Proposal C and the Magical Missouri Health Care Fairies
At at time in my life where the crushing pace of work prevents me from doing almost anything I enjoy, writing about politics is *not* something I really want to spend what little time I have doing. Yet as someone with a little bit of a health policy background, there remains a duty to at least speak out, if for no other reason than to make those willing to listen understand. And so, this entry about an election on Tuesday, in my former state of residence, Missouri, which you all are surely going to hear trumpeted all over the media. A vote on a ballot measure which captures incredibly well the sheer stupidity of the right-wing.
Missouri ballot Proposal C, the "Health Care Freedom" proposal, asks Missouri voters to strike down a key provision of the hard-won 2010 Health Care Reform act. Specifically, the 2010 Health Care Reform act will, by 2014, require all Americans to have or get health insurance; if not, they will be subject to a financial penalty. Missouri Ballot Proposal C seeks to overturn this requirement, in the name of "keeping government out of health care" and "protecting the individual's right to make health care decisions" -- specifically, the right to choose *not* to buy health insurance.
Except that, once you take a even the most cursory walk through the facts, one realizes the whole affair is an act of flat-earth scale stupidity.
To walk through the stupidity here: remember that, as of right now, physicians and hospitals are *required* to provide health care to any dying patient brought to an emergency room. Whether the dying patient has any insurance or not. After all, critical illness doesn't really give a shit whether you have insurance or not.
Every year, all across America, hundreds of thousands of adults without any health insurance rack up billions of dollars of health care costs -- without any insurance to help them pay for it. A single, uncomplicated heart attack can cost a quarter of a million dollars. A *complicated* heart attack can cost twice or four times that. A serious car accident or gunshot wound can cost a million dollars or more. The average individual or family has nowhere near that amount of financial assets -- and never will. For the vast majority of Americans, a single car accident or heart attack will be the single most expensive thing they ever have to pay for. And without insurance, they simply, literally, won't own enough to pay.
So after the hospital comes and takes away all their savings, repossesses their car, forecloses on their house, and drives the family into bankruptcy, even then the hospital probably is *still* holding the bag for hundreds of thousands of dollars in costs, because most individuals and families have nowhere near the financial assets a nice simple car accident can rack up in medical costs. Even after taking every penny it can from the now bankrupt family, the hospital *still* won't be able to squeeze enough out to recoup most of the bill. It's a lose-lose scenario. The reason why medical bills are the most common form of bankruptcy in America. And a major reason why hospitals are being crushed by debt.
So, having squeezed every possible dollar out of the now destitute family, the hospital *still* has hundreds of thousands of dollars of bills left to be paid, and which *must* be paid, somehow. After all, the drug companies demand to get paid, the medical supply company demands to be paid, malpractice lawyers demand to get paid, and since you can't make residents work 120 hrs a week anymore, you've got to hire someone to do the work once the resident hits the 88 hr mark. So the hospitals have to tack on extra costs to the people who *do* have insurance, which makes health care even more expensive for the rest of you.
Bizarrely, it's not actually *poor* people who are the biggest problem here. After all, poor people *do* have health insurance -- Medicaid, the public option government plan to provide health care to the poorest individuals. The poorest individuals actually *do* have a health insurance plan. Likewise, the poorest children, the elderly, and veterans had their own public option government health plans -- Medicaid/CHIP, Medicare, and TriCare, respectively. Desperately underfunded and increasingly overburdened health care plans, but at least all those groups *have* one.
In the past, the problem often was patients who *did* have private, for-profit health insurance, but then got fucked once they actually got sick. Got dropped by their for-profit insurance company like a hot potato once they actually started getting bills (recission), and then found themselves unable to buy new health insurance thanks to their new "pre-existing condition". Which is why the 2010 Health Care Reform Act specifically and explicitly bans recission, and bans using pre-existing conditions to deny health insurance.
In the past also, the problem was children who had no income, and teenagers and young adults starting out on their own who couldn't afford to buy individual health insurance on entry-level salaries. The problem of children was addressed by expanding public option health insurance plans to cover all children (CHIP and s-CHIP). The problem of young adults was tackled by the 2010 Health Care Reform Act, which allows parents to keep young adults on the family health insurance plan until the age of 26.
I'll take a moment here to note that Republicans and right-wingers fought each and every single one of the above plans. Every single fucking one. Not one Republican -- not one single fucking Republican Senator or Representative -- voted to support any of the 2010 Health Care Reform act provisions cited above. Not one.
Anyway, with all of the above reforms and programs, one of the last major remaining categories of patients without insurance are working adults who *could* afford health insurance, but *choose* not to. For example, to directly quote one such friend who would rather keep the thousands of dollars per year that insurance would cost for all the years in which we are healthy, and spend them later when something goes wrong. The entry Sticker Shock rips into that particular stupidity. But there are a lot of people who *are* that ignorant, arrogant, or both. People who *could* afford health insurance, but think they can get away with not spending money on it.
