Health Care/Joan Retsinas

Canaries and the Politics of Immiseration

How miserable can this administration make us? We are sinking into an abyss of misery as “retrenchment” reigns. This president has cut subsidies, from food to housing to health care. He cavalierly shut down the government for more than a month, leaving workers without paychecks. His sidekicks in Washington cheer his cruelty, his stubborn petulance.

The healthcare mine grows darker, glummer: premiums are rising, “skinny” plans are emerging, large co-pays are standard and states are cutting Medicaid. The census of uninsured adults rose to 13.7% in 2018 from 10.9% in 2016 — the highest since 2014. Similarly the census of uninsured children rose — an anomaly in a time of prosperity. Children without insurance, and hence without health care, spurred the heart-wrenching stories that undergirded both Medicaid expansion and the Affordable Care Act not so long ago. Yet under this administration the number has grown. To add to the desperation, families have turned to “crowdfunding” to pay for healthcare.

“Insurance” was supposed to safeguard us from calamitous expenses, not be a way-station on the plunge to bankruptcy. Some of the cyberspace pleaders are fraudulent; some of the cyberspace treatments are scams; yet other pleaders are the “ordinary” Americans our President promised to help.

In the spirit of springtime optimism, though, look at some health care stories, buried below the fold. They are canaries, tweeting in the mine, signaling danger to the status quo — and, at the same time, the possibility of change. Miners heeded those canaries; this administration might too.

Here are the canary-tweets.

Lawsuits against Medicaid “work requirements.”

Requiring Medicaid recipients to work has always come with loopholes. Even Scrooge would have exempted children and enrollees too ill to work. Furthermore, people must be healthy to work, and Medicaid, giving people contact with primary care physicians, with vaccinations, with medications, keeps people healthy — which enables them to work.

I exclude mention of compassion: Scrooge as well as our president would eschew that. The reality is that Medicaid work requirements are administratively nightmarish and not “cost-effective,” the mantra of the age. Groups in Arkansas and Kentucky have sued; expect more suits.

New York City’s decision to insure 600,000 residents

The city has recognized what the administration hasn’t. The decision to deny health insurance to a large swathe of residents leaves them without normal health care. They grow ill. They grow unable to work. In crisis they rush to emergency rooms. The mayor has proposed insuring 600,000 residents, at an estimated cost of $100 million. Analysts say that the city may end up saving money with this move.

A public option for insurance: the idea that hasn’t died

States are supposed to be the laboratories of democracy, trying programs that later wend their way to other states, ultimately to Uncle Sam. At the federal level, “Medicare for All” is stalled (although at least one Congressional head plans to hold hearings on it). The notion, though, frightens conservatives — who themselves may be enrolled happily enough in Medicare.

California, New Mexico and Washington are exploring ways to extend insurance to residents through a “public option,” like Medicare or Medicaid. (George W Bush had talked of opening up enrollment in the plans that insure millions of federal workers.)

The individual mandate to buy insurance: another idea that lives

Even while many in Congress try to kill the “individual” mandate at the federal level, four states have passed such a mandate: the District of Columbia, Massachusetts (famous for “Romneycare”), New Jersey and Vermont (slated to start in 2020). California, Connecticut, Hawaii, Maryland, Minnesota, Rhode Island and Washington are considering one.

The common-sense way to make insurance “affordable” for individual enrollees is to enlarge the pool of enrollees. States, if not our president, have recognized this economic fact-of-life..

Canaries are a signal to miners: leave. A few states, stuck in this administration’s health care abyss, are struggling to break free from his politics of immiseration.

This president, if rational, should similarly retreat.

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

From The Progressive Populist, March 1, 2019

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