Profitizing Health

The Patient Protection and Affordable Care Act is being debated in the Supreme Court today, the question is – as always with the Supremes – constitutionality. This specific issue is around requiring individuals to purchase health insurance for themselves, the other issues depend on the answer to this question. I get the feeling that it is going to stand, but my progressive leanings are very “out to lunch” around this whole issue. This is Obama’s crowning achievement, and still the case has not really been made for the American people. I do believe healthcare should be a right for all Americans – the richest nation in the world has a stated mission of sharing life, liberty and the pursuit of happiness among all of it’s people; those are all impossible goals to try for if you don’t have your health.

Wade into the health insurance discussion and get ready for some facts…oh, I’m not providing them, I’m just saying there are a lot of them. Progressives loove to do their homework, fact check it, and then bring the details to the “fight”. This is how progressives approach most problems, they try to find some sort of backing before feeling empowered to participate. This is all wrong. You can “win” an argument with facts and figures, but you can’t win over people with those facts and figures…unless you’ve already done the hard part – framed it your way. Facts and figures act as annoying clutter until you can actually connect with the person on an emotional level.

Now you don’t need to cry in each other’s arms or make a new BFF, you just need to have enough of a conversation so that you encourage respect for each other and listening to each other. Perhaps you connect with some riskier, more vulnerable aspect that connects you to this issue – like a personal story or feeling of injustice – share that first! Humans relate to human stories, humans relate less well to being lectured at. The good framing part is less about catchy phrases (though that can be part of it) and more about connecting values to relatable human stories so that your issue is furthered. In terms of the health care debate, we have no shortage of sad health stories in this country, but most of those stories did not directly relate to the new health care plan, those stories don’t lead us all to the same conclusion for a solution. The simple fact is that for Americans, health insurance does not mean good health. “Health” is not profitable, health insurance is.

For me, that is the crux of the “argument” in the Supreme Court of my mind – I can’t get behind the idea of profitizing human health. Obama’s health care act attempts to walk the fine line that is the value systems of progressives and conservatives. He has tried to find the compromise between empathy and the implied morality of capitalism. We’ve already tried this in our current health care system and in other ways, we know the outcome – capitalism beats the crap out of empathy every time. Empathy wants to hug Capitalism and Capitalism will accept  – so they can better stab Empathy in the back. This dynamic is the problem with much of our polarized system – one side sees capitalism as a cure all, the other side doesn’t mind capitalism in some areas, but in other areas they’d like to remove a profit motive. Capitalism is never satiated and has no moral compass except to amass more capital. Why would I want Capitalism caring for my family?

The truth is that this debate so disgusted me years ago that I am not very well informed. My frame of reference never got activated. I didn’t hear people talking about health for people, I heard negotiations about brokering a deal. Health care is a HUGE industry in this country and the top level of any aspect of it – doctors, attorneys, hospital administrators, pharmaceutical peddlers, medical equipment manufacturers, makes crazy good money. As usual, the bottom level (literally those wiping the bottoms of our loved ones) – does the shit work and gets hardly any of the profit or security as those more removed from the “human component”. These may be important roles in society, but so are sanitation workers, teachers, and social workers. I understand that no one wants a cash cow to dry up but most important decisions made in the health care system, serve the profit motive first and the patient second; there is no trust from this patient that my interests are a concern.

Nothing in the health care act says that the system of care we have in place is going to change – the system of insuring is changing. This will likely lead to some adjustments and changes when and if more people come into the health care system – so, ok, the lobby will get remodeled to accommodate more people, systems will get streamlined to the delight or chagrin of patients – but the fundamental idea of treating people like they just came off of Henry Ford’s assembly line will stay intact.

With this act being proposed by so-called “liberals”, the frame of people as a commodity is here for some time to come. (This is why I think the commodity lovin’ Supremes might let this one stick – plus, what would conservatives complain about without “Obamacare”?).

