The ACA vs. Delusion

Courtesy VOX
Stumbled across this in my news feed this morning,  liberals attacking this Senator for the stupidest tweet ever. Hyperbole aside, this isn't even a remarkable example of the kind of thinking that goes on in libertarian and conservative circles in their attempts to justify their beliefs concerning small government, the evils of government.  Far from being the stupidest tweet ever this is much more like standard operating procedure in any subset of humanity that is trying to justify their unjustifiable beliefs.


I can't count the dozens of times I've gotten in an argument with a small-government type who insisted that laws create crime; ergo fewer laws means less crime. Less government equates to more freedom.  Less regulation yields a fairer, free-er marketplace. It makes sense, if you stand back and squint at the concept for awhile. The mind is amazingly agile at creating justifications for things that you believe, whether or not those beliefs are justified.

If you were to approach one of these small government types and suggest that the behavior in question, let's say murder for example, remains egregious or unacceptable even if the laws don't exist, they would probably brush the argument off as reductio ad absurdumwithout realizing that the argument is legitimate in any case. The thought never crosses their minds, or is easily diffused with some other simple heuristics. People are peaceful and don't murder. It is government that murders, not individuals defending their rights. 

What happens when individuals without government have competing claims, though?  What if neither of the parties involved actually knows who has prior claim to property, as another example. Who is defending their rights and who is the transgressor? What authority will they empower to potentially strip their claim from them? The thought that government might have been created specifically to address these kinds of conflicts doesn't even occur to the anarchically minded, small government types. Can't occur to them, in a general sense.  To contemplate how laws and government serve a legitimate purpose brings on cognitive dissonance, which the believer will avoid at almost any cost.

Apply double-think (thank you George Orwell) like that illustrated above, and you can reverse cause and effect and suffer no cognitive dissonance.

The ACA isn't good in the estimation of the libertarian and conservative mindset. It can't provide a benefit, because it is a bad program. The people who benefit from the program can't actually be benefiting; that would be an admission that the program isn't bad, that it served some larger purpose. The blind assertion that healthcare is a personal choice rules out any possibility that healthcare might be a public good. That the group as a whole benefits when the health of individuals in the group is improved. That poor people will economize with healthcare to the detriment of their health if they are allowed to include those costs in their calculations of how much money they have to spend on other necessities. Things like food, shelter, etc. 

No, the ACA is bad in their estimation, so ending it is good. How then to justify denying care to millions of poor people who will not get care without the ACA? It extended false hope of being seen as valuable while remaining poor.  The poor cannot be of value because they are poor and beneath notice. Insurance is for those who can afford it. Everyone else should get to the business of getting wealthy or dying, makes no difference to those who have the benefit and don't want to share access to it.

Quite some time back Robert Reich posted this status. I saved it for this article I'm writing now. I knew I would get around to writing it at some point in the future, because I knew I'd stumble across some idiot who hadn't bothered to check his beliefs before posting something stupid on the internet;
Republicans who are intent on stopping 9 million needy people from getting subsidies through Obamacare and 15 million through expanded Medicaid don’t seem to realize that almost all other Americans get subsidized health insurance, at a far larger cost. Who am I talking about? 
1. Over 50 million Americans get Medicare (Part A and/or Part B), at an annual cost to the government of around $500 billion. The amount retirees receive in Medicare benefits is several multiples of what they paid into the system, even after accounting for inflation. 
2. About 158 million other Americans – me included -- receive a whopping $250 billion-a-year insurance subsidy through our employers, because employer-provided health care is excluded from our taxable incomes. This is the equivalent of a tax expenditure of $250 billion. 
In other words, around two-thirds of all Americans already get subsidized health care. And most are not nearly as needy as those who have signed up for Obamacare or those who would get extended Medicaid if all states signed up.
The ACA is unpopular precisely because it shares the benefits of living in the US with the poor people who cannot afford those benefits without help.  There is no other reason for opposing it, because it has been demonstrated to be a benefit to those who did not have access to healthcare before it was instated. There is no cost-based reason for opposing it, because the US government already subsidizes everyone else's healthcare in the US, with tax dollars taken from the pockets of the poor as much as from anyone else in the nation.

The poor are a hated group in the US.  The hatred of the poor for being poor (generally by poor people who can't admit that they themselves are poor)  is so pervasive that it is masked by quite a few other prejudices which are really just a shorthand for saying poor people.  The sooner we Americans realize this, the sooner we can escape some of the delusions which entrap us.  Delusions which shackle us to concepts which no longer serve a useful purpose.



The SCOTUS did as I expected and interpreted the phrase "the state" to mean the US government (which is also a state; i.e. government) the fact that anarchists and small government types would willfully spend millions of dollars to contest the meaning of one word in one phrase in a several thousand page set of laws simply speaks to the desperation motivating the people who brought the suit.
The case was, in other words, a sophisticated game of gotcha, based on what was, again, essentially a typographical error. The case was only about trying to destroy the law by denying insurance to millions and setting in motion a death spiral of raised premiums, cancelled policies, and more rate hikes until the system collapsed. 
courtesy The New Yorker
So that is that.  The ACA will stay in force for the foreseeable future. If the Republicans want to overturn it or modify it they are going to have to come up with a better plan than just throwing the poor back out in the cold (as the lawyers in the case alluded to with their response "deal with it") but I doubt that the Republican party leadership really wants the law repealed. There is little doubt the base of the party does, which is why you get the kind of hypocritical pandering from their representatives that I started this post with.

In the end, the poor will exact the cost of their existence from the system, whether the government factors that cost into the calculations it makes or not.  Personally, I'd rather they had access to the cheaper preventative care rather than have them clog the expensive and already overburdened emergency care system.  That will mean building out the system more than it is now.  Recruiting healthcare professionals to fulfill the needs of the poor.  Making it easier to become a doctor or a nurse.  You know, economic investment.

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