Health Care/Joan Retsinas

The Dark Side of Paradise: Decision Time

It is Decision Time in Trump’s Paradise. nnPonder “The Decision,” as many politicos do, in a five-star resort like the Greenbrier in West Virginia, where Republican honchos recently plotted strategy, relieving their heady work-sessions with heady golf-games. During this hot summer, the fortunate 1% among us enjoyed spas that dwarf the Roman baths, eight-course tasting menus, and 24-hour pampering.

Resort guests, though, must confront “The Decision.”

What kind of life do the pampered owe the pamperers – the maids, waiters, manicurists, plumbers, gardeners, bookkeepers, drivers, security guards – some visible, most not – who make the resorts purr? Luxurious resorts are built upon the labor of a host of servers – servants in this age is too loaded a word. How difficult should life be for those families? How hard to procure housing, food, and transportation? The Age of Trump, which has enriched the 1%, demands an answer.

Zeroing in on healthcare, should the servers – not just at resorts, but throughout the nation — have all the exams, diagnostic tests, procedures, rehabilitation, and medication – the full shebang – that our wondrous medical system offers? that the resorts’ “guests” take for granted?

In brief, do we want the nation’s workforce to be as healthy as they would be if they swapped places with the 1%?

On the one hand, nobody wants workers with infectious diseases; e.g., manicurists with hepatitis or waiters with tuberculosis. And we want productive, not ailing, workers.

Yet we have tied health insurance to workers’ hours (minimum hours for insurance), to tenure, and to skills (the bookkeeper versus the gardener’s assistance). In contrast, Western European countries have made health insurance a right.

And we have made workers pay. Historically, large employers picked up most of the tab for their workforce; but since “healthcare” comprises part of workers’ total compensation, that decision levied the cost on workers. Some employers, though, didn’t cover any employees; some covered only employees, not families; some charged premiums too high for low-wage employees; some hired part-time and self-employed contract workers. The system had gaps.

The Affordable Care Act (a.k.a. Obamacare) offered a partial solution: low-wage workers could enroll in their state’s Medicaid plan. Also, the Affordable Care Act subsidized the “contract” workers and “independent entrepreneurs” forced to buy insurance on the “individual” market. As for who pays for those government subsidies, the Republicans are correct: taxpayers do. But in the skewed tax code, the burden falls disproportionately on the middle class, not on the 1%. In fact, the Age of Trump gave the 1% a tax bonus.

Now the Age of Trump has re-introduced “skimpy” insurance plans (low premiums, low benefits), along with exclusions for pre-existing conditions, high co-payments, and high deductibles. The Administration has vowed to ax the Affordable Care Act’s subsidies. States are retrenching on Medicaid.

For the question, how healthy do we want the nation’s workers, in Trump-Paradise, the answer is clear: We are OK with sick workers.

The second decision: what kind of healthcare do we owe the people who are not making the resorts, much less the economy, purr – the single mothers waiting for housing vouchers, the unemployed adults with no marketable skills, the people whose disabilities shut them out of the workforce, the gang members loitering on city blocks, the addicts, the ex-felons….? We may preach “work”; we may prescribe “job training”; we may tie benefits to “work”; but Horatio Alger successes are not likely. Do we want these people to be as healthy as our wondrous system of care permits?

In Trump-Paradise, we have answered the question: We don’t care whether these people survive. Many have no insurance, no ready access to care. The gang member may have a regular dealer, but not a regular physician. The felon treated for hepatitis in prison might lapse once released. The addicts wait for beds in rehab. Immigrants fear that if they go to an emergency room, they will risk deportation. Over time, we have shrunk the “safety net” of public clinics and hospitals. In Trump-Paradise, healthcare is not a right. It is a benefit. Whatever homilies preachers preach, a swathe among us don’t merit care by virtue of their humanity. On our city streets we don’t see blind/disabled/scabies-ridden beggars, as we do in the countries that manufacture our goods – yet.

Trump-Paradise is a Darwinian marvel, where some Americans are healthier than others; the determining factor is largely wealth.

Yet Trump-Paradise is still a democracy. The burden-to-decide lies not just on the 1%, but on all of us. Who should be healthy? Decide, and vote.

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

From The Progressive Populist, September 15, 2018

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