Page 2 of 2 US healthcare debate sick to the heart
By Julian Delasantellis
slavishly competing to satisfy their every whim, the program that serves them,
Medicare, even though it is a government program, cannot be a "government
program." All over the country, Democrats and supporters of Obama's healthcare
reform efforts have been confronted with angry calls by seniors and others to
"keep the government's hands off Medicare", thus exposing a societal fault line
that is going a long way towards fatally sabotaging Obama's efforts.
Since health insurance past the age of 65 is government guaranteed but under 65
is a factor of employment, younger workers just starting their careers have
just about the lowest rates of health insurance coverage. These workers may be
just starting out in lower paid jobs that don't provide health insurance, or
they
may be working in multiple part-time jobs, none of which provide affordable
coverage.
Through the exclusion of all facts, to instead focus on the vulnerable elderly
population's fears and apprehensions, the foes of healthcare reform actually
have many elderly Americans believing that the Obama administration is going to
fund health care for the young by euthanizing the old.
Why not believe it? After all, in Wild in the Streets, the 1968 story of
the first baby boomer president before Obama, Max Frost (Christopher Jones)
imprisoned people over 35, including his own mother (Shelley Winters) no less.
What more evidence do you need?
The young people are blogging and tweeting, but the old people are voting, and,
right now, to congressmen like Larsen, that makes all the difference.
A surprisingly intelligent, for this forum anyway, question comes from a young
woman who asks whether healthcare reform will change the American health care
system's focus towards, as she puts it, "value rather than volume". In essence,
she is asking whether more emphasis can be directed towards better patient
outcomes rather than just pushing more pills, procedures and surgeries towards
patients.
Larsen blows some approving verbiage at her, and the crowd applauds politely.
This think-tank type wonkery, this intellectual petits fours, is not the
steaming and bloody red meat that this crowd is here for. That comes in the
form of a question as to, when the Obama daughters get pregnant, whether their
abortions would be paid for under the healthcare reform proposals.
Young adult and teenage daughters of US presidents have lived in the White
House during a number of recent presidencies, among them those of Lyndon Baines
Johnson, Richard Nixon, Gerald Ford, Jimmy Carter, Bill Clinton and George W
Bush, and I never remember any questions being raised about the public policy
consequences of their apparently boundless licentiousness and debauchery.
Still, why is this question being raised about Obama's daughters, who are,
after all, now only 11 and eight years old? It seems to me that the questioner,
without submitting his research findings to any sort of peer reviewed journal
in sociology or genetics, is contending that teenaged promiscuity is not a
result of deficiencies in environment or upbringing (like that apparently
suffered by Alaska Governor and 2008 Republican vice presidential nominee Sarah
Palin's daughter Bristol), but stems from the inherited factor of being an
African-American female, something that a less pedantic intellect might very
well call pure and unabashed racism.
And I'll buy that questioner 100 rounds of increasingly scarce shotgun
ammunition if he can tell me the difference between a peer reviewed journal and
a grocery store manager's fresh fruit ordering list.
As dusk's gloom spread over the diamond (no way was Larsen going to ask to
switch on the field lights and keep this thing going into the wee hours), I
left the park no wiser about healthcare policy but a lot wiser about how the
divisions in American society are skillfully exploited by its privileged
classes.
Rather than a reasoned debate or an informed discussion of the issues, what
went on that night was a temper tantrum, something like what a two-year-old
will engage in once he discovers the awesome power of the concept of "no". "Do
you want a cookie?" "No!" "Do you want to watch cartoons?" "No!" "Do you want
to go to McDonald's?" "No!" After that long first year wherein the toddler had
almost no way in his surroundings or circumstances, he now is given just a
little chance to influence his world, and is using it for all it's worth.
It's the same recently with the American populace. They, too, have been forced
to undergo unspeakable indignities with little or no say in the matter. Their
opinions related to illegal immigration are ignored. They're now suffering
through a severe recession, which they feel they had no role in creating - it's
all the bankers' fault, according to the public.
Then along came the hundreds of billions to trillions of dollars worth of
system support mechanisms, the TARPs and the TALFs and the PPIPs, and all the
auto industry and financial industry bailouts, initiatives that the public all
vehemently opposed but passed anyway over their objections. The public would
much rather see all this largesse flowing its way instead of what it sees as
having the elite feeding the elite, and they feel, probably incorrectly, that
this will all eventually come out of their taxes.
So, when the public finally does get its opinion solicited, as in the town hall
meetings, is it all that surprising that they are stamping their feet on the
floor, holding their breath until they turn blue, and screaming out "no!"
It would be one thing if the process was improving the product, but that is
clearly not the case. The real problem with US healthcare is not that extension
cords are being stolen from grandma's life-support machine so kids can play
video games; it's the bloated and bulging cost structure of US medicine,
expensive by a factor of two to four times per capita than other advanced
industrial democracies, and scheduled to account for one out of every five
dollars of gross domestic proudct by late in the next decade.
Healthcare costs and the uninsured are not separate problems. They are two
sides of the same problem, as it is the high costs of the system that makes
insurance unaffordable to the uninsured.
But healthcare reform's exposure to the democratic process is, if anything,
making the problem worse. Obama's weekend concessions that he is willing to
accept a final bill with a weak or non-existent "public option" removes what
could have been a powerful tool to employ competitive pressure to discipline
some of the more rapacious instincts of the for-profit health insurance
industry.
