The Grand Illusion
The other day I was talking with people at a wedding. The majority of them were Republicans, and all of them opposed the Affordable Care Act, aka Obamacare. What floored me wasn’t so much that they opposed the ACA, but the grounds on which they opposed it. One man told me that anyone who couldn’t afford health insurance was covered by state Medicaid. Another person insisted that if someone couldn’t afford health instance, she didn’t want to pay for it. When I pointed out that all of us are already paying for the uninsured through higher medical prices to cover unpaid emergency room and hospital care, she said that they could go to InstaCare, as if local acute care clinics didn’t have the same problem as hospitals and emergency rooms.
While my wife and I are fortunate enough to have health insurance and in a position where we cannot be denied coverage, we both have seen and continue to see the array of problems. There’s the college student born with hydroencephalitis, who works minimum wage jobs and cannot get insurance nor meet the criteria for Medicaid. There are the scores of self-supporting college students who have injuries or long-term health problems whose parents refuse to include them on their own health insurance, or whose parents themselves have no insurance. There are the Walmart employees whose hours are capped so that they cannot have health benefits. There was the wife of a friend whose cancer treatments were not covered by his company’s health insurance policy and who died because the cancer spread while they tried to raise money for a deposit demanded by the hospitals in order to prove they could pay for the treatment. Or the full-time retail employee who did have health insurance, but was hospitalized, required surgery, and even after insurance, still ended up owing, as a result of deductibles and exclusions, more than most of his yearly take-home pay. I could give a very long list, and not one of those I listed would be either a so-called welfare queen or deadbeat. Beyond that, my list wouldn’t begin to deal with all the problems faced by the over 40 million Americans without health insurance.
I can’t begin to solve these problems, but I am very much aware of them, and we’ve helped where we could, yet most of the people to whom I talked at that wedding refused even to acknowledge that such problems exist, almost as if they occurred in another world. I’m seeing more and more of this, especially in recent years, and the current Congressional impasse over the federal budget reflects, I believe, the growing trend of Americans – and perhaps those in other industrialized countries – to deny what is happening outside their “world” – or their “bubble,” as the comedian Bill Maher terms it. The problem with such denial is that compromise is impossible when people in different worlds refuse even to acknowledge the events that are happening to others because those events, and even facts, don’t fit into their own world.
Put in another way – we don’t need space travel to find other worlds; there are more than enough alien worlds right here on earth, even if no one wants to admit it.
Hi Mr. Modesitt,
To be brutally honest, I’ve been looking forward to a post from you about this, and I’m gladdened to see you’re at least somewhat defensive of ACA/Obamacare, even if it doesn’t affect me (as I’m in the UK).
This has been quite a shocking turn of events, and like yourself, I’m really concerned as to why this has even happened. Are a small group of people so self-absorbed that they can’t see the issue (or look down on those affected as they’ve never been in the situation), or is it a little bit more when it comes to Congress itself?
The only explanations I could reasonably come to was that those who opposed the bill and caused the shut down are either motivated by cruelty and heartlessness, or by money (i.e. by those funding their campaigns, etc.) After all, who would these politicians rather help? The starving black child in the ghetto? The disabled student struggling (if not failing) to fund both education and healthcare? The loving mother dying of treatable cancer, who can’t afford the medicine and services she needs? Or would they rather help those they know, whose hands they shake before striking up a round of golf? Those heading vast corporations who thrive off charging the sick and enfeebled extortionate amounts of money for the medicine they need to live?
It just seems so anti-American (nevermind anti-human), especially for a faction who often claim to be the ‘real’ Americans with ‘real’ American interests and goals. Surely the American thing would be to help those who are struggling, to love thy neighbour, to do the honest and right thing.
Causing potentially global issues over *affordable healthcare* that will affect millions of lives in a negative way doesn’t seem very American to me.
But hey, this is modern politics, right?
Actually, I’ll have even more to say on this later this week, and what I say will probably make more than a few people less than happy.
I’m English, happiness isn’t an option.
But I do look forward to your thoughts.
Hi, I’m an Aussie and happiness is a way of life down here. 🙂 However, I totally agree with Kathryn. Your health is probably the single most important personal attribute you have and therefore, it behooves any gov’t to deal with health issues as a priority. Most ‘rich’ countries do this, I know the UK does and Australia has an excellent system. For once can’t you Americans STOP playing politics and do what is right for your greatest resource, your people!
Some of us are trying to…
I’m not really happy with the ACA as it is right now, and i’m not looking forward to having to pay for bare minimum insurance that wont even cover anything if I end up needing it, just so that i’m “legal.” I don’t have health insurance and havn’t in over 6 years, I havn’t been able to afford it. But at least they’re trying to do something about it and help people out like me, and hey, there’s no saying that the ACA right now is the way it ends up being forever, they can always make it better, the hardest parts are done now. I’m really interested to see what you have to say latter Mr. M! I’ve been a dedicated reader of your blog and books for years now lol. Keep it up sir! I’ve always loved how you respond to your readers.
