The Morality of Health Care Reform, Pt. 5

"The fundamental truth about health care in every country is that national values, national character, determine how each system works."

Prof. Uwe Reinhardt, Princeton Professor & Health Care Economist

"I think health care is a privilege. I wouldn't call it a right."

Sen. Jim DeMint, R-SC

Drop Dead

Whether or not it's a crisis that millions of Americans are uninsured or underinsured, that thousands lose their health insurance every day, or that tens of thousands die every year because they lack health insurance is a matter of perspective. The same goes for the economic crisis, the foreclosure crisis, or any other crisis.

Depending on your perspective, there's nothing wrong with hundreds of thousands, or even millions losing their homes to foreclosure. (Even if deregulating the finance sector made it easier to sell them time bombs, in the form of mortgages, that went off long after the people who really matter made an easy buck and moved on.) There's nothing wrong with millions of people having no health insurance, and thus no access to affordable, quality care. There's nothing wrong, because it's all right, and there's no need to do anything about it.

That's why I have to disagree with the following assertion, from Simon Johnson and James Kwak [1].

No one is against expanding health coverage on principle. As we come down to crunch time, the health-reform debate is all about money.

We can't assume that "no one is against expanding health coverage on principle," because it's flat wrong. Just like there were plenty of people who were against mortgage modification on principle, and just like there were plenty of people who were against the economic stimulus on principle, there are plenty of people who disagree with expanding healthcare coverage. And they disagree with the very principle that everyone should be covered.

The examples are abundant, on just about any issue; take Phil Gramm (who considers Wall Street a "holy place" [2]) grumbling about a "nation of whiners" squeezed in the vise of an economic downturn his on political maneuverings helped create [3], or Rick Santelli's [4] (perhaps a high priest of holiness, in Gramm's view) (manufactured [5]?) rant against bailing out "losers" (whose numbers have risen to account for a record number of foreclosures [6]), while ignoring irresponsible financial giants being bailed out by taxpayers; or take South Carolina governor Mark Sanford turning down stimulus funds, and offering a jobless South Carolinian his prayers instead [7].

The examples in the realm of health care reveal a whole new dimension of "Drop Dead Conservatism." [8].

Drop Dead. That's the best answer that some conservatives have been able to offer to a country in teeth of the worst financial crisis we've faced in a generation. When the Wall Street crisis loomed and the bailout was being debated: let the market fail, and risk another Great Depression, "for the sake of the altar of the free market." Now, the economic downturn having worsened - and in ways that are more deeply felt in parts of the country far from centers of financial or political power - their response to rescuing the largest remnant of our manufacturing sector? "Drop Dead," and devil take the hindmost.

Drop dead. That's the overall message of conservatives who (a) see nothing wrong with the status quo in our health care system, because they (b) see nothing wrong with millions of people having no insurance and no access to care.

Seen from that perspective, it's clear that the people who confronted GOP lawmakers in townhalls were talking about their wants not their needs. As such, they got put in their "place," for whining about privileges they clearly haven't earned because they can't afford them — like the woman Tom Coburn schooled (to thunderous applause) for wanting help for her husband's medical problems.

Coburn's non-answer [9] to his constituent's call for help is actually less telling than the audience response.

Sen. Tom Coburn, R-Okla., is a medical doctor; his press releases frequently refer to him not as "Sen. Coburn" but as "Dr. Coburn." He is also a fervent opponent of Obamacare. Coburn purports to favor an alternative bill so similar to the Democrats' own that one can't help wondering whether his opposition is mere partisan posturing. Another possibility is that Coburn is insincere when he claims to support any change to the current system.

Evidence for the latter is an exchange between Coburn and a weeping constituent who said at an Aug. 24 town hall meeting that her health insurance wouldn't cover rehabilitation for her husband, who suffered a traumatic brain injury. Writing in the New Republic's health care blog, the Treatment, Harold Pollack*, a professor at the University of Chicago School of Social Service Administration, said that when he saw this clip neither he nor his wife, a clinical nurse specialist, "could … believe what we were watching."

...Pollack, his wife, and Philip Pizzo, dean of Stanford Medical School, found Coburn's answer to be deeply disturbing. I did, too, of course. But what truly shocked and depressed me was not Coburn's let-'em-eat-cake response but the fact that it wasn't met in the room with a collective sharp intake of breath. Instead, Coburn received two quite robust bursts of applause. I have no idea how Congress and the White House can possibly sell health care reform to people like that.

It's not surprising, though discouraging that no one in the Coburn town hall stood up to ask: how is "neighbors helping neighbors" supposed to work when our neighbors are losing their jobs and their health insurance, in communities still receiving aftershocks from an economic downturn that started with an implosion on Wall Street. (Which, by the way, is doing much better now.) How is "neighbors helping neighbors" supposed to work when entire communities are devastated by layoffs [10], services are curtailed due to decreased tax revenues, and families barely have enough to keep themselves a roof over their heads and food on the table?

