At the health care inflection point

The Thinker by Rodin

Back in January I mentioned a mindful eating course I was enrolled in. A full discussion of the course is probably for another time if I think it warrants a blog post. (I’ve become pickier about what I blog about, as I post less frequently and am trying hard to make my posts more relevant and topical.) One of the interesting takeaways from the course though was to learn to trust your body.

It turns out this is a really hard thing to do, particularly here in America. For most of us spend lives trying to respond to conformance requests coming mostly from outside ourselves. It’s constant and incessant. In the area of eating, you get endless “shoulds” and guilt-laden advice about what to eat, when, how much and using which techniques. These techniques rarely work in the long term because they are not natural to us, which is why so many of us are overweight and obese. Trusting to your own inner wisdom shouldn’t be hard, but it is hard because we simply don’t know how.

Of course it’s much more than food. We spend much of our lives being inauthentic to ourselves. We pray to gods we don’t really believe in. We chase after status symbols thinking we’ll be better or happier when we possess that McMansion or that BMW. We take advice from popular people in our class or some loudmouth on the TV or talk radio thinking they are actually wiser than we are. More topically, we vote for people who don’t have our best interest at heart, ending up more unhappy and miserable as a result.

We do this at least in part because we’ve learned that to get along you got to go along. We want to belong and since most of us don’t have local tribes anymore, we join our virtual tribes instead. They are often led by people looking to screw us over, if not monetarily then at least mentally. Facing the reality of our bad choices is hard. If we were to face them, we would often realize we were played for a fool. So rather than face them we continue to work against our own self-interest.

Logically most of those who voted Republican or for Trump should be regretting their choices. Many of them are but of course even Trump has a dependable group who will stick with him no matter how much he sticks it to them. As I noted recently, ninety percent of Republicans voted for Trump, despite knowing full well what he was about: a bankrupt-prone, pussy-grabbing businessman with zero common sense and a racist streak a mile wide.

It seems though that many who voted for Republicans are waking up. We see this not in a pressing desire to vote for a Democrat, but in polls showing waning enthusiasm for their fellow Republicans. There are other polls that show even majorities of Republicans disapproving of their party’s actions. Both the House and Senate health care “reform” bills are widely despised, even among Republicans.

Trump ran partly on a platform of reforming health care. It would be easy to reform he told us, and you would get better coverage for less. Whereas the sad reality is that Trump really has no idea what’s in the bills he has been promoting, other than he heard the House bill was “mean” so he instructed the Senate not to make their bill “mean”.

Trump is not being mendacious; he is simply unable to absorb detail. But if the Congressional Budget Office is to be believed, either 22 or 23 million people will be uninsured within ten years if either of these bills become law, with 14 million losing health insurance within the first year and likely a majority of them will be Republicans. Those with insurance will pay a lot more, both in higher premiums and higher deductibles. Technically these don’t amount to higher taxes since this money is not going to the government. If it did, it might buy something useful. It will feel like a tax hike however as your standard of living rapidly erodes.

If either of these bills becomes law, it will be a disaster. It certainly will be for those losing health insurance. The reality however will be much more brutal. Health care spending is a huge part of our economy. It will close hospitals, mostly in rural areas. Without insurance people won’t see doctors, so doctors will bill fewer hours and make less money. The cost of emergency care will be foisted on those still with insurance, raising the cost of insurance even higher. It will have a huge cascading effect of not only people dying prematurely and in misery, but in creating huge amounts of medical debt and lost health care jobs. It will careen like a locomotive off its tracks and wreck much of our economy. It won’t affect just the healthcare industry, but all those businesses that depend on health care employees and health care spending, which is most of the economy.

All this is to give huge tax cuts to the 1% who don’t need the money. Arguably the taxes these rich people pay pay for themselves in sustained economic growth, which is keeping stock prices and their portfolio rising.

Some lessons for me:

  • Our current healthcare system must be fundamentally changed if it is to survive at all. The current system works poorly, but it works a whole lot better than it will if either of these bills pass.
  • It’s really in everyone’s best interest to reform our health care system, as it is unsustainable. If there is any industry too big to fail, it’s not on Wall Street but our health care system. It feeds off patients. And patients need insurance to see doctors because only the top 1% can pay for their own healthcare.
  • Obamacare is dying, but not for the reasons people think. It’s dying because it tried to work using a system of private insurance. It’s the private health care system that no longer works as it puts profits first, not people.
  • Expanded Medicaid is demonstrating to new generations that socialized medicine does work. Ask most of Mitch McConnell’s constituents, who are on the program. Only to them it’s something called KyNect.
  • Like it or not we are at a health care inflection point. We must solve this fundamental issue in the only way it can be solved: through comprehensive national legislation that addresses its critical defects. Obamacare does not need amending. And it needs to be replaced with something that is the complete opposite of what both bills in Congress purport to call “health care”.
  • My life, and yours, depends on us rising to the occasion.