Mr. Modesitt,
I’m an avid fan and have read most of your books 3 or 4 times. I generally agree with your thoughts, but this one I had to disagree with. The problem with healthcare(not insurance) is costs. In the last 50 years healthcare has grown to substantial amount of the U.S’s GDP. Insurance is a way to pay for healthcare, nothing more. As prices increase on healthcare, insurance premiums should rise. The ACA, I feel is similar to Recluse sending the group of Order-masters in the Order war. What we really need is a discussion on Healthcare costs. I have a CPA, and to be honest I have a hard time reading medical bills, what discounts are applied, what insurance paid, what I pay, etc. What we need is to have a frank conversation about costs of healthcare.
Healthcare costs are definitely a problem, but they aren’t likely to decrease so long as medicine and medical technology improve. Even if we could stop the rise in costs, paying for medical care would still require some form of insurance, and that means both the costs of health care and the means of paying for it have to be addressed.
The reason a great many people object is due to the fact that our Constitution does not empower the federal government to take on what it has, invalid Supreme Court decisions notwithstanding. Most egregious is the individual mandate, something fabricated out of whole cloth, and for which there is absolutely no authority to be found in the aforementioned document, and which I point out when asked why I oppose the ACA.
The Roberts court got it wrong with the individual mandate. In the opinion, Roberts (writing for the majority) wrote that Congress has the power to regulate commerce (to what degree within the US is arguable, but we’ll accept that at face value for now), but that it did not have the power to regulate inactivity. Thus, he rightly concluded that Congress could not enact a law requiring activity where none was occurring, meaning that it could not compel anyone to engage in commerce.
In virtually the next breath, however, he wrote that Congress could impose a “shared responsiblity tax” (which is naught but a redefinition of the word “penalty,” used throughout the BarryCare bill), should an individual opt not to engage in said commerce. Given that the “tax” would only apply in that case, there can be no doubt whatsoever that it is indeed a penalty.
So, where does that leave us? With one entirely unconstitutional imposition on our liberty and natural right not to participate: Today, government can penalize a person for failing to do something that the government cannot compel him to do in the first place.
While I have no disagreement that health care costs in this country are spiraling out of control, I believe that addressing the causes of the rise, rather than forcing people into something government cannot lawfully do in the first place, will go further toward getting control of the situation. And, before you say that I know nothing about which I speak, know that one of my parents is, in fact, a doctor.
Still, I think a public discussion of the issue–something that has not been done–with an eye toward actually fixing the problem, so that all who want it can have an affordable health care plan may do so. Some early indications suggest that ACA will not be the panacea many thought it to be; there must be a better way, and a public discourse, in which many voices can be heard may reveal it.
Again, I don’t object to reforming health care, but if the federal government is to be involved, its involvement must be limited to what the Constitution actually permits.
You may be right about some things, but the Constitution itself declares that the Supreme Court is the arbiter of what is legal and valid. If you’re going to cite the Constitution, then you have to cite all of it.
That is true, but the Constitution does not give the Court the power to redefine the Constitution itself, and that has happened as a matter of course for many years, most notably within the last century. The result has been that the meaning of the Constitution has changed, absent any amendment as required by Article V, the outcome of which is that the meaning of the foundational law against which all others must be weighed, is a moving target, ever changing, with no one really knowing what it means day to day, or year to year.
Surely, you’d agree that, in order to apply and enforce the law effectively and consistently, it must be read as it was understood at the time of its adoption, would you not? With that in mind, do you think, for even one minute, that the Constitution, as originally understood, even considered legislation such as ACA?
“That is true, but the Constitution does not give the Court the power to redefine the Constitution itself”
Actually, yes, it does, and this has been understood for hundreds of years. This is the central theme of Marbury v. Madison (1803). Just for fun, given that most of the founding fathers were still alive when the Supreme Court made that decision, that they did not stage another revolution seems to indicate that the case was how they “originally understood” the constitution to work.
Marbury v. Madison was the case in which the Court gave itself the power to (re)define the Constitution. In fact, some Framers did consider it to that to have been something of a reach, but were hopeful that it would not result in terrible abuse. While it did not, to an excessive degree, at the time, that did not remain so.
Oh, and by the way, I do enjoy your books very much, so please keep ’em coming! I do hope that, at some point, you might consider another Rhennthyl volume …
Sorry, Grey, didn’t mean notice intially that it was your response. The note on the books was, obviously, directed to Mr. Modesitt. 😉
Pvblicvs –
So, wait, you are saying that fewer than 15 years after the Constitution came into effect, the very founders were in disagreement over their original intent?
This doesn’t seem to bode well for originalism…
I had thought widespread internet availability would allow “the facts” to reach people being misled by politicians or partisan media outlets. This now seems naive, as the effect has been to help one find a bigger, self-reinforcing pool of persons with similar mindsets. People just don’t want to challenge their beliefs.
Is a side effect of this ‘bigger pool’ the seemingly-increasing cognitive dissonance (or digging in) we have all experienced when inconvenient facts are raised? I suspect so; why not discard or ignore contrary facts if they go against everything you and your big pool know to be true?
I work as part of the ’emergency net’ that supposedly keeps people from ‘falling through’… falling to what is a source of confusion for me, though.