But the sharp shock of the 2008 financial crisis paralyzed the U.S. economy. Mass layoffs have been at a record high, flooding the labor market with job hunters. Six years of manufacturing-job losses were compressed into 18 months, overwhelming retraining programs. The collapse of home values and the tightening of credit make worker mobility a moot issue. Instead of connecting the jobless to new jobs, the employment system has seized up. After 33 weeks of searching for work, Whitfield is looking warily to December, when his unemployment insurance ends.

In an unhealthy economy, a single lost job becomes infectious, combining with others and spreading through family, neighborhood and community. Widespread cutbacks in spending by families mean lower demand for businesses and lower tax revenues for the government. This belt-tightening means fewer car sales and thus fewer jobs for car-part makers. It means less government spending on infrastructure and other public services, including economic development. The sum effect is less available work for job seekers — a perfect vicious circle. For a well-educated job loser like Whitfield, it can mean a permanent drop in earning power and standard of living — a reversal of the American Dream.

It not Coburn's problem, of course. He has a job. Though, as the CNN host pointed out above, Coburn's job is, well, a government job. So any help from his office (it's unknown whether the constituent contacted or received help from Coburn's office) would be help from the government.

Coburn might have remembered Jason Rosenbaum: Why Can't We Have Health Benefits as Good as Chuck Grassley? [11]">Sen. Chuck Grassley's "get a government job"

response to one constituent.

Iowa Senator Chuck Grassley gets a pretty sweet deal as Senator on health care. He pays $356.59 per month, and the most he pays when visiting a doctor or hospital is $300. Compare that to your average Iowan family, who would pay almost $600 a month and be on the hook for $5,000 or more if they went to the hospital.

And who pays for Grassley's benefits? Taxpayers like you and me.

Senator Grassley's health benefits meet his needs and they're affordable. So why can't people like you and me have something just as good?

Grassley was asked this very question by an Iowa voter at a town hall a few weeks ago. Instead of honestly answering the question, Grassley dismissed it, saying first that the citizen should get a job with John Deere (which recently laid off hundreds in Iowa) and then that the citizen should get a job with the federal government - a job like Senator Grassley's - if he wanted health care as good.

Sens. Grassley and Coburn could, perhaps, have helped their constituents by offering them jobs in their own offices — and let them work for their health insurance — but it's unknown whether they did that much, even.

Fortunately, for those constituents, they don't live in Rep. Phil Gingrey's Georgia district [12]. He might listen to their stories, but he won't be able to help them until he stops laughing.

Media Matters catches Republican Congressman Phil Gingrey (Georgia) in a pretty insensitive moment during a speech on the floor of the House. At one point during his long speech railing against health care reform, Gingrey found the idea amusing that 14,000 Americans losing their health insurance every day constituted some kind of health care crisis:

14,000 people are losing their health insurance every day NOT because of the cost of health insurance [laughs], they're losing it because they lost their job!

Perhaps Gingrey thinks that Democrats (and the constituents who came to Coburn and Grassley — their elected representatives — for help) are overreacting to the health care "crisis," just as Rep. Eric Cantor (the no. 2 Republican in the House) felt Democrats were overreacting to the economic crisis [13].

Maybe that's what Cantor thought of the constituent who brought up her relative's problems with medical care: she was overreacting. That's why he told her to just find a government program [14] or get some charity.

The constituent said she has a close relative in her early forties "who did have a wonderful, high-paying job, owns her own home, and is a a real contributing member of society." Then she lost her job and found out she has stomach tumors and needs an operation.

"She has no insurance," the constituent said.

"This person is a very close member of my family," she said. "She's ill. And she has no way to have this operation. So I'm asking you, what would you do if this were your close relative. Your niece, your aunt, your sister or whatever."

Cantor suggested looking into "an existing government program."

"There are programs, there are charitable organizations, there are hospitals here who do provide charity care," he continued.

"No one in this country, given who we are, should ever be sitting without an option to go be addressed."

And apparently this Republican wants us to rely on government and the charity of others to ensure that.

There's a great irony, though conservatives tend not to "do" irony, in Cantor's recommendation of a government program, and his failure to recognize the limitations of charity [15].

As for relying on charities and the kindness of strangers to save those facing life-threatening illnesses, what Cantor may not realize is that these charities, through no fault of their own, necessarily have to ration care and force patients to endure long wait times -- there are fewer resources than patients.

In other words, Cantor's warnings about the perils of a reformed system are already a reality.

It would seem obvious that the health care crisis is too big to be entirely solve by charity, though there's a definitely role and need for it, because there aren't many charities big enough to effectively solve the problem. But whether there's a big health care crisis, or lots of individual health care crises — or whether there's problem to solve at all — depends on your perspective. It's a matter of perspective whether you see the perils of a system that provides everyone with access to affordable, quality care or whether you see a system already in peril.

Even former presidential candidate, Sen. John McCain had to face a pointed question from a constituent who thinks there's a problem with health care coverage: Why didn't Republicans ever reform health care while they were in power?

Um. Because there's nothing to reform. Everything is working just fine. Otherwise, why would the GOP have no plan of its own [16]?

