HEALTH CARE/Joan Retsinas

Mad Victors

Lewis Carroll, meet the Mad Victors, those people who hoisted high their banner of “Choice” in the war against Obamacare, fighting for their right to choose their health insurance. They won, at least temporarily, a reprieve: thanks to computer glitches, the Mad Victors wore down those fascists who wanted to take away “choice.”

Carroll, who designed Wonderland, where, as the Cat told Alice, “we’re all mad here,” would understand, because this swathe of Americans is mad, in two senses of the word. First, they are mad, as in Wonderland. Second, they are angry-mad. And the combination fueled a bizarre campaign to save “choice.”

Of course many people insured on the “individual market” are content: they have chosen insurance with premiums that they can afford – sometimes with cheap premiums. They fear that under Obamacare they may pay more. And the Mad Victors have summoned up more than a few of them to scream and protest and complain: It’s not fair. It’s un-American.

Yet their insurance is often illusory: it will crumble when they go to use it – insurance for a topys-turvy Wonderland, or, as Alice would say “uncommon nonsense.” The fine print gives the specifics: treatments and conditions not covered, exorbitant co-payments, high deductibles, and low caps on outlays. These people are insured: they carry cards to prove it. But does their insurance cover obstetric care? Cardiac rehabilitation? Open-heart surgery? Colonoscopies? Does it cover routine well-child visits? Sick-child visits? Respiratory therapy? Medications? Diagnostic tests, like MRIs and CAT scans? Even if the insurer says “yes,” what is the deductible? What is the annual cap? Is it a lifetime cap?

Realistically, no enrollee knows the fine points of a policy until he needs healthcare. So all those photo-ops showing happy people eager to keep their insurance are showing healthy people. Ask people who are ill, needing treatment, whether their insurance is wonderful. Medical bankruptcy is one casualty of our healthcare system: people losing whatever nest egg they had, or hope to have, because of an illness. Even people with insurance can end up in debt. Only in America does the term “underinsured” exist: people have insurance that won’t cover much of what they need.

Ironically, the Affordable Care Act makes “insurance” a rational, legitimate product, with few of those financially catastrophic loopholes. Indeed, the coverage is comprehensive (people can quibble how comprehensive, but it marks an improvement over some of the cheap policies floating in the market); the co-payments and deductibles, reasonable. As for the cost of the premiums, the Affordable Care Act includes subsidies. Under the Affordable Care Act, some of the people screaming to safeguard the status quo will end up with a better policy, at a lower cost. “Curiouser and curiouser” that people should object.

The ultimate irony, though, is that the people battling for “choice” overlook the 42 million Americans who have no choice at all. They are uninsured. They can’t get insurance through their employer – either because their employer doesn’t offer it, they don’t work sufficient hours, or they can’t afford the insurance the employer does offer. They can’t buy it on the private market, generally because they can’t afford the premiums. Or they may be ill – in market terms, “uninsurable.” The Affordable Care Act gave states the option of expanding Medicaid to include more of their “uninsured” and “uninsurable” residents; yet some states, eager to safeguard their credentials as conservative avatars, said “no.” Maybe they expected those people denied Medicaid coverage would gratefully accept the consequence of their leaders’ conservative purity.

Alice left Wonderland; I’m hoping Americans soon leave this bizarre world of empty choices.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, January 1-15, 2014