Friday, May 05, 2017

Pre-Existing Moral Conditions. My Political Lament.

Moe Brooks, representing Alabama's fifth Congressional district, is a man with firm moral principles.  Those principles keep him cozy, the way the shell of an escargot does.  A mobile little home of moral self-administration, that's what our Moe carries with him:

In a CNN interview, Representative Mo Brooks, an Alabama Republican, makes the case for Trumpcare in much starker terms: It will free healthy people from having to pay the cost of the sick. “It will allow insurance companies to require people who have higher health care costs to contribute more to the insurance pool that helps offset all these costs, thereby reducing the cost to those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy,” explained Brooks.
An example of someone who has failed to lead a good life, someone who has failed to do the things that keep bodies healthy might be the newborn son of Jimmy Kimmel:

Kimmel noted that before the ACA, also known as Obamacare, was introduced, “if you were born with congenital heart disease like my son was, there was a good chance you’d never be able to get health insurance because you had a pre-existing condition. You were born with a pre-existing condition and if your parents didn’t have medical insurance, you might not live long enough to even get denied because of a pre-existing condition. If your baby is going to die and it doesn’t have to, it shouldn’t matter how much money you make.”

Other people have clearly not led good lives because they have aged, and so deserve to pay for their own health care expenses.  Why should young people have to subsidize such recklessness as aging?

Joe Walsh, the politician who cannot even be bothered to financially care for his own children had this to say about Kimmel's son:

As Joe Walsh, a former congressman, tweeted on Tuesday afternoon: “Sorry Jimmy Kimmel: your sad story doesn’t obligate me or anybody else to pay for somebody else’s health care.” Walsh, by the way, doesn’t even want to pay for his own kids’ healthcare – at one point, he owed $117,000 in child support. Now there’s a guy who truly understands the American values of individual freedom and choice.
Messrs Brooks and Walsh express common conservative values in this context: individuals have the power and the duty to lead "moral" lives and  individuals have the right not to care about or for others in the same society.

To have those values is a pre-existing condition, one which interprets the very concept of "morals" narrowly and selfishly and with a focus on individual rights and responsibilities, one which from the outside looks like an escargot shell or the shield of a turtle:  Something to keep the world out.

But it's not those odd "morals" alone (where getting sick is a religious sin or a serious moral failing, even if the illness has a genetic origin) which make the above quotes worth thinking about:  It's also the odd errors many conservatives make in explaining health insurance to us peasants.

Moe Brooks believes that illness is largely within the control of an individual, that by living "good lives" we can live forever, and that those good choices make some of us deserving of low cost health care, while others deserve to die if they cannot pay for the expenses of their rotten lifestyles. 

Joe Walsh doesn't want to pay for anyone else's health care needs.  Now that will make it tough for him to participate in any kind of insurance scheme, because the basic way those work is by pooling the risks and paying for any care some need from the premia all pay in.* 

And even the US secretary of Health and Human Services,  Tom Price,  seems to argue that the older and sicker people should pay their own high health care costs so that the twenty-somethings don't have to subsidize them and can buy health insurance (which they at that age few of them truly need) at a very low cost (with the exception, naturally, of any coverage of pregnancy or childbirth which they at that age might actually need.)

The subtext in all those opinions is the denial of the fact that our lives are related to each other**, that good individual choices are not sufficient to save us from illness and death***, that good individual choices are far more difficult for those who have committed the grave religious sin of having been born into a poor family living in a polluted area with few good jobs, with many bad schools, but with an abundant atmosphere of despair and hopelessness, or into an addicted family in one of those ghost towns in the rural areas where the only large factory employing people has long since packed its bags and moved to China or Mexico.

But the subtext is also a particular interpretation of how insurance markets work, one which would prefer only trivial differences in risks to be pooled.  Thus, secretary Price sees the low-risk people, mostly youngsters, as being asked to subsidize older people, because the former have lower risks, for the time being.  That those risks grow over time for them, too, is ignored. That the system could be seen as fair over one's whole lifetime, given that what one pays earlier one gets back later, is also ignored.