Everyone wants to blame someone; everyone has someone else to blame. The patients blame the doctors and the insurance companies; the doctors blame the insurance companies and the lawyers; the insurance companies blame the patients, doctors, and government; and the government (i.e. taxpayers) end up paying for most of it while the lawyers get rich with litigation (that only drives costs up more).
As US citizens, we’re all to blame.
Those who cannot afford health care should acknowledge that the rest of us carry them along and at least put in a symbolic pittance, which nearly none of them do. The hospital where I work does not even collect the $5 copay for ER visits.
92 year old grandma shouldn’t get her third coronary artery bypass – and her kids and grandkids shouldn’t keep the poor woman enslaved to a ventilator or daily dialysis if she is irretrievably comatose.
People who willingly do things that jeopardize their health should pay more: smoking, obesity, risky hobbies (BASE jumping, full-contact martial arts, etc.),
Insurance companies don’t need a 20% profit margin, no matter what their shareholders think: we regulate public utility profits, why not healthcare?
Cardiologists and Neurosurgeons don’t need to become independently wealthy after 5 years in practice. Family Medicine, Internal Medicine, and Pediatrics need more pay: their preventative care is about the only thing that has been shown to slow down the rate of growth of cost (not stop rising costs: nothing has done that).
Government can and should help regulate this. Is ACA the way to do it? I don’t know… and neither does anyone else. If it doesn’t work, scrap it and start over. Health care is not free. Health care is not a right if one fails in their responsibility of pursuing health.
It is an expensive privilege that we – as a society – have decided is a priority for individuals that we – as a society – are willing to pay for. Come to my ER and work for a week: after that, the little statistic of 5% of people using 50% of the health care dollars becomes more than an interesting statistic and points out that there are many ways to look at so-called ‘social justice’ when it comes to health care dollars.
Reporting from the trenches, WG
WG, you mentioned preventative care slowing the rate of cost growth. This is one of the touted benefits of universal coverage: currently the uninsured show up at the ER to address serious medical issues – at extreme cost borne by taxpayers – that could have been prevented or mitigated by the primary care provider they could not afford to see.
What has your experience been? Does this describe a noticeable percentage of your ER patients?
Wine Guy I totall know what your talking about in terms of a few people using up inordinate amounts of healthcare dollars that are never paid for and the hospital and others end up paying for. I work in security and have spent hundreds of hours on 1-1 watches ensuring that 51-50 patients (CA legal definition for someone who is a danger to themselves or others) and I’d say honestly a good 90% of these “crazy” people are homeless drug addicts and drunks that show up to the hospitals saying they’re suicidal just to get a few days food and shelter, then a week or more in a mental facility. They’ll leave when discharged, then go to a hospital that’s part of a differant sytem, rinse repeat, then we’d have them back again after they’d hit the other 4 major hospitals.
Universal coverage only means something if the person receiving the care takes responsibility for their health: take the meds as prescribed, do the exercise/diet programs, get the medical surveillance done, etc.
Those who have no skin in the game (i.e.: they pay nothing at all) come in because they have been conditioned by the rules that say EDs cannot turn anyone away – even it if the cold symptoms have only been going on for 4 hours. EVERYONE gets an evaluation because the Powers-that-Be are convinced that laypeople cannot tell the difference between an emergency and a not-emergency. If there’s a real question in a person’s mind, by all means come in. If you’re coming in because the same back pain that has been hounding you for 3 years is flaring up again…. not so much.
The working uninsured rarely come in because they cannot afford to take time off from work. Those people I bend over backwards to help. Many people have long term chronic conditions that are progressively getting worse because they are not getting regular checkups for their chronic diseases.
Personally, my health insurance sucks. I rely on the fact that I’m relatively young (just past 40), keep myself healthy, and use no meds. I have it for catastrophic events. In a few more years, I’ll stop funding my kids’ college educations and start using that money for ‘real insurance.’
Many people forgo regular surveillance for diseases that are completely curable if caught early (breast ca, colo-rectal ca) because 1. mammograms and colonoscopies are uncomfortable and moderately embarrassing and 2. they’re expensive. There are MANY things like this: pelvic exams for gyn problems, pap smears for cervical cancer, rectal exam for rectal cancer and prostate problems, smokers and drinkers minimize their use, obese people avoid talking about diet/exercise/portion control/etc.
Now, realize that I see a certain segment of the population and, yes, I realize that it skews how I view all of health care. However, I spend between 50-75 hours A YEAR keeping up on the medical advances and techniques – and part of this is keeping current on statistics and the politics of healthcare because it is merely prudent.
I work in rural California. But it is in every ED. Even the ‘stand alone’ EDs, though from the way that most are structured, those seem to exist merely to harvest money from Medicaid and Medicare.
5150’s are a personal hell. Every day, I have 2-4 of them languishing in the ER taking up bedspace. Out of every 10 I see, 2 are actually ill, 2 have acute problems (situational depression that resolves quickly), 2-3 are the cops deciding to put them on a psych hold instead of arresting them (cheaper and less paperwork), and the rest are malingerers.
/rant.