House Minority Whip Eric Cantor (R) and Rep. Bobby Scott (D) got together yesterday for a forum on health care policy in their home state of Virginia. By all accounts, it was a civil gathering in Richmond.

Cantor was pressed, however, on a couple areas of interest.

Richmond resident Ben Ragsdale demanded to know how Republicans were going to expand access to healthcare if they have only a four-page list of bullet-points as their plan.

"What is your substantive proposal to meet these real everyday problems that people have? Where's the beef?" Ragsdale asked, triggering applause from the crowd.

The telegenic GOP lawmaker said Republicans and Democrats agree on 80 percent of fixing the nation's healthcare system, but could not show the crowd a detailed plan that has been endorsed by House Republicans.

Cantor earlier this year said House Republican leaders would release an alternative healthcare plan, but have not done so yet.

There are two interesting angles here. The first is the constituent's very good point -- there's still no Republican health care plan. House Minority Leader John Boehner (R-Ohio) told reporters in July that GOP lawmakers were putting "the final touches on our bill," which, he said, would hopefully be available "soon." That was 61 days ago, and no one's heard a peep about their bill since.

Depending on how you see it, the constituents in the Cantor, Grassley, and Coburn townhall meetings, aren't part millions of Americans caught up in the crisis of health care and health insurance. They aren't a sign that we have a big problem. Instead they are just people with small, individual problems, that aren't anybody else's problem anyway.

After all, it's not like they have a right to health care. As Sen. DeMint pointed out above, it's a privilege, not a right. And Rep. Zach Wamp further clarified out early on in the debate it's a privilege for some people, but not for all.

Presumably, Sen. DeMint was including among those who don't deserve the privilege of health insurance or health care the 17.4% of South Carolinians who are uninsured [17], according to recent census data. And Rep. Wamp was counting among those who don't deserve the privilege of health care the 1.7 million Tennesseans who were uninsured [18] at some point between 2007 and 2008, including 32.4% of non-elderly Tennesseans who were uninsured for a month or more — many of whom were probably among the thousands so desperate for health care they can't afford that they'll wait to get treated in livestock stalls.

He flew in corporate jets to industry meetings to plan how to block health reform, he says. He rode in limousines to confabs to concoct messaging to scare the public about reform. But in his heart, he began to have doubts as the business model for insurance evolved in recent years from spreading risk to dumping the risky.

Then in 2007 Mr. Potter attended a premiere of "Sicko," Michael Moore's excoriating film about the American health care system. Mr. Potter was taking notes so that he could prepare a propaganda counterblast - but he found himself agreeing with a great deal of the film.

A month later, Mr. Potter was back home in Tennessee, visiting his parents, and dropped in on a three-day charity program at a county fairgrounds to provide medical care for patients who could not afford doctors. Long lines of people were waiting in the rain, and patients were being examined and treated in public in stalls intended for livestock.

"It was a life-changing event to witness that," he remembered. Increasingly, he found himself despising himself for helping block health reforms. "It sounds hokey, but I would look in the mirror and think, how did I get into this?"

He might even be addressing himself to all of the Americans served by the Tennessee-based charity that those services and provides similar services all over the country. Founded with the remote areas of the world in mind, Remote Area Medical n now does 60% of it's work in the US, bringing health care to uninsured Americans who can't otherwise afford it.

Most recently, the organization brought its services to the Los Angeles area [19], where nearly 100,000 came seeking medical care [20].

Like a giant MASH unit, the floor of the Forum, the arena where Madonna once played four sold-out shows, housed aisle upon aisle of dental chairs, where drilling, cleaning and extracting took place in the open. A few cushions were duct-taped to a folding table in a coat closet, an examining room where Dr. Eugene Taw, a volunteer, saw patients.

When Remote Area Medical, the Tennessee-based organization running the event, decided to try its hand at large urban medical services, its principals thought Los Angeles would be a good place to start. But they were far from prepared for the outpouring of need. Set up for eight days of care, the group was already overwhelmed on the first day after allowing 1,500 people through the door, nearly 500 of whom had still not been served by day’s end and had to return in the wee hours Wednesday morning.

The enormous response to the free care was a stark corollary to the hundreds of Americans who have filled town-hall-style meetings throughout the country, angrily expressing their fear of the Obama administration’s proposed changes to the nation’s health care system. The bleachers of patients also reflected the state’s high unemployment, recent reduction in its Medicaid services for the poor and high deductibles and co-payments that have come to define many employer-sponsored insurance programs.

Many of those here said they lacked insurance, but many others said they had coverage but not enough to meet all their needs — or that they could afford. Some said they were well aware of the larger national health care debate, and were eager for changes.

Many don't have coverage "enough to meet all their needs"? But it's not even a need, but a "want," as Andrew Card pointed out.

Card, I guess, should tell that to these people.

And even if were a need, other people's needs — whether sitting in a livestock stall in need medical care, or facing foreclosure and needing shelter — are not our problem to solve or our responsibility to provide.

After all, we've got ours. We already have health benefits. We're safe. So it doesn't really benefit us to make sure everyone else gets the care they need want. It doesn't do the rest of us any more good, anyway.

Does it?