Dear Supreme Court: please free our political moderates

The Thinker by Rodin

The Supreme Court has agreed to hear a case on whether Wisconsin’s state assembly map constitutes an illegal partisan gerrymander. The court has never struck down a voting district map based solely on its political boundaries, so it’s unwise for those who would like to see fairer voting districts to get their expectations up.

I’m not enough of a lawyer (not being one at all) to understand the legal issues, other than the constitution specifically delegates voting criteria to the states. The Voting Rights Act requires that certain criteria (like race-based criteria) cannot be used in drawing maps. This hasn’t kept states from doing this anyhow. In most cases courts strike down these maps after an election where they are used to partisan advantage. New districts are drawn that are generally still illegal, so the cycle seems to continue forever and never really gets settled. At least that’s been the case since the Supreme Court’s 2013 ruling that certain predominantly southern states no longer need to have their voting maps cleared in advance.

State assembly maps are where the real power is, because generally they draw the political boundaries for both state and federal voting districts. Republicans used this to great effect after the 2010 election when they won Congress and state houses. Voting districts were required to be redrawn based on the 2010 census so Republicans used it to lock in their power at least through 2020. Quite frankly, this has a lot to do with the mess we are in at the moment. These highly partisan voting maps as well as state voting restrictions that don’t pass the smell test have given Republicans enormous political clout that far overstates their power if voting districts were created fairly and impartially.

Pretty much everyone agrees that our politics are a huge mess. This is a direct result of extreme gerrymandering. I sure hope the court finds political gerrymandering illegal, but most likely they will not. I hope this not just because I necessarily am pining for more Democrats in office. I say this because to end our political mess we need lots of moderates in office. I can’t see any way to bring moderates back into politics unless we end political gerrymandering.

Democrats may be in the minority in Congress, but it’s becoming even harder to find any moderates left in Congress. Moderates of both parties used to form the political center. Their presence allowed government to function because they facilitated political compromise. These days significant change is only possible if one party controls both Congress and the White House. Usually when that happens you get laws that only appeal to the rabid wings of the party. Trumpcare is liked by only 16% of Americans, with even only 34% of Republicans liking it, but that doesn’t mean that Congress won’t pass it anyhow.

If it happens it will be a law of immense cruelty. Make no mistake: the Senate’s current version of the bill has nothing to do with improving health care. That’s merely a smokescreen. It has two principle purposes. The first is to give tax cuts to the wealthy. Republicans see it as restoring tax rates for the wealthy to what they were before the Affordable Care Act. The second is to end Medicaid as an open-ended entitlement program. For more than fifty years it has set a floor that no citizen could sink beneath. By limiting federal contributions, it encourages states to race toward the bottom: limiting enrollment and cutting benefits. In effect, the poor will simply get poorer, making the wealth gap even worse than it is now. The effect is pretty obvious: lots of people are going to die prematurely and painfully. It’s an outcome that only the Marquis de Sade and today’s Republicans can love.

All this is from a supposedly “pro-life” party. It’s obviously quite the opposite. I’ve discussed these gaping inconsistencies in many other posts, so I won’t revisit them here. What I will note is that whether it is Republicans who want to kill off their poor constituents because they don’t believe the rich should help subsidize their health, or whether it’s far left partisan Democrats who won’t accept anything less than single-payer health insurance, ideally at government-run hospitals and healthcare centers like the Veterans Administration, these are solutions favored by a fringe. Ask your typical man or woman in the street if they favor either of these approaches and you are likely to get a resounding “No!”

But you don’t see many of these people in Congress because gerrymandering conspires to leave them out. That’s the real crime of gerrymandering: trying to force the government to be run by the extreme partisans when it needs the consent of the governed, which includes a lot of moderates. Gerrymandering extends political dysfunction, empowers people that hate their own government, fosters conflict and may pave the way toward a new civil war.

All of this is preventable if government can become of, by and for the people again. With moderates forming about 35% of the population, but likely represented by no more than 10% of legislators their interests are simply not getting considered. This is political disenfranchisement on a massive scale. Blacks may be disproportionately under represented, but at least these highly-partisan voting maps gives them some diluted representation. Moderates though have little to no representation. Unless the Supreme Court steps up and declares political gerrymandering unconstitutional or (much more unlikely) Congress sees the light and acts against their own partisan interests to enact such a law, it’s not hard to predict that our government will become more detached from its citizens, ultimately representing mostly a highly partisan few. That’s a recipe for national disorder that only the Kremlin would approve because it is simply not democratic. It’s not even republican.

So the Supreme Court could become the savior of our democracy if they find the legal standing or discipline to do so in their upcoming decision. If there was ever a reason for Americans to pray, praying the Supreme Court sees the light on this seems a priority for religious Americans of all types.