let Me Go, Kazuo Ishiguro

We are the hollow nation. We are the stuffed nation, “Leaning together/Headpiece filled with straw.”

It has been almost seven months since a motorist struck a pack of cyclists I was riding with on Christmas Eve 2016, injuring four of us—two seriously and permanently.

The motorist was deemed at fault on the scene, but received only a $76 ticket, less than the monthly payments I am making on my remaining medical bills since the insurance claim for the accident has yet to be settled.

My own insurance has paid much of the cost, but I am required to repay those payments once I have a settlement. The orthopedist, as well, overcharged me during my fracture treatment, refunding that amount more than six months later.

Nine or ten insurance companies and multiple lawyers have been wrestling with this accident, and the other injured cyclists and I have received a barrage of bills and notices from the ER, the hospital, the ambulance service, and numerous doctors. One cyclist was airlifted from the scene, and since the motorist had minimum coverage, his portion of that insurance likely was erased immediately in that urgent care.

This recent Monday morning, my mother was found unconscious by my youngest nephew, her grandson. She had a stroke, requiring an ambulance to transport her to our local hospital that then had her airlifted to a larger hospital nearby for emergency surgery on the clot discovered in her brain.

She has been in neurological ICU, and now a regular hospital room since Monday—but soon she will be transferred again to a rehabilitation facility for 2-3 weeks.

My father has been quite unwell recently; therefore, we are guiding him around in a wheelchair, circling our own wagons because my mother’s stroke creates a new and terrifying reality: she was his caretaker, and the family now must seek ways to provide both of my parents care.

Working-class children of the 1940s and 1950s, my parents have only Social Security and Medicare to sustain them.

Our next steps are swamped by if and how well their insurance and social services cover the medical care and rehabilitation my mother needs, if and how well my father can receive the daily care she has been providing.

My accident and my mother’s stroke are not nearly as extreme as the terrors of the healthcare system in the U.S. that countless people suffer daily. But these “terrors” are not really about the healthcare.

The treatment my mother has received, the seemingly miraculous surgery, has been the sort of kind and skilled medicine that leaves you mesmerized by the power of humans to make this world work in ways that are good and right and life-affirming.

But that care, I am afraid, is an isolated outlier in a calloused and awful system of administration, bureaucracy, and dehumanization caused by our lack of political courage as a people, as a country.

The power of universal healthcare and a single-payer system to provide humanity and dignity to the amazing medicine and brilliant healthcare providers already in the U.S. is left in the wake of our hollow nation.

A nation that is the wealthiest and most powerful in human history.

A nation that allows more than 1 in 5 children to live in poverty.

A nation of heartless and vicious partisan politics poised to dump an already inadequate system into the laps of caretakers, family members.

My accident exposes the hollowness of calls for individual responsibility; the system is designed to allow serial carelessness that leaves innocent victims responsible.

My mother’s stroke exposes that we as a nation genuinely do not care about a generation of people who may have bought the American Dream myth most sincerely—people such as my parents who were buoyed by white privilege they denied, who preached and practiced  the rigged rugged individualism scarred by racism with the faith it would pay off as they decline into their new reality of being dependent on the kindness of not only family, but the kindness of strangers.

Wealth and security are hoarded by a few, a vicious tribalism of a country that denies community, the power and dignity of everyone caring about everyone—not just the tunnel vision quest of “me getting mine,” the mean-spirited Social Darwinism that lurks beneath our national platitudes about working hard and fair play.

A hollow nation that denies the humanity of all sorts of “others” because of race and religion, but also culls away many at the edges of white privileged—white poor, white working-poor, white working class.

My parents represent that even the wink-wink-nod-nod promise of the American Dream (the white nationalism of “Make America Great Again”) is a lie, a calloused lie within the larger lie to the tired, the poor, the huddled massed—and especially a bald-faced lie about the so-called melting pot, a metaphor more accurate if named a witch’s cauldron.

With these realities before me, it is tempting to call for the removal of the Statue of Liberty, but at least, we must strip it of the poem inscribed at the base and post instead:

We are the hollow nation. We are the stuffed nation, “Leaning together/Headpiece filled with straw.”