HEALTH CARE/Joan Retsinas

Inequality in the Age of Affluence

The widening wealth-gap has sparked dismay. Half of us are “low-income,” and, when the economy is growing, the top 1% of us reap most of the gains.

We must shrink the gap – or so the political rhetoric holds. But do we lower the top rung of the ladder, now soaring into the financial stratosphere? The politicians who promise less government are sparking a groundswell of enthusiasm. Clearly a large swathe of the electorate does not want Uncle Sam to lower that ladder. After all, Horatio Alger rose higher and higher; and even if Joe the Plumber (Sen. John McCain’s working class hero) and Dickey Flatt (former Sen. Phil Gramm’s hero) stand little chance of morphing into billionaires, at least if Uncle Sam keeps his hands off their enterprises, maybe, just maybe, they might. The American Dream is not so much great wealth, but the possibility – however slim the odds - of great wealth.

So I’ve almost given up on lowering the top rung. I don’t think enough people want to.

But the floor is sinking, and we need Uncle Sam to shore it up. Ironically, the conservatives who want Uncle Sam to keep his hands off the top rung of the ladder, with lower taxes, fewer regulations, and less oversight, don’t see that if Uncle Sam backs away, the top rung may indeed rise higher, as the nation records more billionaires – but the bottom will sink lower.

The Darwinians among the conservatives may accept a sinking floor; but do they truly want the consequences? Through the prism of health care, let me offer a glimpse of our country, as Uncle Sam retrenches, as we bifurcate further into two classes, much like the world’s frontier markets. What will we see?

More amputees wandering our streets. They may not be begging (though if we retrench on income supports, they may be begging); but they will be visible. A variety of illnesses, most prominently diabetes, need treatment. Without health insurance, people cannot easily get treatment; without treatment, those patients run the risk of gangrene. If we retrench on orthopedic devices, we will see the results of that neglect.

This brave new world of retrenchment has started. Twenty states did not extend Medicaid, even with generous federal incentives. That principled rejection of Uncle Sam left thousands of citizens uninsured.

Even insured patients are vulnerable to cutbacks. Recently Medicare proposed tightening the eligibility standards for enrollees who need artificial limbs, leaving 150,000 Americans wondering why their government turned its back on them.

More people with white canes. Much loss of vision is preventable, with medical care. Consider cataract operations, now commonplace. Other conditions, like glaucoma, require treatment. Accidents take their toll. Without health insurance, people are far less likely to get treated.

More people with rotting, or absent, teeth. The smiles of people (sometimes children) in much of the world are marred. As with much of health care, one key is dental care. And, again, insurance guarantees people access.

This brave new world has also started. Many employer-insurance plans do not include dental care. And governors looking to slash Medicaid are looking to slash benefits like dental insurance. Illinois’ Gov. Bruce Rauner (R), for instance, has proposed cutting adult dental care, along with mental health, podiatry, renal dialysis and hemophilia. The poor are unlikely to mount a lobbying campaign to save dental care – certainly not the concerted lobbying of millionaires threatened with higher estate taxes.

Abandoned veterans, needing care, getting none. Our wars have cost trillions of dollars, but we neglected to budget into the cost of war, the cost of caring for veterans. So budget-slashing politicians, some who supported the wars, propose to cut the VA system.

Consider a recent proposed $1.4 billion cut in Veterans Services. That cut will translate into less care for more veterans. A St. Louis Rehabilitation facility, a clinic in Alamada, Calif., a community center in Perry Point, Md. – and their patients – will all feel the cuts.

Maybe the politicians spouting “I-hate-government” rhetoric can accept this Dickensian vision. Can voters?

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

From The Progressive Populist, November 15, 2015

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