HEALTH CARE/Joan Retsinas

Where are the Burghers of Congress?

Rodin’s sculpture of The Burghers of Calais tells a tale of selfless sacrifice. According to the tale, six Burghers, faced with the English King Edward’s year-long siege in 1347, offered themselves as ransom, to save the town. The ropes around their necks foretell their fate.

Today the Burghers stand as a monument to patriotism, a sign that the individual will risk his life to save the populace. Modern scholars judge the tale apocryphal, saying that the “ransom” was more symbolic than real; but in this age, as in medieval times, we need tales of heroism. Our Republican politicos should take note.

Where is the patriotism of Congress? At what point are Republicans willing to risk – not death, as the Burghers did – but defeat at the polls, or the wrath of this President? For healthcare, this President proposes strategies that will plunge millions of Americans into misery. Yet Republican members of Congress either mouth platitudes of support, or announce their upcoming retirement.

Consider the drive to drop the “mandate” from insurance. The arguments mount. First is the “free will” argument: people will be free to “choose” whether they want health insurance — a specious choice. The members of Congress know that health insurance is essential for all but the blessedly young and healthy, and even they will eventually age into the diseases of middle age. Next is the discretionary money argument: citizens will have more money, as though the choice between healthcare and food is akin to choosing which car to buy. Next comes taxpayer savings, designed to offset the promised tax cuts: by shelving the mandate, the government will save the money Uncle Sam otherwise would have spent on subsidies for low-income people who bought insurance under Obamacare. (If we drop the subsidies entirely, the government will save even more money. Ditto for slashing Medicaid: we will see more tax savings.)

The rhetoric of good tidings ignores the consequence of dropping the mandate (and the subsidies): more Americans without health insurance. And, since we have eroded the safety net of clinics and public hospitals, we will have more people without healthcare. While some supporters of our President may not see the consequences of shelving this mandate, our senators and representatives do. They understand the damage to the body politick.

Another tired shibboleth: the model T policy. Why should a young healthy person buy comprehensive, but expensive, insurance? S/he needs only a low-premium policy, with a large deductible, because s/he may never need medical care. Cheaper premiums will let more people buy policies. We have a range of “consumer” choices for housing and food. We accept that fewer discretionary dollars will buy less housing, less food.

Yet for healthcare the economy of the pool still rules: subtracting young healthy people from the pool leaves the rest of the people in the pool – those not blessedly young and healthy – with higher premiums. Also, it leaves those enrollees vulnerable not only to major illnesses/accidents, but to mega-medical bills. The members of Congress understand this. Indeed, they have not foregone their comprehensive taxpayer-paid insurance for a model T policy. Nor have they embraced these policies for their families and friends.

The Republicans point to the Tennessee Farm Bureau Health Plans as a model. The plans cost far less than the “Obamacare” offerings. They cover 16% of the 344,000 Tennessee residents who buy insurance via the individual market. The secret to their financial success: they can ignore the onerous regulatory burdens that drive up costs. President Trump via Executive Order wants to spur clones of these plans.

The secret-behind-the secret: medical underwriting. The insurer rates according to age, tobacco use, past illnesses. The insurer asks enrollees about cholesterol and glucose levels. It looks at past diagnoses, including epilepsy, cancer, and stroke. Sicker people will pay more. It can exclude people whose health care promises to be especially costly. It has reinstated the time-exclusion for “pre-existing conditions.” Maternity coverage costs more. Technically the Farm Bureau is not an insurer; the Tennessee legislature exempted it from the Obamacare regulations. (It is exempt from the 2.5% tax that the Obamacare insurers pay on premiums, and enrollees do not pay a tax penalty for not enrolling in an Obamacare policy.) Again, the members of Congress who praise the Tennessee Farm Bureau Health Plans have not introduced these for federal employees, like themselves.

The Republicans understand the reality behind the platitudes. In the good old days, we had no mandate, we had medical underwriting, we had scores of model T policies. The good old days were dire. Yet our Burghers of Congress remain silent.

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

From The Progressive Populist, January 1-15, 2018

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