Two other points that I need to make about this legislation – first “Obamacare”: is it an ok term? The Right made up the term “Obamacare” as a derrogatory term, it is used that way and has been for years now. In fact “Obamacare” for a Republican is a shorthand word that represents the general so-called “socialist” approach of Obama, or liberals ( even though guaranteeing customers and profit windfalls to Big Business is anything but socialist). Should progressives try to “reclaim” the word? Only if you plan on only talking about it with Obama fans. The term “Obamacare” cannot be separated from the name “Obama”. By now all Americans have formed some sort of opinion about the man, repeating his name will only reinforce the ideas that already live in a persons brain. You can’t change the way someone feels about a person just by repeating their name in some sort of political meme – even if the word “care” or “cares” is in there. If progressives want to talk about this plan more easily, they need to come up with their own shorthand name – “Patient Protection and Affordable Care Act” is painfully cumbersome (really Dems? come on and get yourself some naming professionals – give me a call!), and make it about the benefits for the people – not about Obama! Even within the context of this legislation that I am not a fan of, I can see much better “selling” of the idea possible – picture an older person looking at a bill saying, “now that’s a premium I can afford!”

The second point is that the comparison is often being made to mandates for car insurance. Humans are not cars! There is nothing about us that is car like; cars are commodities. When we decide to use a car, we are “buying in” to the driver frame and accepting responsibility for zooming tons of metal around at deadly speeds. We can choose to participate in the car frame or not. We already have to spend big bucks to acquire and maintain a car, insuring it and the health of the people driving it is part of the package deal. You cannot opt out of being born, you cannot shed your body parts, you cannot inflict the kind of damage that a car can inflict with just your body as a weapon (sorry Jackie Chan, not even you).  If the state is going to make a requirement about how we must take care of ourselves, the state needs to provide the means to do it. I already hear the argument “but the subsidies…”, which I might buy into if I could actually access the care that I wanted and apply the subsidies and premiums how I saw fit for my health.  I would not choose to give my dollars to an insurer except for maybe catastrophic injury – for my regular care, but I believe it will leave those determinations up to the insurer. Insurers do not have a history of allowing coverage for naturopaths, chiropractors, massage therapy, nutrition, acupuncture or other “non-western” methodologies. The state requires a purchase, but doesn’t provide for any security around standards, methodologies, or choices – that is left to the lucky company that receives the windfall of new customers.

I have experienced and know that when healthcare becomes inaccessible for you in the traditional sense, you seek it in the non-traditional way. You find friends that are nurses or doctors and ask them questions, you attempt to medicate yourself with supplements, otcs, or other people’s prescriptions. You might even let someone else set a broken bone. When you get catastrophic injuries or illnesses, you might go to the emergency room, but many illnesses cannot be treated there – so you die. Even if our emergency rooms are overflowing with health issues that don’t belong there, a whole other segment of people decide that the financial costs – possible financial ruin – of heading to the ER while uninsured are not worth the risks.

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3 thoughts on “Profitizing Health

  1. lokywoky says:

    There are/were some good things in this “Obamacare”. (BTW – the Dems have decided to wrap their arms around that name and claim it for the campaign season ahead – maybe trying to re-frame it as “Obama cares”?)

    First, the part of the act that requires “best practices”. This does actually change the health care. I know something about this because it is actually practiced in the VA – and the VA has the best healthcare in the country according to several studies. Best practices allows doctors and others within the system to access resources almost instantly when faced with a newly diagnosed patient. These resources let the doctor know what the most up-to-date research is on treatments according to efficacy (what works best) efficiency (how fast) expediency (how quickly it can be delivered to the patient) and availability (whether it is available in that facility or nearby). It also gives the doctor information on safety (side effects) and comparisons with other treatment options with all their qualifications in case the patient is allergic, or for some reason cannot or does not want the first option for whatever reason.

    In a lot of hospitals and practices – doctors do not have all this information available right away – and rely on their memory of what they learned in school (which could have been recent or not so recent) or the last journal they read (which was when exactly?) and just how many journals are there? Busy doctors in HMO practices and ER docs don’t have a lot of time to be looking stuff up but with the computerized systems like what the VA uses – this stuff is there at a few clicks of a mouse. The ACA or Obamacare really pushes this concept forward with funding to help make it happen.