Of course, once these gamblers get hit by a car or suffer a heart attack, they'll still get their emergency life-saving health care anyway, despite having no health insurance. Along with the massive associated bills. (2011 Ed: Like Ron Paul's campaign manager.) And then we're back to bankruptcy for the gambler, and a huge still-unpaid bill the hospital has to figure out which Paul to rob, to pay Peter. And *that* is why the 2010 Health Care Reform Act has the provision *requiring* everyone to get health insurance from somewhere, or pay a penalty to do so. Call it the "anti-freeloader" clause.
In summary, if you can't afford health insurance on your own, you get it from Medicare/Medicaid/CHIP/etc. If you *can* afford health insurance and *want* to take responsibility for it, the 2010 Health Care Reform act helps stops insurance companies from using recission and pre-existing conditions to fuck you over. And finally, the irresponsible who would rather gamble on not buying health care insurance, will be *forced* to own up and buy it. *That's* what Section 1501 of the 2010 Health Care Reform law is all about. Being irresponsible and choosing to gamble on not spending money on health insurance will no longer be an option. Since the health care system guarantees you life-saving care, everyone who *can* pay for it, will now be *required* to pay for it.
You'd think Republicans would be all over that. Here Democrats are, after all, demanding people take responsibility for paying for a service they expect to be guaranteed. Yet this is *exactly* the clause the Republican-backed Missouri Proposal C wants to strike down.
I would have more respect for the right-wingers pushing this ballot proposal if they were honest about it. Honesty would require those right-wingers to simultaneously attach to the same ballot proposal, a counter-clause allowing hospitals to deny life-saving health care to anyone who *can't* present health care insurance. Forget for the moment the countless practical and moral problems with that. To a right-wing, life's hard, get a fucking helmet John Galter, those moral issues don't matter. A truly honest right-winger would acknowledge that the "freedom" to skip buying health insurance, should come with the consequence of not getting emergency health care because of that choice. A ballot proposal which combined (a) eliminating the requirement for buying health insurance with (b) eliminating guaranteed access to emergency health care for those who choose not to carry health insurance, would at least be an honest proposal.
It would also be political suicide, because even Tea Party members assume that doctors will save their lives after an auto accident, regardless of insurance status. Not even most Tea Party members would vote for allowing doctors to turn a dying family away at the emergency room door just because we find no guarantee of payment on arrival.
And even if it weren't: what do *you* think a "Obama wants to take my guns" Tea Bagger is going to do when an emergency room tries to refuse their uninsured dying adult daughter access to the trauma bay?
So, in essence, in Proposal C, Republicans and right-wingers want to *protect* someone's right to dodge paying for health insurance, while at the same time retaining the right to receive hundreds of thousands -- millions -- of dollars of emergency health care they refused to buy insurance to cover. The "health care freedom" being advocated for is the freedom to dodge responsibility for buying insurance to cover emergency health care, while retaining the guaranteed right to recieve it. In that case, who the fuck exactly is supposed to *pay* for the emergency health care bills racked up by someone who could afford insurance but was too irresponsible to buy it? The magical health care fairies?
Republican-backed Missouri Proposal C is basically calling for the right to get guaranteed emergency health care without paying a cent for it. Shit, not even the most ardent liberal in his wildest crack dream would seriously attempt to propose that as a serious political measure! And yet, that's precisely what the right-wing in Missouri are pushing for.
Of course, the right-wingers aren't actually trying to guarantee free health care for all. They're just too stupid to realize the real-world implications of the ballot protest they've launched. Or don't give enough of a shit about reality to care. Since when do things like facts, practical consequences, or, you know, motherfucking reality matter when there's a chance to score some political points?
(That's all, of course, overlooking the "minor" question of whether a state has the right to nullify a portion of federal law in such a way, and thus whether the ballot initiative can even legally exist, or how it could be enforced.)
The stupidity here is obvious to anyone who takes more than a few moments to think through the issue. As the major state newspapers in Missouri detail at length in their united opposition to Proposal C. This is a ballot proposal that, even if it could be legally enforced, is a monumentally stupid health care policy decision that basically requires the existence of magical health care fairies. Yet the fact that the measure sailed through the Republican-dominated Missouri Senate -- and is likely to be approved by fired-up Tea-party activists outvoting their apathetic liberal counterparts -- is yet another stark demonstration of the futility of trying to govern, negotiate, or even discuss issues with the modern right-wing. How do you have a meaningful debate with people who are either too stupid to realize they're voting for magical health care fairies, or know that's what they're asking for, and don't care?
Once again, the sheer futility of arguing with right-wingers -- the same futility, from completely different angles, discussed in River and Rage and Luck is why this entry is tight-locked. The editorials cited above make my same points anyway and can be forwarded, so there's no need for me to unlock this entry. No need for me to yet again court a futile debate with the right-wing, with time and energy I truly do not have.
We fight on.
2012 Ed: The Supreme Court -- or, the five conservative Justices on the Supreme Court -- does have the authority to overturn the individual mandate. That is discussed in the entry Prognosis.