Category: health care Page 27 of 35

Let’s get specific.  The House spending bill linked continued funding to a one year delay of the individual mandate—the requirement that everyone buy insurance.  This is not the same thing as delaying Obamacare, everyone who wanted a policy could still buy one.  While there are subsidies for buying insurance, for many of the working poor they don’t cover most of the cost, and the insurance they buy is very high deductible, meaning that they are forced to either pay a fine, or buy insurance that they can’t afford to use.

Straight up the individual mandate is a transfer of  money from the working poor and the young and healthy to insurance companies and older sicker individuals. It forces people who can’t afford an extra expense every month (and if you have never lived paycheck to paycheck you should shut your mouth, you have no idea what it’s like) to buy something they can’t afford: to choose between food or rent or insurance.

On the face of it, and leaving aside motives, I cannot see that the Republican bill was a bad thing.  Absent a real, robust public option and much stronger subsidies than exist, the individual mandate was always the most odious part of the ACA.  This is not to argue that Obamacare does not do some good, it will save some people’s lives and reduce other people’s suffering. But it does so explicitly by hurting some of the most vulnerable people in America: the price of your healthcare, if it’s helping you, is hurting other, vulnerable, people.

I note, also, that employers were given a delay on their mandate, but individuals: poor people, were not given an extension on theirs.

Let us speak, next, to the details of the shutdown: if you do not like that most of the NSA, say, is still operational, but food and airline safety inspectors are furloughed, that is a decision made by the executive. It exactly reflects Obama’s priorities, it is not a decision made by Republicans.  You can blame Republicans for the shutdown, you cannot blame them for the specifics of how it is carried out, that is entirely Obama’s decision.  Spying on Americans and killing brown people with drones is vastly important to Obama and always has been.  Making sure you don’t die of e-coli, apparently not so much.

The individual mandate, from every poll I can find, is the most unpopular part of the ACA, opposed by straight majorities of Americans and definitely opposed by the Republicans who elected the Representatives who voted to delay it.  This is not a case of Democracy not working, it is a case of Democracy working.  What one House does, another can undo, that is the essence of democratic change.

Roberts voted how he did because health insurance companies are absolutely desperate for the money they will get from the mandate.  All of the legitimacy arguments are bullshit, about 70% of Americans opposed the mandate.(pdf)  This is more similar to TARP than anything else: it is a massive corporate giveaway, opposed by the majority of the population, and passed over their dissent.

Watching so-called progressives shilling for forcing people to buy shitty insurance to subsidize health insurance companies has been another example of why I don’t call myself a progressive.  Yes, a few people’s lives will be saved.  The cost will be many lives destroyed.

Update: to make the other obvious point, that government can force people to buy largely unregulated corporate products is an important precedent for the oligarchy.

Update 2: to point out more obvious which apparently isn’t:

• Roberts struck down Medicaid expansion, which means he closed the hole to creeping single payer
• the ACA is a subsidy from the young and healthy to the old and unhealthy.
• The subsidies to help buy insurance (which are insufficient to begin with) will nonetheless quickly become one of the biggest budget items, and will be taken away in the future.

Change: Changed from 70% oppose Obamacare to 70% oppose the mandate, link added.  The mandate is what progressives wanted upheld.  Note the deafening silence on the fact that medicaid has been screwed—the part that helps the poor most.

The New York Review of Books looks into the question of why there is an epidemic of mental illness, and if the drugs used to treat problems like depression actually work.

Short answer, no, the evidence for the drugs working is exceptionally weak.

Longer answer, the drugs mess with the patient’s brains, and in the longer term they make their condition worse.  The brain tries to neutralize the extra neurotransmitter, or to produce more of the suppressed neurotransmitter, but it eventually fails and burns out, creating what appears to be close to permanent damage (the brain is remarkably plastic so I hesitate to say it lasts forever, but Whitaker’s book, which I have read, includes evidence that even years don’t repair the damage.)

To put it simply, the psychiatric establishment has been corrupted by the pharmaceutical industry.  Shrinks, as a group, remind me of economists, most of them are frauds who follow an orthodoxy they never examine properly, highly credentialed fools who do more damage than good, prescribing medicine based on theories which have never been shown to match reality, or work.

One of the pathologies of American, and to a lesser extent, Western society, which really stands out yet is rarely remarked on, is the absolute epidemic of chronic diseases we suffer from.  From historically apocalyptic rates of cancer to asthma, to heart and stroke disease, we’re one sick bunch.  We walk around, not dead yet, but chronically sick.

This is a direct result of our economic arrangements.  We dump huge amounts of carcinogens into the air, water and the food chain.  We pollute the air in so many ways they’re uncountable.  We build our residential areas to actively discourage exercise.  We subsidize food that is bad for us, especially corn derived foods, and we eat so much sugar it’s surprising we aren’t all crazed.  We dump such massive amounts of hormones into the water and food chain that our children are experiencing record early puberty.  And this is the short list.

All of these are what economists call “negative externalities”, which is to say, the cost of someone’s profits is paid in illness and chronic bad health, which also has a monetary cost.  But, y’know, forget the monetary cost for a moment.  If you or someone you know has a chronic health condition, let alone cancer, do you care how many rich people the US has?  If you’re one of the few doing well out of this system, does it matter to you when someone you love is suffering from cancer or chemo, or has diabetes, or struggles to breathe?

A society which makes itself sick and unhealthy the way we do can’t be said to be a good society to live in.  Human welfare is about how enjoyable it is to be alive, and there’s nothing enjoyable about illness, or watching someone you love puking from chemotherapy.

So next time someone talks about pollution, or additives, or “negative externalities”, remember, what they’re talking about is making you or someone you care about unhealthy or downright sick.  Your suffering, or the pain of your fatther, mother, lover, son, or daughter is what makes other people rich and enables the “lifestyle” of various other folks.  The poorer you are, the sicker you are, as a rule, because all you can afford is the highly subsidized crap food, but even if you’re rich and you eat straight organic, hire a trainer, and so on, you can’t avoid all the water, air and food pollution. You or someone you know is still likely to wind up sick, who shouldn’t have.

The suffering of sickness and ill health is one of the prices of what passes, less and less, for prosperity.