Racism, Right-Wing Rage and the Politics of White Nostalgia. Tim Wise is trying to give America a history lesson. I don’t expect that to end well. Not because his facts are bad (they are excellent) but because America seems committed to pretending that various major events and policies over the last 200 years didn’t happen whenever it looks like the bill might be coming due. Until of course something horrible happens and there is no way to avoid reality. You know what I’m expecting to shake loose the health care debate? Swine flu. Right now it’s not a pandemic, but all that scrambling for a vaccine isn’t for shits and giggles. And if it’s not swine flu it’ll be some other pandemic like the one in 1918 that highlights very quickly what can go wrong when most of your population doesn’t have access to long term quality medical care. Oh sure, there will be people in the hospitals getting treatment after it all goes to hell. But before the point when we know that it’s Killer Infection X? It’s going to get a whole lot of time to spread as people ignore symptoms and keep going to work or to school or wherever without treatment because they can’t afford it. And we’re going to see a lot of “those people” rhetoric and blaming of the victims because of course the poor will be the scapegoats instead of the real culprits.
After a good sized chunk of the population has taken ill/died and we’re struggling to keep America running? You’ll see the same people that are screaming now about death panels, and not paying for any health care for the lazy, and whatever other trigger phrases that are currently in vogue (phrases that amount to “There’s only enough for me and people like me. We’re not sharing with you.”) screaming about how the government failed them. About how “those people” ruined America with their selfish insistence on going to work and school instead of staying at home. They’ll ignore every bit of context that points to the uncomfortable parts of reality in favor of playing the blame game as long as it keeps attention off of their role. It’ll go on for weeks with pundits happily engaging in the demonization of everyone that didn’t beat them upside the head with reality enough times, and refusing to consider that all their scare mongering tactics to prevent the public option from being viable in 2009 are why things are falling apart in 2012 or 2020. The sad part is that we’ve actually already had this lesson several times, but for some reason America can’t seem to remember what happens when you let greed trump common sense, much less what happens when you let racism poison every decision.
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Your main thesis has some validity. In fact, IIRC (and I’ve no time to research this at work), a number of public health initiatives have taken place because widespread infection among poor people have threatened to spread to the wealthier classes.
However, were the examples of the epidemics you linked under “several times” meant to illustrate the danger of not providing a minimal level of healthcare (or healthcare insurance) to all people? Because for most of it’s history smallpox spread in epidemics either because there was no known cure or because the cure was not accepted by the medical establishment, not because it existed but was only provided to people who were able to pay a certain amount. The same thing applies to polio and other infectious diseases. Native Americans weren’t wiped out in the 16th and 17th centuries because they didn’t have health insurance.
I think Wise, like Paul Krugman and Melissa Harris-Lacewell and Philip Kennicott, is overestimating the extent to which this rage about health care reform is driven by racial anxiety. Yes, to the extent it overlaps with the birthers, it’s DEFINITELY about race. Yes, to the extent someone thinks this is about reparations, it’s DEFINITELY about race.
But there is a long history of inarticulate and uninformed conservatives losing their damn minds when the liberal elite wants to make the United States anything other than a fantasy of rugged frontier independence. Adlai Stevenson, one of the whitest dudes ever, had a mob meet him in Dallas in November 1963 because he was JFK’s ambassador to the UN and was suggesting more international cooperation. The Republicans were successfully spinning this proposal as One World Government and Lying Down For Communism. This mob screamed at Stevenson and spat on him and one woman — the 47-year-old wife of an insurance executive — “accidentally” hit him with the sign she was carrying. Stevenson told the cops who were about to arrest her that he didn’t want to press charges and maybe it was an accident.
(Not that this kind of behavior by a large number of otherwise-respectable citizens, and the apocalyptic attitude embodied in this behavior, would give anyone any ideas about carrying out real violence against the dastardly Kennedy Administration. There’s never any connection between what a large group of slightly over-enthusiastic Patriots does today, and what a lone gunman does a few weeks later. Nope. At least back then, leaders were embarrassed by such behavior and the local newspaper had the guts to call it what it was: “Dallas has been disgraced. There is no other way to view the storm-trooper actions of last night’s frightening attack on Adlai Stevenson.”)
Race can bring some people to a higher pitch than they otherwise would be, but Democrats have been getting blindsided by Republicans’ ability to throw out the word “socialist!” to scare voters for almost a century now. Sometimes the Dems overcome it, and we get the New Deal and the Great Society (including that Medicare that Republicans suddenly now consider sacred, after Reagan declared that it would be the end of freedom in America). Sometimes the Dems don’t overcome it, and the public option and end-of-life decision-making get dropped, and we all lose.
I think a public message of “You are upset by the idea of death panels because you’re racist” is not going to help matters. If I thought there would be death panels and forced euthanasia and no health care for someone like Rahm and Ezekiel Emanuel’s sister Shoshana (who has cerebral palsy), I’d be upset too. Thankfully, I’m literate and can read the legislation and see that none of that stuff is in there. As Adlai Stevenson said of his assailants: “I don’t want to send them to jail. I want to send them to school.”
@PG
I linked to those to illustrate the number of times America has faced major epidemics and the fact that we seem to think that we’re somehow immune to another one. Obviously we didn’t have health insurance in the 16th century. We also had no clue about transmission or how to prevent them. Now we do know what’s necessary and we’re still engaging in the same ostrichesque behavior when it comes to doing the right thing.
Karnythia,
I think your comment @3 is more responsive to RonF’s comment @1 than my comment @2.
As for your point about a modern-day crisis forcing us to take universal provision of health care seriously, the same point has been made by many others without invoking 16th c. epidemics that no one knew how to prevent, simply by noting the runaway cost of regular health care. Our health care spending as a percentage of GDP has been rising steadily for years and currently nothing stands in its way to prevent it from continuing to do so.
