health care reform – Sheila Kennedy

State’s Rights and Wrongs

“States’ Rights” are back.

The last time a significant number of states resisted federal edicts was during the 50’s and 60’s, when they were fighting desegregation and insisting that the big, bad federal government couldn’t tell them that “equal protection of the laws” meant giving actual equal rights to black people.

This time around, “states’ rights” has a new name: nullification. But it’s really the same old song; indeed, both the words and the music are all too familiar.

Nullification is the theory that states have the right to reject federal law. It is a discredited theory that ignores pesky constitutional details like the supremacy clause, not to mention the last hundred years or so of constitutional jurisprudence.

Ostensibly, what set off the current political tantrum was the Affordable Care Act, aka health care reform. Like a two-year-old screaming “you can’t make me!” to his mother, legislatures in several states are in the process of declaring that the federal government can’t force them to comply. (Those legislative shrieks of defiance are likely to have precisely the same effect as the shrieks of the two-year-old—which is to say, none. Mothers and the federal government will always have the last word.)

The real question raised by current efforts at nullification is: why? What is so terrifying, or awful, about reforming the health-care system so that 50 million uninsured Americans will have access to at least a minimum level of care? What is so totalitarian/Socialist/Nazi-ish about telling health insurers that they can’t deny you coverage you paid for simply because you got sick? I understand differences of opinion about the particulars of the reform—I would have preferred a different approach myself—but policy disputes don’t spawn the sort of hysteria we are seeing.

It becomes a little clearer when you see what other elements of federal law the more reactionary states are rejecting. Arizona was the first state to enact a draconian measure targeting immigrants, even though immigration is a matter reserved to the federal government, and other states—including Indiana—are scrambling to do the same. Listen to the rhetoric about immigrants, then listen to the fury over health care, and you will hear an ugly common theme: everything that’s going wrong in this country is “their” fault. And who are “they”? Poor people, brown people, gay people…anyone who is different, anyone who is “other.” Unlike “us,” “they” are all undeserving.

History teaches us that inter-group tensions increase during bad economic times. People are anxious and fearful and looking for someone to blame.

I just hope the recovery picks up steam before we “nullify” America.

Spin Cycle

I get so disheartened listening to political arguments about health care reform.

It’s not that I am a big fan of the bill that finally passed. I would much rather have seen “Medicare for All,” for policy reasons not germane to this post. But I have been astonished by the venom that the bill has engendered. It’s bad enough that crazies like Glenn Beck compare Obama’s effort to provide health care to the uninsured with Nazism. The despicable lie about “death panels,” hyped by Sarah Palin and her ilk, was equally odious. But perhaps the most annoying of these efforts at disinformation has been the recent effort by presumably serious GOP lawmakers to persuade the public that the Affordable Care Act–which they dub sneeringly as “Obamacare”–is a “jobs killer.”

This all started when the Congressional Budget Office reviewed the Act. Along with concluding that the reform bill will reduce the deficit significantly over the next ten years, the CBO noted that the measure will allow a number of people to leave the workforce. Congressional Republicans immediately cited this as evidence the Act was a “job killer.”

What the CBO found, however, had nothing at all to do with the number of jobs. It had to do with the number of people who are currently working only because they need affordable health insurance.

In other words, there are people who are only working because they desperately need employer-sponsored health insurance. These are people who have the means not to work full-time, if they have access to a health insurance market that currently shuts them out. Many of these workers will choose to retire early because they will now be able to buy their own health insurance.

This is what Republicans mean when they say that health care reform is ‘destroying jobs.’

There’s a reason many of us despair of ever having reasoned, rational discussions of policy. When ideology and political posturing trump reality, the common good–not to mention common sense–gets lost in the spin cycle.

Debate and Hate

Coincidences over the past few weeks have made me think a lot about civility. A colleague and I were asked to lead an after-play discussion on that topic at the Phoenix Theater; we disagree politically, but have often commiserated about the increasingly toxic tone of public argumentation. I later participated on a panel at Butler University on the same subject.

And then there was the appalling conduct of the anti-healthcare Tea Party demonstrators in Washington who greeted Andre Carson and John Lewis with the “N” word, called Barney Frank a “faggot” and actually spit on other Representatives.

Locally, we’ve had another eruption of nastiness aimed at people who work at Planned Parenthood. Not satisfied with picketing the organization’s clinics, these protestors have taken to disrupting residential neighborhoods by screaming obscenities and threats at the homes of Planned Parenthood staff members and volunteers.

Now, I would be the last person to deny these folks their First Amendment right to express their opinions, and to do so in ways that I personally find repulsive. But I can’t help but wonder what these angry and hostile people think they accomplish with such behaviors.

