Affordable Care for Whom?

So we now have the official word from the reactionary Supreme Court, in the person of John Roberts, no less: President Obama’s signature piece of legislation, the Affordable Care Act, passes constitutional muster not, as expected, because it legally regulates interstate commerce (Roberts said it did not, because it tried to punish people for not buying something—a precedent that would allow ‘do-gooders’ to force everyone to eat organic foods), but because it legally qualifies under Congress’s authority to tax. That is, forcing people who don’t buy health insurance to pay a tax (not a penalty) on their income tax form was somehow ok. I fail to see how this is any different from enforcing the activity under the Commerce Clause, but then I’m not a lawyer. Indeed, what I have always wondered is why Democrats have never made the argument that seems most logical to me: if Americans can be forced to buy automobile insurance (it is a condition of getting a driver’s license and is rationalized in the same way as the health insurance idea: if some drivers do not have insurance, the cost of their accidents has to be borne by everyone else, an unfair burden), then why can’t they be forced to buy health insurance for the same reasons? But they never have, until Friday when Steny Hoyer finally did mention this precedent on the News Hour.

            Still, no matter the rationale, it seems inarguable that this unlikely decision by the conservative Chief Justice was salvational for Barack Obama’s chances for re-election. Without it, he would have been a one-term president for sure, and we would be left with that forged-in-plastic excuse for a human, Mitt Romney, as president. Given the damage already done by the Supremes nominated by Bush, the chance for another reactionary to pack the court with still more political operatives would have been catastrophic. Still might. And even if Obama wins, we’re still stuck with a health care “reform” that does one thing above all: it preserves the privatized system of health care—citizens of the richest nation in the world forced to buy half-assed care from huckster insurance companies—that is the shame of the modern world. Fully 18% of the American economy is spent on health care, and the care overall puts us at the level of the poorest third-world countries—37th overall I think. More precisely, Canadians, who have a single-payer system, spend half of what we do on health care that covers everyone, and get superior treatment whose effectiveness and efficiency is gauged by an average life expectancy far greater than ours. And the Affordable Care Act will now force millions more to sign on to the ridiculous system that makes profit-making its top corporate priority, and in effect transfers more billions from the people to the HMOs and their CEOs.

            The only hope is that once this ‘improved’ health care system is in place, making it possible for millions more to be covered, the defects in the system—especially its continuing rise in cost—will become ever more apparent, and a single-payer system, aka Medicare For All, will become possible. And what will that take? For one thing, it is going to take a shift in the language used by advocates. This is what still astonishes anyone paying attention to the discussion in America, not only over health care, but over the economic situation in general. That is, the word “poor” has become verboten to politicians on both sides of the aisle. This is most noticeable among Democrats. Does Obama ever mention that health care is desperately needed by those who can’t afford it—the poor? Not on your life. He mentions only the middle class. The middle class needs relief. The middle class needs health care. The middle class needs jobs. The middle class kids who go to college need protection from a rise in interest rates on their loans.

            Whatever happened to the poor and working classes? Have they all graduated to the middle class? Have they been outsourced to some third world country, like everything else? Are there no longer any humans living below the poverty line or in inner cities? And if there are, why have they become—especially for this African American president whose election was seen as so paradigm-shifting, so emotionally liberating by precisely those people—invisible? Unmentionable, even by the party that owes its strength and its moral leverage to its historic pact with and for them? 

            The truth, of course, is that the poor and working classes are still with us—their condition steadily worsening, especially in the climate of economic penury resulting from the 2007 financial collapse (just for reminders: there are 20 million Americans with incomes below half the poverty level; 6 million living only on food stamps; unions losing benefits on every front). The truth is that they are, as many have pointed out, in danger of becoming a permanent underclass due to the outsourcing of those manufacturing enterprises that once provided them real jobs and improved living conditions. The bitter truth is that they are in even more serious danger of being wiped out as a class, their purchase on the American promise weakening to the point where their providers have no prospects, their children are abandoned in declining schools, their young men are slammed into prisons and third-class citizenship for minor offenses. The final truth is that their vote—when they are not stricken from voter rolls by Republican sleight of hand and outright fraud—is becoming increasingly as meaningless as their (in)ability to buy elections.

            It is for this reason that no one—not Obama, not Democrats running for office, not social architects of reform—mentions them anymore. Mentioning the poor or working classes has become equivalent to mentioning Marxism or socialism or atheism or, god forbid, abortion. It just isn’t done by the better sort. Except, of course, when Republicans refer to them obliquely as an unbearable burden—as when they lament that the government, with Obamacare, is going to have to subsidize their health care, to the point where it will cost trillions of dollars we can’t afford. Or where states insist that they will refuse the new expansion of Medicaid (again, for the poor), even though the Feds give them the money to finance it! It’s only for those immoral deadbeats after all.  

            Thus an entire class is in the process of being not merely marginalized—we can’t afford the poor anymore—but wiped out. One wonders, grimly, how long it will take, and if anyone (of the better sort) will notice or lift a finger to prevent it, as it does.

Lawrence DiStasi