Friday, May 5, 2017

Eugenics, such an old-fashioned idea

It's the age of genetics.  Billions of dollars have been spent on identifying genes for important traits like diseases, fun traits like ear wax type and hair color, politically-charged traits like who we vote for and whether we're criminals, and much more.  "Precision Medicine," the idea that with bigger and better genetic data we'll be able to predict future diseases and then, presumably, prevent them, is au courant, and well-funded.

The assumption that genes determine not only our disease futures but our personalities, our preferences, and our behavior, appeals to a lot of people; some of us are naturally good and some of us are naturally bad.  And this has lead many of us to worry about the return of eugenics, the darwinian idea that populations can be improved by controlled reproduction.  That is, that we control their reproduction.  Those of us who are naturally bad just shouldn't be allowed to reproduce.  This was an idea that early 20th century America translated into the forced sterilization of the intellectually or socially inferior other, and that the Nazis translated (in many ways copying our lead) into mass murder of anyone they didn't like.

It turns out, though, that the worry about eugenics is now out-of-date.  It's too finely-honed a tool. The Republican majority in the US House of Representatives, with the enthusiastic support of our 45th president, has just passed a bill to repeal and replace the Affordable Care Act (ACA), President Obama's signature program to expand affordable access to medical care to 45 million people who had no health insurance, and to those for whom it was prohibitively expensive.

One of the most humane, important, and best-liked provisions of the ACA was that it did not allow insurers to discriminate against people who had "pre-existing conditions", illnesses that preceded their insurance coverage.  Insurance companies don't like to have to cover sick people because they cost money.  Fair enough, I suppose, given that insurers are businesses, not philanthropies, and have to make a profit (unlike a civilized country's national healthcare system, which is by and for the people rather than the plutocrats).  But, this is how all insurance works, car, home, flood and otherwise -- we all pay in, some of us cost more than we pay in, and some of us cost less.  If it's only sick people, or bad drivers, or people in hurricane zones who buy insurance, insurance companies would all quickly be out of business, which of course is why we all are required to buy car and home insurance.

But it turns out that there are good moral reasons to discriminate against people with pre-existing conditions -- according to a member of the Republican, white, male "Freedom Caucus", the extreme, and let's be honest, extremely ill-informed right-wingers in the House, pre-existing conditions don't happen to people who live good lives.  (Funny how their new list of pre-existing conditions includes pregnancy, rape, sexual harassment, breast cancer, among many other things, but not erectile dysfunction or prostate cancer. Nice discussion of this topic here.)

To ensure that covering actual sick people was going to be affordable, the ACA mandated that everyone have health insurance.  The political right never liked this provision of the law -- depending on your reading, this was due to the libertarian view that governments shouldn't be able to require that we do anything, or because they didn't want their money covering them, or perhaps a toxic mix of both -- and they've been fighting it ever since.  It's long been clear that that have no idea why a mandate was essential.  Because, who knew that health care was so complicated?

As is well known, the Republicans voted at least a zillion times to repeal the ACA while Obama was president.  Finally, yesterday, under the caring leadership of our current president, the Republican-led House passed a repeal-and-replace bill that would essentially eliminate protection for people with pre-existing conditions, as well as the requirement that healthy people purchase insurance.  And, in an ugly and cynical move that makes abundantly clear the racist and other lies behind this bill, they voted to exempt themselves from its new constraints (of course, because they're the good guys!).

This bill is bad medicine.  But that's irrelevant to Republicans and their supporters.  It's not meant to be much more than a tax cut for the rich (protecting wealth being the only core tenet of that party). And a thumb in the eye of anyone who benefitted from the ACA; the poor, the sick, and the Democrats.  It will definitely be a money saver, when 24 million people lose coverage, and then die of things that those with money don't have to die of.  As Jimmy Kimmel said in his emotional defense of insurance for all.

And this is what brings us back to eugenics.  Who needs the kind of very expensive, targeted precision promised by knowledge of genes to cherrypick those who should live and those who should die?  Let's just take away access to medical care from all of Them.  And make our country great for the oligarchs again.


