Page 1 of 2 Middle-class suicide
By Julian Delasantellis
It's pretty much par for the course for science fiction to tell tales of a
bleak and nightmarish future, but even so, Ridley Scott's 1982 movie Blade
Runner, from the Philip K Dick novel, Do Androids Dream of Electric
Sheep? really piled it on with the dystopian delights.
Set in the year 2019, in a Los Angeles with a population of 100 million (10
times its current population), the movie shows what happens when a society
allows its middle class to wither and die. Here, Los Angeles has been rent into
two socioeconomic classes with almost no regular contact - a small, far-off
wealthy class growing ever fatter and happier on the backs of its slave labor
android workforce mining the natural resources of the outer planets, and a
vast, polyglot lower class, speaking a bastardized English composed of parts of
all the languages of the immigrant
communities competing with each other for what few of society's crumbs are
available to them. All this is happening amidst a grossly polluted urban
landscape where toxic rain regularly falls on the unfortunates.
Now, Scott's fatal future is just 10 years away, and, don't you know, many
Americans seem to be expressing a desire to live according to Blade Runner's
dire table of social organization. Obviously, they think they'll be up there
living blessed and bountiful lives among the elite, but statistical probability
would much more likely be having them struggling, or more likely dying, out
there in the pools of black rain in the gutters.
Well, the United States citizenry is now telling political pollsters that it
disproves of President Barack Obama's plan for near universal health insurance
coverage, so forever more it must take responsibility for its actions.
Karl Marx once said that history always repeats itself, first as tragedy, then
as farce; and it's true, the US Congressional Democratic Party, as if they were
understudies at a community college summerstock production of "How not to run a
country", has slipped into the role of its predecessors in the 1993-94
Congress, the institution which morphed into a giant tub of writhing Jello
rather than vote on then first lady Hillary Clinton's healthcare initiative.
This was the last time the US actually tried to address its dysfunctional
healthcare system in something even remotely resembling an adult fashion, and
today's efforts seem to be heading for the same fate; it's almost as if, as the
house lights come down, the stage voice announces that "Tonight, playing the
role of Compuserve will be Twitter". Obviously, Act III of the scripts are
similar; without a fast rewrite, this story will end with yet another
thunderous Democratic Party mid-term election thrashing in 2010, then, after
another 14 years in exile, perhaps the healthcare issue can be addressed again
in 2024.
The problem, here is the same as it was back then, seemingly, it's the same as
it's been since time immemorial. While the Democrats have been studying and
researching the healthcare problem the way they do everything, as if it were
all just another case study assignment at Harvard's John F Kennedy School of
Government, the Republicans have been getting the politics down cold, and, once
again, that's the more critical feature of the debate.
Simple to swallow
Using a technique that University of California at Berkeley Professor George
Lakoff describes as "framing", they have boiled down the entire complex
healthcare debate into a way they know common people can understand and support
their side of the issue.
"You've got to remember that these are just simple farmers." Jim the Gunfighter
(Gene Wilder ) warned unpopular new Sheriff Bart (Cleavon Little) in Mel
Brooks's 1974 cowboy howler, Blazing Saddles. "These are people of the
land. The common clay of the new West. You know ... morons."
For almost a half century now, the Republican Party has produced brilliant,
lacerating political strategists, that always operated pledging full alliance
to Jim's teachings - from Nixon guru (and current Fox News chief) Roger Ailes,
to Reagan/George HW Bush era gutter streetfighter Lee Atwater, to George W
Bush's "brain" Karl Rove, to current master pollster Frank Luntz.
Republicans are now aping a Luntz-generated line that the country does not need
a healthcare reform initiative as far-reaching and daring as Obama's; as about
85% of the population is already covered by employer-provided health insurance
or the government's Medicare program for the elderly, there's no reason to tip
over the applecart.
What's really being said here is that the Republicans are offering upper
middle-class white America a deal - reject Obama, stand true with us, and we'll
guarantee that on you or your parents' next visit to the doctor in the suburban
office park, Mom or Dad won't be distracted from their perusal of the waiting
room's two-year-old National Geographics by the din of a single mother
unsuccessfully trying to quiet her brood of, as Jim described Bart, "dazzling
urbanites" each with their own blaring boomboxes.
It's a lot less likely that any family composed of "those" people would have
health insurance and so would never have been allowed to set up an appointment.
That's the main function of American health insurance - it's a gatekeeper, an
ever-vigilant, conscientious Cerberus ever separating those who have it from
the howling masses of lower middle-class pain that lack it.
When American tourists visit the Italian town of Pisa, home of the famed
leaning tower, they feel smug and self-satisfied, confident that their proud
engineers and architects could never construct such a poorly made and dangerous
building that could seemingly collapse at a moment's notice; that's just about
what Italian and other tourists feel upon seeing the US healthcare system at
work.
Long ago, it was determined that healthcare was not a market like those for
other goods; if your car needed brake service you could just shop around for
your best price/quality deal, but if you needed heart service, like open-heart
surgery, no matter who in the phonebook you called, the vast majority of
potential customers weren't going to find somebody they could afford to do the
operation.