Swine flu, like most forms of influenza, doesn’t really have a treatment. I received an inoculation against the regular flu last fall, yet still came down with severe flu-like symptoms in the first week of May. I have perfectly decent insurance through my employment, but in the absence of verging-on-death symptoms (which would have probably sent me to an ER anyway), my physician was swamped and couldn’t see me for several days. I took a few days off work and babied myself. By the time I saw my doctor, my initial symptoms had receded but were replaced by new ones. She said the flu was almost gone, but that I seemed to have picked up a bacterial infection while my immune system was battling the flu, and prescribed antibiotics (which thankfully wiped out the bacterial infection in a couple days).
So lack of health care is less of a problem for flu recovery than lack of downtime from work and school (although schools do seem to have gotten on the ball this past spring and were closing, though that then leaves families with children who need child care) in order to let the body’s immune system beat the virus. There were hundreds of thousands of people in the U.S. infected with swine flu this past spring, undoubtedly including many whose health care access is poor to nonexistent, yet only a handful of deaths.
I think we’re more likely to destroy America slowly with seniors’ unwillingness to cut back on end-of-life extreme measures so we can afford more preventative care for pregnant women and children, than with something as fast-moving as an epidemic, particularly an epidemic that we know how to prevent yet fail to do simply out of greed. Immunizations, in particular, are an area where the U.S. has demonstrated that it cares more about keeping its kids alive than about saving an extra buck. Pretty much the only children, who were born in the U.S. and spend their toddler years here, who go to school without immunizations are those whose parents are (IMO somewhat selfishly) refusing to get their kids immunized. Immunizations, we do. Even Republicans I’ve talked to will concede that so long as we have these darn poor people wandering around where decent folks are, we’d better immunize them. They’re just opposed to providing any health care *beyond* immunizations.
Actually, PG, immunizations we don’t do so well any more, and it’s not just because of anti-vaccine activism. Poorer kids are vaccinated later and less comprehensively than kids from higher socio-economic brackets. There’s been some slight improvement, but significant disparities persist. (See Smith et al. in Archives of Pedriatric and Adolescent Medicine May 2009.)
I also wouldn’t blame seniors for the huge amounts of money spent on end-of-life measures. Go after the doctors who refuse to admit that everyone dies sooner or later or the hospitals that push unnecessary tests and treatments because they see their MRI or CT scan machines as cash cows.
Actually, Nan, there’s pretty good evidence that a lot of tests are ordered to prevent lawsuits, not disease. Tort reform (while preserving a means of compensation for people who are genuinely victims of malpractice) would help cut medical costs quite a bit.
Nan,
Being poor tends to lead to worse outcomes in a lot of ways even when the government is providing something; a poor kid in the same public school as a rich kid is more likely to be cited for behavioral infractions, to get lower grades, etc. The government is nominally providing the same service to both the rich and the poor, but the surrounding circumstances affect how well the service will be utilized.
I don’t have access to more than the abstract for the article you cite; could you provide the figures for what the vaccination disparities between poor children with insurance and those without is? This study indicated that insurance coverage through SCHIP had much less of an effect on whether children were fully vaccinated than the authors expected, and that income level rather than insurance coverage seemed to be the big factor. My understanding was that karnythia was criticizing the lack of universal insurance coverage as likely to lead to an epidemic that would be preventable if only we had such coverage. My point is that vaccinations are freely available without insurance, and the failure to obtain them usually has to do with something other than insurance.
I also wouldn’t blame seniors for the huge amounts of money spent on end-of-life measures. Go after the doctors who refuse to admit that everyone dies sooner or later or the hospitals that push unnecessary tests and treatments because they see their MRI or CT scan machines as cash cows.
Seniors are the demographic group voicing the greatest level of skepticism about health care reform, on the perfectly sensible reasoning that Democrats’ only plausible way to make greater health care coverage deficit-neutral is by reducing spending on Medicare. The fact that much of that spending fails any rational cost-benefit analysis doesn’t seem to be slowing down the folks who object to the idea of a Medicare Payment Advisory Commission with teeth.
That can never happen. I’m referring to tort reform that preserves a satisfactory level of compensation for victims of malpractice. And, honestly, a lot of tests are ordered to ease the physician’s worries about lawsuits rather than to prevent lawsuits. That’s a lot easier to deal with via education rather than yet another round of bad tort reform.
RonF,
If you really believe that, I recommend looking at medical costs in Texas since 2003, when we amended the state Constitution to permit damage caps in tort lawsuits. The folks in McAllen are still ordering a ton of MRIs on … oh, what’s that? the clinic has its own MRI machine? what a coincidence! (I am beating up on McAllen because Atul Gawande made them an easy target, but I’m sure my dad and his cohorts in East Texas are hardly innocent.) But seriously, looking at how doctors behave even after states pass tort reform indicates that it’s not the cure-all you’re imagining.
Incidentally, speaking of what drives childhood immunization rates, the Table 2 here is fascinating. Why do Iowa and Colorado have polio vaccination rates below 90%, but a place like Arkansas is above 95% on every vaccination?
there’s pretty good evidence that a lot of tests are ordered to prevent lawsuits, not disease.
One should be a little cautious in interpreting any arguments about “defensive medicine” because it’s sometimes used as an excuse. To give one example, suppose you have a patient who has a strange infection or maybe an unexplained pancytopenia (lowering of all blood components). You want to get an HIV test on this patient but s/he gets angry and feels insulted. Saying, “Oh, I know it’s very, very unlikely, but if you did have it through some bizarre accident and we didn’t test the lawyers would be all over us.” allows the patient to save face and get the test they need done.