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The health of nations


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The U.S. political system faces a monumental challenge to its capacity fight off parasitic disease in the form of the Republican Party's attempt to dismantle Obamacare and use the proceeds to enrich its biggest donors. Historically, it is rare for democracies to establish a widely beneficial entitlement, then to have a major political party attempt to simultaneously roll back those services and redistribute resources to the most affluent members of society, intentionally exacerbating inequalities that have been growing for decades.

It is all the more ironic given that the president of the United States, who campaigned on the claim that he would reform health care without cuts to existing services, now serves as a useful idiot in Senate Majority Leader Mitch McConnell's attempt to score a partisan victory on the backs of those white, working-class voters who make up the president's base.

From a supposedly populist election wave, this would be among the least popular bills ever passed. The Senate bill as proposed includes more than $1 trillion in cuts to health care programs, most of it aimed at Medicaid, which serves the nation's low-income workers, elderly, disabled, and children. More than 15 million citizens would lose health coverage in just the first year of implementation, including more than 75,000 residents in SLO County currently covered through California's insurance exchange or MediCal. The only way to prevent a massive loss in coverage would be for the county to come up with $6 million to support our local safety net of hospitals and other care providers.

It is deceptive to call this a health care bill at all. Rather, it is a scheme to redistribute wealth back to the already wealthy, who were paying for these programs through a 3.8 percent investment fee and taxes on individuals making more than $200,000 per year. They, along with health insurers and prescription drug makers who will also receive tax cuts, are the only beneficiaries. In short, this is a bill designed to exacerbate the already toxic levels of inequality straining the American political system.

By toxic, I literally mean that income inequality poisons our society. The immediate effects of this bill and increased levels of inequality will be amplified levels of mental illness and drug abuse with fewer services to address them, as demonstrated in Pickett and Wilkinson's now famous study "Inequality: an underacknowledged source of mental illness and distress." The U.S. already has some of the highest rates of inequality, mental illness, and drug abuse in the developed world, and this bill will only worsen these conditions.

Exacerbating inequality will also further deteriorate our ability to cooperate on collective solutions. Steve Loughnan, Peter Kuppens, and associates, in their paper, "Economic Inequality Is Linked to Biased Self-Perception," show that "the extent to which people engage in biased self-perception is influenced by the economic structure of their society, specifically its level of economic inequality." The bias of partisanship, confidence in one's "tribe," and identity politics will only worsen as social mobility deteriorates.

Thomas Shapiro, professor of sociology and public policy at Brandeis University, has persuasively shown, in his book Toxic Inequality, how increased inequality permits fewer families to manage crisis, create opportunity, and build wealth. Conversely, a lack of assets, concentrated among families of color, holds more and more people back from escaping poverty or planning a future for their children.

This tragedy of the commons is not inescapable. If Congress committed to a bipartisan bill, it would likely take one of two forms. Simply expanding Medicare for all Americans and establishing a public option in all health insurance exchanges would address nearly all the inefficiencies associated with Obamacare. A big purchaser like the government in every exchange would drive down costs and provide quality care at a lower cost than private insurance, which could be deregulated, and provide high-end premium coverage to those who want it, or those who prefer to pay out of pocket for faster, higher quality service.

Given that the GOP would still lead the way, a market-driven outcome would be far more likely, and a system such as Switzerland's would be an alternative. The Swiss system is largely privatized, with a universal mandate (like Obamacare) that ensures coverage. Crucially, the heavily regulated market requires that all insurers provide a basic coverage package, and many costs, including pregnancy, are fully subsidized, as they are considered public goods.

Those are basically the options for civilized nations. These are humane alternatives that would generate lower levels of inequality, lower infant mortality, higher life expectancy, less mental illness, and higher social mobility. America will never be great until we face up to the way that we exploit the least among us to prop up a parasitic class of elites who increasingly wield their economic power to insulate themselves from the financial and ethical responsibility that robust democracies require. Δ

Michael Latner is a political science professor and Master of Public Policy Program director at Cal Poly. Send commentsthroughthe editor atclanham@newtimesslo.com.


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