The potentially backbreaking cost of your treatments had to be spread around,
had to be pooled among others who, in return, would receive assurances that,
when needed, their needs too would be covered as well. This introduced the
concept of health insurance, the large pools of insurance payers from which
payments to doctors and hospitals could be drawn. Also, since the "pool" would
always be dry if everybody waited to purchase insurance until they really
needed it, the health insurance would have to be acquired and maintained in
periods of good health as well as bad.
This fact, and the social dangers thought to be inherent in denying health
security to large numbers of potentially desperate people, had most advanced
democracies moving by the first years after World War II towards some sort of
government-provided healthcare.
But not in America. Doctor opposition to universal government-run national
health insurance, sometimes derisively called "socialized medicine", sunk an
attempt by president Franklin Delano Roosevelt to include it in later New Deal
legislation. No, the American model has public healthcare clearly and
undeniably always arriving through the back door.
War orders to arm the Arsenal of Democracy had factories previously covered in
rust and spider webs humming along 24/7 by the early 1940s; factory managers
couldn't get the workers they needed to fill the orders from the Allies, even
before America entered the war after Pearl Harbor.
Roosevelt's wage and price controls prevented factories from utilizing the
standard remedy for worker shortages - higher wages. However, a loophole in the
regulations allowed extra non-cash benefits to be offered as an incentive to
workers. Health insurance was one of these, and most factories were soon
offering this as an incentive to keep their large pools of valuable and skilled
workers. When the war ended, president Harry S Truman once again reached for
national health insurance, once again failing in the face of more medical
industry opposition.
But for a long time, this system worked. US factories, with a huge domestic
market to serve and most of their foreign competition bombed out of existence,
were so insanely profitable that providing what was then cheap health insurance
to workers wasn't much of a problem; the idea was to keep workers contented and
employed so as to not foment strikes that would turned away have flush
customers ready to buy anything in the showroom with their fistfuls of cash
(or, even better, their newly introduced credit cards!).
In 1965, president Lyndon Johnson wanted his Medicare health program for the
elderly to be expanded eventually into a program for all ages, and in 1970
president Richard Nixon talked about a sort of national managed-care program,
but while prosperity raged on there was just no appetite, in the country or in
Congress, for big changes.
Then, starting around 1980, healthcare technology spurred healthcare inflation,
and with the foreign manufacturing competitors rebuilt and fighting the feeble
old American industrial giants for every sale, and so denying them their cushy
monopoly rent, there was a problem, and there has been ever since.
In 1975, Paul Bartel directed another future dystopian epic movie, Death Race
2000, about a cross-country car race where the drivers are awarded
points by hitting and killing pedestrians. This is similar to the way Americans
experience their healthcare system, the big difference being that they
experience it not as the drivers but as the pedestrians.
Say, at the beginning of the game, you're a young fellow just starting your
career, finally freed from mom and dad's healthcare policy. The objective of
the game is simple - you have to cross a street from where you are now, at age
22 or so, to the other side of the street, age 65, when all Americans
regardless of income become eligible for the wildly popular uber
socialized-medicine government program called Medicare.
Ten years go by, and things are going well - our contestant hasn't yet been
hit, perhaps he's picked up a spouse, a few kids, maybe a house. Now the game
gets interesting; he's got something to lose.
How well our contestant is going to do depends on two things - his skill and
his luck. If he makes it to the other side of the street, age 65, to Medicare,
unhit by a racer or untouched by a major medical crisis, he'll win the game.
He'll be able to keep everything he's earned in life, that is until he has to
enter a nursing home for his final years and Medicare takes everything. If he
dies before enfeeblement and infirmity force this, and he's able to pass down
everything he owns to his successors, he's really a big winner!
But if he starts taking hits in the middle of the road, he's in trouble.
Whether he will be able to continue going on without incurring such large bills
that will result in him losing everything in bankruptcy court (for almost all
private sector insurance policies have some sort of lifetime or yearly upper
benefit limit that has insurance coverage ceasing when broached) is the core of
the game.
Without any health insurance, anything much more serious than a few doctor's
office visits, maybe a surgery or two or a chronic condition requiring extended
treatment, will break him and throw him out of the game . A better-insured
contestant can take a few more hits, but even here, a serious, long-term
condition such as multiple myeloma will probably push his medical bills beyond
his policy's limits, and then he's gone. Even contestants with very good
coverage will be thrown out of the game if forced to deal with long-term
complex diagnoses, such as those requiring an organ transplant or DNA therapy.
So, therefore, to win the game, unless he's throwing the dice and betting on
luck (which millions of Americans are now doing by going without health
insurance and then clogging the bankruptcy court when they lose) to get to
Medicare and win the game one must be shielded by as much health insurance as
possible. If health insurance for the under 65 population is something granted
by the employer, how does one get one's employer to provide lots of health
insurance?
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