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Pre-existing conditions

Obamacare_replacement_brainstorming_session.jpgFriends from countries with national health services - that is, any developed country other than the US - often ask in puzzlement why so many Americans oppose something that the rest of the developed world regards as a human right. Ill-health comes to us all, whether because we hedonistically drank, smoked, drugged, sugared, salted, fatted, and unsafely fucked our way to it or despite our living in drink-free, smoke-free, drug-free, vegetable-filled, celibate austerity. There is as the late film critic Roger Ebert wrote, a pre-existing condition we all have. It's called life.

A new round of questioning will likely follow yesterday's House vote to repeal the Affordable Care Act (aka "Obamacare") and replace it with the American healthcare Act. The bill's provisions, Mother Jones reports include defunding Planned Parenthood, cut Medicaid funding by 25%, and allowing insurance companies to raise premiums for pre-existing conditions, and deny coverage for maternity care and mental health. (Gotta love the logic of denying both contraception and maternity care.) The margin was only four votes, and the bill hasn't been scored, so its path through the Senate may stall.

In the meantime, what do you make of a country where people call care for the elderly abusive socialism and totalitarianism?

Asklepios_-_Epidauros.jpgIt looks increasingly like the best chance at national healthcare were blown in the early 1970s. The plan Nixon announced in 1972 was, as many have pointed out, very like the AHA President Barack Obama pushed through in 2010. Reportedly, long-serving Senator Edward Kennedy (D-MA) was prepared to cut a deal with Nixon to make it happen, but ran afoul of labor leaders demanding a single-payer system. Nearly 50 years later, that hope is receded: Nixon was then seen as deeply conservative; today we call Obama a liberal. Nixon's personal history of a childhood in poverty and the loss of two brothers to tuberculosis was the key. By 1980, it was on to Ronald Reagan, who called universal healthcare as socialized medicine, despite passing the law requiring hospitals to treat all patients needing emergency care, whether or not they could pay.

Tarring healthcare with "socialism" was superb marketing in a country that deeply feared communists. Wikipedia pins "socialized medicine" as a term of disparagement to 1945, when President Harry S. Truman proposed a universal healthcare plan, right when the House Un-American Activities Committeewas peering everywhere for communists, most notoriously in Hollywood. As Ebert wrote in 2009, "socialist" served as shorthand to shut down all discussion - Godwin's Law of American medicine. Ebert also marveled at the marketing prowess of death panels (he called them a "lie" and a "meme"; today we'd yell, "Fake news!").

Roger_Ebert_(4590674207_d0ab1b653d_n)_(cropped).jpgHowever, Ebert also said something that ought to give anyone pause: "I had group health insurance plans through my unions at both jobs. They were good plans. But during the course [of] four major surgeries--no, make that five--I maxed out one, and so much for that policy. I'm approaching the cap on the second. Most policies aren't unlimited, you know. Luckily, I now qualify for Medicare."

If someone as prominent and successful as Roger Ebert cannot make it in the American healthcare system, you know it's utterly broken. This is why so many British people stepped up during the 2009 debates to say, We love the NHS.

So: why are they like this? "Socialism is bad" is clearly one deep-rooted reason. Related is calling healthcare a "benefit" and tacking it to employment. An American with a good job is "taking care of themselves", an idea the folksinger Bill Steele lampooned in his song Please Take Care of Me. Paid healthcare is aspirational, something anyone can qualify for out of merit and hard work, a cleanly devised class system that can pretend to be no such thing. It is of course profoundly destructive: it means that American workers, fearing the loss of health insurance, cannot afford to stand up to their employers and effectively turns the American middle class into peasants. It makes starting your own business once you have children hugely risky unless you're already wealthy. See also I Owe My Soul to the Company Store.

The same individualist element that helped immigrants survive in populating the country works against Americans here by making collectivism seem like imposing an unfair burden on people who think everyone ought to be able to manage their own lives. This ties neatly into some of the more extreme religious attitudes you come across that suggest that ill-health is some god's way of meting out punishment the sick person undoubtedly did something to deserve. The best response to that came from late-night comedian Jimmy Kimmel, whose newborn son has a heart condition.

Yet the lack of universal access to healthcare is far more dangerous now than it was 50 years ago. The spread of cheap air travel links us all together in a physical analogue to the internet. Bacteria and viruses don't care who they infect. Even in New Zealand.

Illustrations: March 2017 White house meeting to replace the ACA (aka Obamacare); Asclepius, god of medicine; Roger Ebert.

Wendy M. Grossman is the 2013 winner of the Enigma Award. Her Web site has an extensive archive of her books, articles, and music, and an archive of earlier columns in this series. Stories about the border wars between cyberspace and real life are posted occasionally during the week at the net.wars Pinboard - or follow on Twitter.


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