Heal thyself

This whole healthcare debacle is starting to get under my skin. I’m used to everything being terrible, I don’t have any expectation of living in a just or rational society or anything like that, but this is different. It’s not just that the situation is empirically untenable (every country with universal healthcare is healthier than the U.S.), or even that it’s morally scandalous (if you can spend money to save someone’s life, you should obviously do that, even if it has other negative consequences). It’s that the argument against universal healthcare is actually, in the strict sense of the term, illogical. It contradicts itself.

While Obama was in power, Republicans went on at some length regarding the need to “repeal” Obamacare. This is a least a coherent statement. If you think a law does the wrong thing, your goal should be to repeal it. But as soon as they gained the ability to sign legislation (specifically, as soon as it became the case that throwing millions of people off of health insurance would be their fault), the phrase suddenly morphed into “repeal and replace.” This no longer makes sense. The objection to Obamacare was supposedly that the government shouldn’t be meddling in the health insurance market, in which case there obviously shouldn’t be any “replacement” for it, since that would also involve the government meddling in the healthcare market. And if the problem was just that Obamacare was a poor implementation of a good idea, then there was never any reason to cry “repeal” in the first place. The specific problems should have just been fixed.

Now, the actual motivation here is pretty transparent: Republicans are lying about wanting to improve healthcare in any way other than reducing the amount that rich fucks have to pay for it. But the same logic applies to Obamacare itself. While, politically speaking, it’s sensible to defend Obamacare against an alternative that’s going to be worse, what we’ve been seeing recently is a bunch of people arguing for Obamacare and against universal healthcare. This is incoherent. If you believe that the government should intervene in order to improve healthcare outcomes, then there’s no reason that needs to be tacked on to a system of private profit. Healthcare is basically just risk pooling: everyone pays a little bit in and less fortunate people take more out. Certainly, there are all manner of details to be worked out (I heard recently that healthcare is actually really complicated), but that’s the basic structure of the endeavor, and it works that way regardless of whether you have private insurance or a government-run system. Private insurance has the disadvantages of a) siphoning away some money as profit, making it more expensive and b) denying care based on cost, making it less effective. There are no “innovation” or “quality” advantages, because the insurance companies are not themselves the ones doing medical research or providing care. In short, Obamacare is only comprehensible as either a band-aid or a half-measure in the direction of the real solution (or both). It’s not the kind of hill that you die on.

So, the thing about this is, even before Obamacare, we already had socialized medicine. Private insurance companies are part of society, and they redistribute wealth based on need. Also, they’re already choosing who lives and who dies based on cost-effectiveness; we already have death panels. The only thing that would actually qualify as a “free-market” solution would be to ban insurance and force everyone to pay their own way on everything – which would include all other forms of insurance, which are redistributive in exactly the same way. The fact that people voluntarily choose to enter into insurance contracts is irrelevant because a) they don’t, insurance is almost always mandatory, and b) that doesn’t change the functional nature of the endeavor. If people are going to be doing this anyway, you might as well manage it such that moral standards can be applied and profiteering can be reduced.

In other words, civilization in general is a collective endeavor that exists for the purpose of redistributing wealth and reducing risk. I mean, obviously, right? Even on a straight Hobbesian view where you’re forming literally any type of society just so you can survive, that’s still what’s going on. The only way to coherently argue against universal health care is to argue against society.

Which means there has to be something else going on. People have problems with this sometimes; they think that once they’ve shown that something is “illogical,” they’re done, but that’s actually where you have to start. People don’t just have opinions beamed into their heads by cosmic rays. If something doesn’t hold up along one line of reasoning, there must be a different line of reasoning along which it does; otherwise it could never have come from anywhere in the first place. That is, the current healthcare system didn’t just randomly contort itself into the worst possible shape – it has to be serving an actual positive function.

Let’s start by considering the function of the term “Obamacare.” This name was made up by Republicans to make the law sound bad. Their strategic purpose was, of course, the same strategic purpose that Republicans always have: to associate the things they’re opposed to with black people. This has been successful to the point that we now have people who oppose the heavy-handed and disastrous Obamacare in favor the reasonable and effective Affordable Care Act (non-comedy version). You’ll note that this is essentially the same opinion as “keep your government hands off my Medicare”: it draws a distinction between the good kind of benefits for good people and the bad kind of benefits for bad people. And in America, the bad kind of benefits, the kind we call “welfare,” are coded black. It is generally the case that the bad kind of government meddling (“your government hands”) is the kind the benefits black people, and the good kind of government meddling (“my Medicare”) is the kind that benefits white people. So what we’re talking about here is segregation.

The thesis that mass incarceration constitutes a “new Jim Crow” is in fact not hyperbolic enough. Segregation is one of the primary purposes of society in general. As mentioned, society is inherently a collective endeavor, which is a problem for rich fucks. They’re only capable of getting rich in the first place through collectivity (think through the logistics of owning and operating a corporation), but they wouldn’t be able to get rich if they actually had to pay what they owe. The way they square the circle is through segregation.┬áSegregation is how you get around the fact that society requires you to care about other people. You establish a class of people who “don’t count,” and therefore contribute labor without receiving its full benefits – or without receiving any, in cases such as prison labor. In fact, prison labor is an extremely clarificatory example, because it shows us how things work now. Rather than branding certain types of people at birth with the mark of Cain, condemning them to wander through society as permanent exiles, we now have the proper procedures for this sort of thing. We fill out all the paperwork and consult with panels of experts and make the rational decision that some people aren’t really people. The old “Whites Only” signs strike us today as hopelessly backward, but the truth is we never really rejected them. We just evolved beyond the need for them. We no longer require explicit signage, because we now have a society that segregates itself automatically, as though it were the natural order of things.

So this problem is all over the place, and liberals are totally in on it. Charter schools are all about resisting integration by picking out “deserving” children and giving them real educations, while the rest languish in underfunded hellholes. Abortions are easily obtainable if you live in a major urban area and fuck you if you live anywhere else. Highly skilled workers don’t need unions, so there’s no reason to protect them; they don’t help anyone who matters. And the police are always there to protect and serve you – for certain values of “you.”

This is why running the numbers and arguing about what’s going to cost what and who’s going to get taxed this much to pay for that is all entirely beside the point. The point is that we’re having a debate about segregation. After all, health is pretty much the best possible thing to spend money on. Arguing about cost-effectiveness blunts the issue’s moral edge. And because that edge is extremely sharp, it’s very important for us to keep it honed. We need it to cut things. This is the real importance of this decision. We’re deciding whether the benefits of civilization are for everybody, or only for the “deserving.” And because segregation is no longer explicit, this is no longer an explicit decision. Simply trying to do the right thing for yourself (finding the “best deal” on healthcare, or sending your child to the “best school”) maintains the existing situation. Even if you don’t actively want the underprivileged to suffer (which, frankly, most people do), their suffering is required in order to maintain your lifestyle. It’s the cost of doing business.

Universal health care does have majority support, but that’s only because it’s the most obvious thing in the world. Ideology is a hell of a drug, but it’s not all-powerful. Still, even if we eventually get this one very basic issue under control, the general dynamics aren’t going away. You have to decide what you really want and do what it requires. Otherwise you’re just managing symptoms.