I won’t get into my real ideas about health care reform, universal health care, socialism, communism, et cetera – I’ll try to limit myself, for now. If you want to absorb some of my ideas about these subjects, I recommend you read my fiction, especially my latest novels, Sophia and Emily (Never Let the Right One Go), which cover a lot of “health care” ground while telling engaging stories about love, personal growth, and vampires in a utopian/dystopian setting. For now, I’ll try to stick to this week’s hot topic, the Patient Protection and Affordable Care Act (PPACA, sometimes referred to as “Obamacare”), with particular attention to this week’s most contentious aspect of the Act, the “individual mandate”.
But first: Go read this analysis of the history of the support for the part of PPACA known as the “individual mandate”. I’ll wait.
Have you read it?
No, really. I’m not going to cover all of that here, but I’ll summarize: Fifteen to twenty years ago, conservative “think-tanks” and Republican elected officials were putting forth most of what makes up the PPACA (and definitely the individual mandate) as their ideas for how to reform health care in America. By five years ago, bills with these features had bipartisan support, though it was still leaning more to the Republican side for support. Four years ago, during the run up to the 2008 elections, one of the small differences between the Democratic candidates for President was their support for (or lack of support for, in the case of Obama) the individual mandate; the Democrats had taken up support for most of the goals which ended up in PPACA, but didn’t all agree on the idea of the individual mandate. After Barack Obama was elected, things changed: By February, 2009, Republican support was being pulled, and by December, 2009, not a single Republican would vote in favor of something they’d largely introduced, again and again over the last 20 years.
This shift, I believe, is merely representative of a larger overall shift in America’s political landscape over the last 20 years (really a major shift in two or three steps over the last 50-60 years) which has been brought to a head since the election of Barack Obama. Let me draw you a few pictures, to illustrate my point. I’ll begin with the Civil Rights Movement, which as I’m sure you can see by looking at the current discourse, is a relevant place to start:
You’re probably familiar with this sort of political chart, where rather than simplifying all politics to a single line (I’ll get to that in a moment) people and/or parties are mapped on two axes, a social axis and an economic one. I’ve described the two axes simply here, but you must understand they describe complex sets of ideals. Rather than try to explain them all to you, I’ll just clarify (as it relates this this post) that by “Economic Freedom” I generally mean what politicians mean, which is “Economic Freedom for Businesses” (usually also “at the expense of individuals” and sometimes also “at the expense of small businesses”) – such that the opposite of “More Economic Freedom” also means more regulation on businesses and economics, to protect individuals (and often small businesses) from big, corrupt players.
Legend: I’ve used blue to represent the Democratic Party and red to represent the Republican Party in all the charts in this post. Should be pretty obvious to modern readers.
You may not agree with how I’ve mapped this out; that’s fair, I’m not an expert. If you would like to do a more nuanced analysis, I will gladly update this post and/or do a followup post containing information from Political Historians. My impression, though, is that for the period leading up to the Civil Rights Movement in America (i.e.: prior to the 1960’s), for most of a century but particularly after the stock market crash, the major political parties in America were separated by a gulf of ideas about how to manage economic and business interests. Democrats, on the “left”, were also fairly divided between Northern Democrats and Southern Democrats, the latter of which were still upset about the Civil War and the Emancipation of their slaves. Whether this long period of resentment about losing their economic and political power resulted in or was the result of racism, I cannot say; what I can say is that by the 1950’s, the Southern Democrats were pretty darn racist. Republicans, on the “right”, were less clearly divided amongst themselves, representing a broad range of social ideals, though still strongly based in the civil rights ideas on which they had become known (via men like Lincoln), and a limited range of economic ones (their economic ideals match pretty closely with what modern readers would consider baseline conservative (economic) values). This created, despite the limits of a two-party system, a governance which represented all corners of this political spectrum (I may post another time with my more complete, multidimensional conception of the true political spectrum; that would probably take a few thousand words to express, by itself, and much more complex charts) and quite a lot of moderate thought – only true centrists were not well-represented there.
After the Civil Rights Movement, many (well, really, most) Southern Democrats, in opposition to the Democratic Party’s apparent support for civil rights (the reality is quite nuanced; this is broad strokes), “switched sides”, joining the Republican Party. (The Democrats, as they say, lost the South over Civil Rights, and have only recently begun to make political headway in that region again.) Simultaneously, the Democratic Party continued to narrow its focus to social issues while the Republican Party narrowed its focus in opposition. Some (few) Republicans, who had been with the party for its strong Civil Rights platform, also switched sides, joining the Democrats. These contractions of what each party was focused on, and trying to represent, especially focused because of the nature of two-party politics, flipped the political spectrum on its ear, as I’ve illustrated below:
After the Civil Rights Movement, rather than representing a meaningful and broad spectrum of social and economic ideas, the Democrats and Republicans dug in, changing the nature of the conversation in the process. When the narrowing of the conversation took place, “left” meant both more social justice and more economic justice, while “right” meant more freedom for businesses (and banks), limits on civil rights, and a strong anti-welfare (both social and economic) position. After the view was narrowed, most lost sight of the complexities (and nuances) which had come before, and the views of each side seemed to be becoming more polarized. Likewise, the old meanings of “left” and “right” corresponding largely to economic differences were forgotten – on a one-dimensional spectrum, there is only “my side” and “your side”. No matter how their positions change on the original chart, Democrat has meant “left” and Republican has meant “right”, and then they continue to pretend “left” and “right” still correspond to “liberal” and “conservative”.