Take the attacks on Planned Parenthood. I understand being opposed to reproductive rights for women (and let me hasten to say that most opponents of abortion rights do not engage in these tactics), but Planned Parenthood is primarily about women’s health, not abortion. It provides cancer screenings, testing and treatment for STD’s, along with contraceptive advice and education. (In fact, nearly 95% of Planned Parenthood’s work is focused on pregnancy prevention; ironically, that means that no organization does more to reduce the actual incidence of abortion.)

Do the people screaming all night in front of the homes of Planned Parenthood staff members and volunteers really believe that Indiana would be a better place for women and children and families if the organization stopped serving its nearly 90,000 mostly low-income patients with pap tests and birth control and treatment for STDs? Do they really think any other provider would fill that void? Or are they simply willing to sacrifice women’s health in order to get their way?

For that matter, do they really think these tactics will help them get their way? Do they think this is how you persuade other people of the merits of your position?

I sometimes have to remind myself that we live in uncertain and anxiety-filled times; a certain amount of irrational behavior is understandable, if unhelpful. I do recognize that a very tiny percentage of Americans actually engage in these despicable behaviors. My concern is that these expressions of bile are doing real damage to our ability to engage in genuine debate.

While few partisans are spitting on elected officials or threatening local volunteers, many more are engaging in fact-challenged arguments and distortions in an effort to win political points. Health insurance reform will not allow government to euthanize granny. Planned Parenthood is not encouraging young women to abort.

It’s time to get a grip.

Comments

Begging to Differ

David Brooks is one of the few remaining conservative columnists whose commentary is always rational. I may agree or disagree with the substance of any given column, but Brooks is a remnant of the days when liberals and conservatives disagreed about aspects of a shared reality–unlike today, when they appear to inhabit different solar systems.

It is in that vein that I want to take issue with a column Brooks wrote earlier this week, in which he suggested that the health reform debate is really a debate over competing values, which he defined as additional security on the one hand versus social “vitality” on the other. He seemed to be echoing (albeit in a far more reasonable fashion) cultural arguments over the “Europeanization” of America–the argument that our entreprenuerial energy will slowly give way to a wave of genteel European social welfarism, and in the process will somehow destroy our “special” American character.

I get the argument, but I think Brooks’ central assumption is faulty.

As any economist will tell you, the largest single drag on job creation and entreprenuerial activity in the US today is the cost of providing health care. We are currently the only advanced country where health insurance continues to be provided primarily through employers–an aspect of the current landscape that current healthcare reform proposals will not change, unfortunately.

The business sector currently spends an amount in excess of its net profits to provide health insurance for employees. The difference between what it costs an employer to create a new position and the amount that employee actually receives is sometimes called the employment “wedge.” As health costs and insurance premiums escalate, the wedge grows larger, and inhibits hiring additional workers. In good economic times, that is troubling; in times like these, it can be catastrophic.

For the shrinking number of companies that can afford to offer health insurance, negotiating and administering medical benefits, and complying with the government regulations attendant to them, consumes untold hours of HR time. This is a drag on productivity—a generator of overhead costs that reduce profits and divert effort away from the core business operations. Single-payer would remove those costs and that burden, but even the inadequate proposals contained in the Senate bill would significantly ameliorate them.

Then there is competitiveness. If you don’t think that healthcare reform would be economically significant, let me share an example. In the case of our struggling auto industry, amounts paid for employee health add somewhere between 1800 and 2000 of the price of each new car. No wonder American automakers have found it difficult to remain competitive! (In the single payer systems with which we compete, not only are those product costs eliminated, but doctors’ expenses are reduced as well: currently, medical offices spend considerable sums on personnel whose only job is dealing with insurers—confirming coverage, complying with insurer regulations, submitting claims on multiple different forms and collecting amounts due.) Doctors and employers alike could save millions of dollars each year just by standardizing insurance forms!

Smaller companies—the real engines of economic growth and job creation, the “entreprenuers” about whom Brooks is so worried—are increasingly unable to offer benefits, and that puts them at a competitive disadvantage when they try to hire good employees. If health coverage were de-coupled from employment, the United States would become a much more attractive location for new businesses, and incentives to outsource production to overseas workers would be reduced. (Not too long ago, Toyota was looking for a site for a new factory in North America. Several southern states were offering tax abatements, infrastructure improvements and other incentives worth millions. Toyota decided to go to Canada, which was not offering anything. When asked why, the company explained that in Canada, they didn’t need to provide healthcare.) We aren’t going to solve that problem any time soon, but almost everyone I know has a story about someone who wanted to start a business, but couldn’t due to an inability to get reasonably-priced health insurance, or any at all.

Contrary to Brooks’ assumption, rationalizing American healthcare, and removing the burden of providing insurance from employers, would unleash a new era of productivity and usher in an entreprenuerial renewal.

Comments