HEALTH CARE/Joan Retsinas

Battling Obamacare

In every war, non-combatants – toddlers to septuagenarians – suffer. Too bad, too inevitable. We know this from the mayhem in the world. Whether the battle rages around religion, ethnicity, or ideology, bystanders die. In fact, most of the casualties can rarely parse the partisans’ rhetoric, let alone embrace it. But the belligerents will explain that “collateral damage” is the price paid for a brave new world, a better one (even though the bystanders might have preferred their current world to oblivion).

The battle against the Affordable Care Act is no different. The partisans are rabid, campaigning on promises to repeal, decimate, castrate this horrendous Act, which a President whom they loathe pushed through. They promise nirvana. In a brighter tomorrow, a legion of right-thinking solons will push back the legislative clock, erasing Obamacare. Under the banner of “repeal,” the campaigners vow to construct a better way to pay for health care, one that frees us from the tyranny of a socialist-leaning Uncle Sam. Every other country that covers most citizens’ health care has relied on government; but the United States needn’t trod that un-American path. It is time for them, and for us the electorate, to assess the collateral damage of this war – to translate ideological victories into numbers.

How many premature deaths can we stomach?

To date, the rhetoric on the Affordable Care Act has focused on the “uninsured.” The Act sought to reduce the number – once pegged at 44 million – with no insurance. But “uninsured” is a sanitized word, signifying only that a person is not enrolled in any plan, private or public. Being uninsured per se does not mean much. It is the consequences that matter. People blessed with wonderful health, often due to wonderful genes and luck, may never draw on insurance. Most people, though, will find themselves sick, in pain, or injured at some point. For them, insurance matters.

Consider the bulwarks against illness – the slew of preventive screenings and tests. Insured people generally get them; uninsured people generally don’t. (If lucky, they may get preventive care from a publicly subsidized clinic – but Uncle Sam foots that bill). If the right-wingers repeal Obamacare, we can expect more cases of breast cancer, uterine cancer, lung cancer, more strokes, more babies born with complications, more people with shingles, whooping cough, tetanus, measles. And once these people become ill, they will be at the mercy of hospitals for “charity” treatment; but the often-cited safety net of providers that treat people with no coverage is flimsy. (In fact, federal legislation – Uncle Sam – has forced hospitals to beef up their charity care.) So the victors of this ideological war can expect more deaths. (Statisticians can soon assess the collateral damage in states that extended Medicaid versus states that, on ideological grounds, said “no.”)

How many injuries? How much suffering?

Let’s not limit collateral damage to casualties. Injuries happen. And people suffer. People with untreated asthma, with poorly controlled diabetes, with undetected high blood pressure – all will suffer. Ditto for those with arthritis, multiple sclerosis, bipolar disorder (the list goes on) who depend on expensive medications. The casualties include children and adults. Both will live harsher, sometimes shorter, lives than their insured counterparts who take the correct medications. Do we have a metric for assessing this damage? Are ideological opponents of Obamacare willing to make this fight personal?

Collateral damage is troubling, but are the partisans willing to suffer? They sing the siren song of the status quo, warning against the semi-radical change embodied in the Affordable Care Act (forgetting that, long ago, we trod that road to government insurance with Medicare). But it is easy to assure other people that they will ultimately be better off, in the long run., without this semi-radical Act. Can the partisans sing this song to themselves?

Will they accept the loss of their insurance, if they are downsized out of a job? Will they pay the premiums for their families if they die? Will they trust that their family can find insurance on the marketplace? Will they let their young adult children go without insurance (the Affordable Care Act allowed family plans to cover young adults)? Will they welcome back the “pre-existing condition” exclusions, now outlawed under the Affordable Care Act? Will they themselves enroll in a free-market policy that covers very little (the Affordable Act set a threshold of coverage)? Sometimes partisans find their victory Pyrrhic.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, October 1, 2014

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