Unfortunately, in the last several decades, there has been a major shift, with much going-off-the-rails in the last 15-20 years. It is exemplified in the example of the PPACA and the individual mandate, which I made you learn the history of, earlier. Here’s another chart, showing my perspective on how to accurately map out the shifting political climate of America’s two-party system over the last few decades, but with the actual left-and-right of the spectrum being mapped to the original economic left-and-right from the first chart:
By the 90’s, we had a Democrat President passing free trade agreements Democrats had been fighting against for centuries, and the false hope of single-payer healthcare for all Americans. The Republican response in opposition to a single-payer system was one where everyone (not already covered) would be required to buy private health insurance (i.e.: the individual mandate); this is the pro-big-business way to answer the question of health care, without in any way addressing the underlying problems of exponentially-increasing costs and dwindling effectiveness – take more money from everyone, especially the poor and the lower middle class, and put it in the hands of big business. It didn’t pass.
But the conversation continued moving to the right. The politics continued moving to the right. In economic terms, whether the Democrats were in office or the Republicans were, it was big business which was winning, and winning more and faster every year. Less regulations on banks. Less regulations on business. Less taxes on the rich and on business; more subsidies & kickbacks for the rich and big businesses. (And when the Republicans were in office: Fewer environmental protections, reductions in civil rights, and interventionist international policies to create new wars from thin air.) By 2008, as I said above, the Democratic candidates for President were debating which version of the Republicans’ old proposals for health care [insurance] reform they supported; single-payer wasn’t even on the table. By now, the Democratic Party has effectively shifted all the way across the spectrum to where the Republican Party used to be. They’re putting forward what had until-recently been Republican ideals, and have apparently thrown out much of what they (at least the Northern Democrats) have stood for across most of the last hundred and fifty years.
Sadly, while the Democratic Party has shifted all the way over to what used to be the far end of the “right”, the Republican Party has marched in lockstep with them, further and further to the right. By the old measures (if the first chart’d had any units marked) the Republican Party of 2010+ would be well off the chart. By 2008 they were far enough to the right that they’d begun to splinter, the extremist “Tea Party” being an expression of just how far from reality and rational discourse the “right” has drifted. The Republican Party has shifted so far from where they once were, and the dialogue has been so defined by the confrontational two-party system, that they’re fighting tooth-and-nail against what were recently their own ideas, just because the Democrats have finally come around and agreed to accept them. In order to maintain their opposition to all-things-Democrat, and in order to distract the body politic from what’s really been going on, the Republican Party has been narrowing their already-narrow focus even further, removing their support for equal rights for women, for states’ rights, and for several constitutional rights set forth in the Bill of Rights. Even worse, the Democratic Party is following them down this rabbit hole, and losing its sense of social justice in the process (see also: loss of due process, 4th amendment protections, et cetera) of trying to keep up with the Republicans’ increasingly-extremist views.
I have one more chart for you, then I’ll try to wrap things up. This one is pretty straight-forward; it’s the current (insane) political spectrum represented by America’s two-party system, mapped back to the original chart (you must imagine the units have changed; everything on this chart is to the right of that first one):
I don’t know what else to say, really, except wake up! Unless you’re some sort of extremist, extremely wealthy, or a big business, you aren’t being represented by either of the two parties in America’s “two-party system”. If I were to attempt to map the Libertarian Party of today on this chart, it would probably be a single pixel, hard up against the right edge of the chart, probably 2/3 or 3/4 of the way down from the top. That’s probably not really you, either. I haven’t done enough research on the Green Party to really say, but my general impression is that (with the shifted axes) they’d look pretty centrist on this chart. Realistically, we actually have a one-party system, and it’s a little like the pre-Civil-Rights Republican Party, except shifted a few steps to the right. It’s a party of big business, of big money, and of increasingly-concentrated power & wealth.
We now have a system where the two “sides” are just arguing over how and how fast to deliver the rest of the wealth to the wealthy, and how to keep everyone else from noticing what they’ve been doing. The PPACA isn’t going to improve the state of health care in America; it’s going to improve the bottom lines of the health insurance providers, the bureaucrats, and the representatives & senators who supported it, while increasing medical bankruptcy rates for the citizens it was intended to help and doing nothing to address the literal bad medicine which comes out of our current system of ridiculous/rampant malpractice suits and fear-of-lawsuits-based treatment (the two of which create a vicious cycle with one another, creating ever-worse care for ever-higher costs). Oh, and I wish you’d stop calling it “Obamacare”. Barack Obama is only tangentially-related to this monstrosity of a right-wing program which has been on its inevitable trajectory for decades, fueled by American politicians’ recent rapid shift to the right.
One thought on “A few political thoughts; illustrated by health care/insurance ideas”
Sounds right to me, which means the current state of the system is very wrong.