Monday, May 14, 2018

Health care (Things that worry me, part 1)

It was never my plan to write so many multi-part things, and even when I knew I was going to be doing War is Hell, I thought it would be three posts, not six. Then I was going to move on because I have lots of things that I want to write about before I get into general civics and politics.

However, about three weeks ago there were a few things going around Twitter that concerned me, and they would certainly fit into political and civic discourse later, but that doesn't feel quite right either. I am going to try and cover them this week, and hey, maybe the parenthetical numbering will be helpful.

The first one was a thread from Andy Slavitt on health care that was primarily a series of links to other articles, but together they made an alarming trend: 

Those links are all available, but here is a quick list of things happening under this administration:
  • elimination protections for transgender people
  • not recognizing the sovereign rights of Native communities
  • gutting the rights of people with disabilities
  • allowing insurance plans that allow unlimited profits (by not requiring coverage for all conditions, preexisting conditions, and setting caps)
  • putting work requirements on Medicaid (many of those using Medicaid are already working, but an interruption in their job can then leave them uncovered)
  • attacking nutrition programs for low-income groups
  • ending guarantees on birth control coverage
This is how Slavitt ended his thread:
"2017 was a ground war, covered every day in the news as Congress sought to repeal the ACA. 2018 is a cold war— millions will lose coverage, millions more will lose protections, millions more vital elements of their care by the end of the year and it is not a major news item./end"
I think it is more accurate to call this a guerrilla war, but the point stands: after multiple failures to completely overturn the Affordable Care Act, the new goal is death by a thousand cuts.

There are a few things that stand out to me. Perhaps the most annoying is my added note to the Medicaid line, because I know how popular work requirements are with conservatives, and because I don't think it is fair to ignore how many people are working and still need help (which could lead to a good discussion about wages and benefits and things like that) I leave open the issue that some people can't work, or it is feasible for them to work now, or all of the many good reasons why someone can still deserve health care just for being a human being. These are frustrating discussions when there is so much heartlessness and cruelty underlining the need for the discussions.

One part of the Medicaid discussion is the sovereign rights discussion, as it is over the work-for-Medicaid requirements. Indian health care policies have been set up on the basis of treaty and land theft and a host of other things. That means not only that there is added unfairness to something that is already unfair, but I can see additional attempts to erode their sovereignty becoming a big part of the war on the environment.

Going right along with that, it should be no surprise to see protections for corporate profits going as a key plank in the attacks, but it is also disingenuous. Compliance with disability requirements would stimulate the economy. It involves consultation and construction and it helps more people be fully engaged and contributing to society. If it seemed like an undue burden on companies (especially smaller ones), there could be government funding as a stimulus package. This administration will always choose doing harm over doing good.

However, what stood out most was that the way of administering the thousand deadly cuts is by going after marginalized groups, for whom health care is an important part of an often precarious situation. There will be people who applaud transgender individuals not getting their "special" right to health care. Lots of people will be thrilled to see cuts to anything that helps poor people. That's the direction we've been heading.

Looking at it like this, though, the first thing that it makes me think of Martin Niemöller's quote:
"...Then they came for me -- and there was no one left to speak for me."
There was something else that made it more ominous though. I told you there were a few things going around Twitter. I'll try and get to the second one tomorrow.

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