A similar weakening of cost cutting discipline will come from Obama's
concessions to the pharmaceutical industry; in exchange for a pledge of tepid
support for his proposals, Obama has apparently agreed to continue the odious
practice started with the Republican 2003 Medicare drug act that forbids the
Federal government from leveraging its considerable pharmaceutical buying power
to negotiate lower consumer drug prices.
The controversy over the ridiculous claims that seniors will soon be forcibly
euthanized under mandate from Stalinist "death panels" means that any chance of
any real national discussion over America's unique custom that calls for
extraordinarily expensive technological, and frequently intrusive and painful
medical interventions to be administered to patients whome doctors know are in
their last month or days of life falls to nil. To prove that they had nothing
to do with these figments of Sarah Palin's febrile imagination, Congress will
probably soon mandate that Stage 4 cancer patients on terminal life support be
provided with government-purchased grand pianos.
Without a real focus on costs, it is hard not to see that all the sturm und
drang of the current healthcare debate will soon all come to naught,
whether a bill is passed or not. The cost of providing healthcare will continue
to bankrupt the gradually fewer companies that still offer it to employees;
other companies will soon follow the US auto industry to the corporate
graveyard, all of them felled by being unable to compete with companies based
in countries where the government foots the bill for healthcare. The auto
companies' care in sparing their Canadian plants from the worst of the factory
closing wave is an example of this.
On the public side, high and growing healthcare costs should bankrupt even the
admittedly efficiently run Medicare program by the end of the next decade; at
the state and local level, the costs of providing healthcare to public
employees means more future teacher layoffs and overcrowded classrooms, in an
educational system that even now poorly competes with foreign school systems;
more crumbling infrastructure; fewer public parks and transportation; and,
ultimately, more bankruptcies like that which has so recently laid California
so low.
Without realistic medical care cost control and containment, this issue will
surely return to the nation's attention. Next time, though, the freedom to act
as if actions have no consequence may be a luxury no longer available to
postpone difficult choices.
One thing that the Obama administration's continuing retreats on the health
policy battlefront proves is the awesome political power of a new weapon that
the reactionary forces in American politics now have at their disposal - the
less-informed voter, or LIV, especially effective when stoked white hot with
cultural envy.
The Obama administration is not being defeated by the town hall's reasoned and
intelligent argument; indeed, like a World War I doughboy felled by shellshock
in the trenches, Obama's Ivy Leaguers seemed stunned into mute catatonia by the
sheer asininity and inanity of the arguments presented in opposition to it. The
death of grandma comes to mind first here, but my favorite was a housewife's
comment at a town meeting with Pennsylvania senator Arlen Specter, that the
Obama healthcare plan would make the United States indistinguishable from the
old Soviet Union.
It wasn't the USSR's genocidal forced agricultural collectivizations or the
murder of the kulaks that bothered her, nor was it the establishment and
maintenance of the Gulag. What she said really scared her about the prospect of
the Soviet States of America was not the fact that the old USSR had no freedom;
it was that it had no toilet paper.
The left wing's coping strategy to deal with the LIV is to try to bring the
light into the darkness, to educate them as to the errors of their ways, but
that is proving to be like a hand grenade tied to a boomerang coming back to
explode in their face. The right, seeing this "education" that the left is
trying to provide the LIVs, whispers this message back in their ears: "They
think you're stupid; that's why they think you need to be educated. They look
down on your trailer parks and country music and stock-car racing and unwed
teenaged birth and methamphetamine addictions and say you have to change; if
you vote for us we'll gladly affirm all of that as part of your cultural
heritage. They may have all these programs that they say may benefit you,
things like workplace safety and college loans and healthcare, but we'll give
you somebody to resent and hate; hey, you know which one you'd rather have."
What the howls of August really prove is that, unless the Democrats can find a
way to deal effectively with the LIV phenomenon, they could be looking at truly
awesome losses in the 2010 and 2012 elections, including that of Barack Obama's
presidency itself. That would have Obama going down in history as a sort of
modern day Oliver Cromwell, an illegitimate interloper to the throne whose
reign interrupted that of the country's rightful rulers, in 17th century
Britain the Stuart kings, in 21st century America, the free-market
conservatives.
Perhaps Larsen had the right idea. Whenever a questioner identified the town he
or she was from, if it was in the Congressman's district, he would immediately
rejoin with a cheer that displayed to the questioner that Larsen knew the
nickname of the town's secondary school athletic teams, as in "Go Bears" or "Go
Vikings". When the event was about three quarters finished, he called for a
break, which, as the event was in a baseball stadium, he called a "seventh
inning stretch", a baseball tradition. Following in that tradition, Larsen
entreated the crowd to follow yet another baseball ritual, a communal sing of Take
me out to the ball game.
The stunt seemed to cut the tension a bit for the remaining duration of the
event. In Andrew Lloyd Webber's Evita, an Argentinean oligarch sniffs at
the new demagogic first couple of Juan and Eva Peron, noting that
"Statesmanship is more than entertaining peasants".
Not on this night. Maybe, in present-day United States and in the America of
the near-term future, that's precisely what statesmanship and good governance
will have to be.
Julian Delasantellis is a management consultant, private investor and
educator in international business in the US state of Washington. He can be
reached at juliandelasantellis@yahoo.com.
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