    Secondly, the problem of long-term care for the elderly. Right now, the only way most people get long-term care is by spending themselves into the poorhouse so that they can get onto Medicaid. But Medicaid is being slashed by Republican governors right and left (no pun intended!) In the ACA/Obamacare was a program for long-term care insurance that seemed do-able. However, earlier this year, HHS Secretary Sebelius scrapped it because she said the numbers weren’t working out. Under normal circumstances (you know, with a reasonable Congress) they should have been able to go back to the Congress with a fix and get it re-budgeted so that it would work. But with the Republicans in control of the House now and determined to kill the entire thing, it just wasn’t worth the effort.

    Long-term care for the elderly is a problem that is going to have to be addressed sooner or later – and especially for the boomer generation. And sooner would be much better. Funding this insurance program will be much easier if we start now. It was based upon a funding stream similar to Social Security where everyone starts with a very small premium when they begin their working life (at around $5-$7 per month). For those of us who are already nearing retirement – the premiums would be much higher – and we would have had to pay in for 5 years before we could collect any benefits (I think my estimated pay-in was about $155 per month and I am 61) but I was happy to do this since at my age I cannot buy long-term care insurance at all on the open market. Anyway – those original premiums might have had to be adjusted or some subsidies may have been needed. But this program is very necessary – and I think would have saved a lot of money for Medicaid over the long term.

    There is a long list of other benefits of the ACA/Obamacare that have already kicked in – insuring kids to age 26, closing the ‘donut hole’, no more exclusions for pre-existing conditions, subsidies for small employers who provide group health insurance, no more lifetime caps on payouts, requiring insurance companies to use 85% of premiums for healthcare and so on.

    I don’t like having to purchase health insurance from private for-profit companies. I would have preferred Medicare-for-all. But something is better than nothing – and we can work on this. After all, Medicare itself wasn’t as good as it is now when it was first passed either. Neither was Social Security. They both have undergone major tweaks and fixes since they were enacted. Those laws were a place to start – not the be-all, end-all. The ACA/Obamacare is a starting place.

    I just hope and pray that this SCOTUS doesn’t throw the whole thing out because of that mandate. And I hope whoever that was that forgot to put in that severability clause is twisting in a hot bath with no relief right now!

    • Amy Meier says:

      Part of me wants to recognize what you’re saying, but there is a stoppage. The problem is the whole hierarchy of thinking within frames.

      I cannot endorse a law that further commoditizes human health; I don’t buy that frame. Knowing that it was mostly written by the Heritage foundation reinforces that idea that the frame doesn’t fit my values (here’s a bit more on that by Jason Linkins

      The values must align before me – or anyone – will even bother to go into the details. The relevance of the details hinges on “buying into” the values.

      I do recognize the needs of a revamped healthcare system; I just want a different choice – one that doesn’t require me to do commerce with businesses that I would not otherwise choose to do business with.

      BTW, I hope I’m wrong and it works out great!

  2. lokywoky says:

    I totally understand. However, in life we are faced with choices. If given a choice between Medicare-for-all and Obamacare/ACA I would obviously choose Medicare-for-all. We don’t have that choice at present. I worked as hard as I could for the choice I wanted. It did not happen.

    Now we have another choice – ACA/Obamacare with all its flaws and working to fix as many of them as possible or going back to the way it was before and the likelihood that it will be another 50 years before any kind of healthcare-related legislation will be brought up successfully again. I know it sucks big time – but here we are. Unless there is a sure-fire way to get comnplete control of all three sections of government including a truly filibuster-proof Senate, it’s not going to happen. And maybe not even then unfortunately because “it’s already done”.

    So, again, choice now is ACA or nothing again. I choose to focus on what is good about it – and work to change the disagreeable stuff. The worst part of the current bill is that there is no control over premium prices. That needs to be the first “fix”. As long as the Republicans control Congress, that fix won’t happen so the first order of business is to get the House back and also to elect more progressive Dem senators so that effective control of the Senate becomes a reality as well.

    Of course, right now we have to get past SCOTUS………

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