HEALTH CARE/Joan Retsinas

Barreling Toward Dystopia

Thomas More’s Utopia was fictive – an after-the-Fall Eden with no crime, rancor, poverty.

Dystopia, on the other hand, is real. And we are barreling toward it, with a chunk of the American electorate cheering our descent.

The headlines scream chaos: refugee children taken from mothers; childhood poverty at an all-time high; epidemic opiate addiction; widening gap between rich and poor; a rising census of homeless; a return to DIY coat-hanger abortions (probably with Youtube instructions). On the international front, Canada is our enemy; Russia, our friend. This administration touts the good news of a tax cut; but we will pay for those cuts dearly.

The conundrum: why do so many Americans support this administration’s descent into dystopia?

Perhaps the reason is that those voters are not refugees; they are not poor; they have health insurance; they are employed; they cannot imagine needing an abortion. And, so long as they are not drafted into the military, they don’t care about the alliances we form or reject. These voters are the fortunates among us. Our president speaks for them.

Sadly, the Sunday school lesson of Martin Niemoller, a Protestant theologian who protested the Nazis, holds: people didn’t speak for the Jews because they weren’t Jewish, for the trade unionists because they weren’t unionists, for the disabled … Ultimately there was nobody to speak for the “fortunates.”

Perhaps a swathe of Americans don’t feel any pain, yet.

Soon they will. Trump USA is tamping down the middle-class, in the name of feel-good rhetoric.

We are discarding the much-hated “mandate” in health insurance. Conservatives cheer: the “mandate” restricted freedom. But we live with Social Security’s mandate. And economists warned that an insurance “pool” needs healthy enrollees; otherwise, the costs would be exorbitant. Simply put, the larger the pool of healthy enrollees, the easier it is to spread the costs of the ill enrollees. One patient needing open heart surgery in a pool of 100 will spike premiums. Enlarge the pool to 1,000, and the premiums drop.

The challenge: how to get healthy enrollees into a pool? The only way is to mandate their enrollment; otherwise, many healthy people will decline coverage, choosing to enroll at the first dire diagnosis. The sicker the pool, the higher the premiums.

That has come to pass. In the “individual market” where enrollees are not tied to a group, premiums have risen. In Maryland premiums jumped 30%; in Washington, 19%; in New York, 24% — all higher than the 10% spike the Congressional Budget Office predicted. Some states are trying to establish their own mandates. Ironically, voters who cheered the demise of the federal mandate – too much government control — are being asked to vote for a state one.

Even people insured via their employer’s group are discovering the financial hazards in Trump USA. Deductibles are rising. (John Tozzi and Zachary Taylor, “Sky High Deductibles Broke the US Health Insurance System,” Bloomberg News, Jun 26, 2018). The National Business Group on Health reports that in 2009 22% of workers had deductibles of $1,000 or more; today half of all workers have high deductibles. The original rationale for high-deductible plans was a tradeoff: low premiums would offset the initial buy-in; the result, though, has been steep premiums, coupled with rising drug prices. Today a $400 tab for an emergency visit is common.

Finally, conservatives aghast at the creeping socialism of Obamacare yearn to pare the Medicaid rolls. Obamacare encouraged states to extend Medicaid to the working poor – people who couldn’t afford their employer’s coverage, or people whose employers didn’t offer coverage, or whose work-schedules left them ineligible for their employer’s coverage. They may not have been destitute, but they couldn’t afford health insurance on the open market. Medicaid solved their problem. Now this administration is letting states drop these enrollees. Expect once-insured people to watch their insurance evaporate into the miasma of state cutbacks. Before Obamacare, we logged as many as 44 million Americans without insurance. Will we top that?

Dystopia is not inevitable. We can awaken in ourselves – in the fortunates among us – our better angels, if not our self-interest. We can exercise the power of democracy: we can speak out to our legislators, again and again, in force. We can lobby against harmful regulations, for helpful ones. We can mount our own pulpit of fairness and compassion to drown out the bully pulpit of greed and meanness. We can vote.

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

From The Progressive Populist, August 1, 2018

Populist.com