Similarly, in the conservative moral universe the rich have no obligations toward the poor.  Thus, Medicaid is a lamentable mistake, to be corrected by turning it into block grants to states and by removing the connection between the numbers who need subsidies from the total amounts of subsidies.   The "moral" explanation in this context is similar to the one Brooks made when explaining why the healthy "deserve" their health and the low health insurance premia:  Those who have more money have earned it by being industrious (or by having picked the right parents), and from that follows the reverse:  Those who have less money do not deserve the money.  The money belongs to the rich, just as the health belongs to the healthy.

It's a Calvinistic predestination view of the secular world, a world of pre-existing moral and ethical conditions which we cannot refuse to pay attention to, given the Republican dominance in US politics.  But it's also a sign of the poverty of imagination among many Republicans, a sign of the vast, vast desert of no empathy which seems to trigger so many of the conservative stances.  Suffering doesn't seem real and undeserved until it hits some Republican politicians' own family.

And that is the pre-existing "moral" condition which colors the conservative understanding of how the US health care system should function:  The rich should have access to good health care because they have earned their wealth, the poor should have much less access, because they have shown themselves to be undeserving, lazy, without agency.  The rich should not have to subsidize the poor or the healthy the sick, because poverty and illness are both deserved consequences of bad life choices.

That the killing of the Affordable Care Act (ACA) would mean giant income transfers toward the wealthier from the poorer is not a horrible outcome from that conservative moral point of view:  It is correcting a moral flaw in the ACA and returning the money to those who are judged as its true owners.

That conservative world view is not just tribal**** but also Ayn-Randian:  The individual is the sole king of all he surveys, assuming only that he realizes this.  By striving and beating all the other would-be kings in the jungles of life he has earned his throne and his tiny reign over his family.  And if he succeeded in that, well, those who did not clearly deserve their lower status and suffering.  They played the same game and lost!

Thus we now have a president who believes that he is a successful business mogul, the greatest deal-maker of all times, a self-made billionaire, when in reality he was helped and supported from the moment his tiny baby body was placed in that golden cradle.

This is my understanding for the cheering party atmosphere after the US House Republicans repealed the ACA.  The moral universe has been returned to its proper hierarchical order:  The deserving get their money back and the not-so-deserving get the minimal help required to soothe slightly itching conservative consciences.


*  A proper discussion of health insurance is too long for this post.  It would address the fact that the insurance model really is not a good model to be used in health care, and it would also address the questions of moral hazard and adverse selection and the kind of pooling of risks which is desirable and the kind which is not, from a pure efficiency point of view.  But in reality we have an odd mongrel system which is neither pure insurance nor a single-payer system, neither a pure market system nor a pure government system.  It cannot be evaluated as if it was exactly like car insurance, even though conservatives usually do that.

**  And we don't even have to adopt a particular spiritual view of the inter-connectedness of all life to see what we share:  A society without good basic health care for all is vulnerable to sudden epidemics of Ebola, the plague and many other infectious diseases from which even the conservatives cannot defend themselves.  A society without good basic health care for all will not have a good labor force or enough students capable of learning the necessary life skills.  A society without good basic health care for all is not the kind of society where even the riches would like to live, unless they utterly seclude themselves from everyone else.

***  Or from causing high health care expenses later in life.  It's the ones who live longest, perhaps because of good health habits,  who are most likely to end up in nursing homes, and nursing home care is expensive.

**** Though it is tribal, too:  Race and religion are used to determine who is worthy of getting care, and that is one reason why the conservatives would prefer to see churches in charge of charity (the other reason being that then they themselves wouldn't have to chip in). 

Even gender is a tribal concept here, and that's why conservative men don't see why they should pay for someone's pregnancy or for someone's birth in their insurance plans, despite the fact that they, too, were born through that process of pregnancy and birth. 

But other women should have to face higher premia for the reason that women are the sex which reproduces the next generation.  This is partly because in the conservative worldview the purpose of women is for sex, procreation, sandwich making and obedience to the kings of the jungle, but not to see that reproducing the next generation matters to all of us is also a part of that Ayn-Randianism.