HEALTH CARE/Joan Retsinas

To the 47% ...

You 47-percenters – the ones Mitt Romney said wouldn’t vote for him no matter what – speak out. Shriek! In Romney-speak, you are the people who see government subsidies as entitlements – whether for housing, income or healthcare. In liberal-speak, you are the people left behind, at the margins of progress, on the lowest levels of a steep ladder.

Of course, the other slice of the nation – the ones presumably not on the dole – still feed at Uncle Sam’s trough – but less overtly. Offshore licensing of corporations, coupled with tax code arcana (e.g., lower rates for carried interest, for capital gains, mortgage interest deductions) have bred a class of multi-millionaires, oblivious to Uncle Sam as their fiscal godfather. This is a strange case of false consciousness: the poor don’t see themselves as exploited; the rich don’t see themselves as exploiters.

Nevertheless, in this campaign season, a slew of candidates are ignoring you. They preach a gospel of micro-government, lower taxes, and, uber alles, personal responsibility. In this brave new world of Republican ascendancy, solons will repeal the dreaded “mandate” to buy insurance, leaving you free to embrace your misery. In this new world, governments may – or may not – expand Medicaid. Insurers may opt to reinstitute those provisions, from caps to exclusions for pre-existing conditions, that made their companies’ bottom lines soar. Government will step out of the way of private insurers, unfettering them to net mega-profits.

These candidates have not arisen de novo. They echo a satisfied flank of the electorate, who care about a lot of issues — immigration, abortion, terrorism, the deficit, trade – but not about you. Above all, those voters care about the economy. They see a tradeoff: government spending versus economic prosperity. Their reasoning is simple: the less the government spends on regulations and subsidies, the more robust the private sector will be. And the more robust that sector, the better off “everybody” will be, ultimately. If the proverbial tide rises, all boats will rise. A slew of economists have questioned the wisdom of this simplistic assumption, but data don’t tamper the power of a popular myth.

Many Americans, though, have waited decades for their boats to bob. Even in a surging economy, their boats barely stayed afloat, whatever way the GDP or trade balance pointed. Not so long ago, once upon a more prosperous time, with low unemployment, 44 million Americans had no insurance, and as many had abysmal coverage.

Healthwise, the Affordable Care Act improved some Americans’ lot. The Act expanded coverage, while setting minimum standards for policies. The Act is not perfect. Nineteen million Americans remain uninsured (most in states where governors did not expand Medicaid). And those uninsured face a porous “safety net.” Consider the emergence of Surgery without Borders. It is not an outgrowth of Physicians without Borders, which operates throughout the developing world. Instead, it brings surgery to uninsured low-wage workers in California’s Central Valley. As for the insured, even with subsidies, they face costs that strain middle income budgets, as their premiums, co-pays and deductibles mount.

But the Act is young. Republicans who couldn’t abort it have promised to repeal it. Many Americans would cheer repeal; for some, repeal wouldn’t matter. (In spite of the rhetoric, repeal wouldn’t spur the nation to full employment.) But repeal promises misery for the people in leaky boats. They risk losing what little ground they’ve gained. And they have few champions among the Republican Presidential candidates. Only one has shown common sense decency. John Kasich expanded Medicaid, while 19 fellow governors refused. He did it to help struggling Ohioans. Yet in doing so he alienated the base of Republican voters.

So it is time for you to argue your case, to heed La Rochefoucauld’s maxim that self-interest reigns. (It reigns with Republican voters.) You need the Affordable Care Act. Indeed, you need more than the Affordable Care Act. You need guaranteed coverage as an entitlement – gasp, the dreaded word – of citizenship, the entitlement that every American over age 65 takes for granted, that they get regardless of income, regardless of their weight, their smoking history, their “eligibility.”

We all – not just Romney’s 47% — need that. The candidates blather about uniting us. One way is to guarantee us access to the treatments, medications and professionals that can keep us healthy. Certainly a country that can help multi-millionaires through fiscal legerdemain can provide health care for all of us – which ironically should cost less than today’s profit-driven system.

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

From The Progressive Populist, May 15, 2016

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