David J. Littleboy said...

Just a point of order. I'm not arguing with your article at all.

An important point about the ACA is that it changed the game insurance companies play. Before the ACA, insurance companies made money by not paying, so they really didn't like to pay. Now, the insurance companies earn (get paid) 20 bucks for every 80 bucks they spend on care, no more no less. So now they have to actually pay some claims to make money. (They have to return any excess if they don't spend it on care.)


They still don't really like to pay, since they compete on price of their policies. But they don't have those previous enormous incentives to refuse to pay claims after the fact due to fine print or an error by the customer when filling out a form or to rescind a product as soon as the customer gets sick. (And they can't sell essentially fraudulent products that are so full of fine print that they're not much use when you get sick.)

The ACA really is a beautiful thing, and no one managed to get that message out, everyone was so busy whining that it didn't give them a bigger pony. (OK, it needs to be more generous and to have a few glitches fixed. But it brings the US into the modern world. No other industrialized country has "pre-existing conditions" or medical bankruptcies in anywhere the numbers we used to.)

It was also an enormous redistribution of wealth from the rich to the rest of us, something the pony whiners completely missed. (Sorry for the rant; I see the pony whiners as one of the reasons for our ongoing disaster.)

Sometimes I think the right-wing types are smarter than we are. Obamacare really is socialized medicine, and they hate it for that. Since medical care is so expensive, one either provides socialized medicine, or lets sick people die without care. Opposing socialized medicine means letting sick people die, and Republicans are perfectly happy with that. Hopefully, they are going to be forced to own that position.

Ken Weiss said...

To me, the bigger story, is the oldest story: the defense of greed by a minority over the majority. It's a version of the basic story of nation states (and before that, even). Marie Antoinette said 'let them eat cake', and one might say she lost her head, if not her composure, in saying such a cruel thing. But "Let them die off!", even though claiming with great piety and showing-off as if 'Christian', is a standard part of the Republican tactics. To be charitable, some (possibly) of the Republicans may not even be aware of what they are doing, but most must be, in one way or another. If this is not the single core 'value' of the party of Lincoln today, there's scant evidence of that.

Anne Buchanan said...

Thanks for these important points, David. There's a lot of cognitive dissonance going on, right? The same people who hate socialism don't want anyone messing with their Medicare, Social Security, now the Affordable Care Act. We could use a better education system.....

Ken Weiss said...

National health care works where it's properly instituted. Our son and his wife lived in England, where it was socialized (and, despite problems that any huge program like that will have) it works well, and now they live in Switzerland, where it's capitalized and works well. Our daughter and her husband live in Italy, where it works. There it is common for them even to make house calls! No system is perfect, but the cynical guise of making a tax cut for the elite while condemning many to the miseries of untreated or poorly treated illness is an inexcusable evil. In fact, the politicians have totally dropped the ball in another way: with public ERs we largely have a publicly paid-for system that delivers at least some health care for everyone. Those who obstruct a humane imposition of a national system, that would relieve the ERs as well as delivering quality health care, need to look in the mirror and ask themselves who they are at their core (not to mention, I may say on this Sunday, those false 'Christians' who are eagerly participating in the new eugenics we wrote about).

David J. Littleboy said...

"There's a lot of cognitive dissonance going on, right?"

We lefties like to joke about this, but in real life, seeing the insane orange baboon in action has lost none of said baboon's support. The people who voted for Trump still, pretty much 100%, support Trump. What that means is that (remember: the median income of Trump voters is about $10,000 _higher_ than the median for non-Hispanic whites; these blokes are not hurting) the commonality between these voters still holds:

They're folks for whom having someone in the white house who is going to put the poor, the sick, and the minorities last is the prime concern. They're the "I don't want my tax money going to them" crowd. They're completely happy with their choice. And won't be changing their minds.

Ken, the system here in Japan works just fine, too. It's essentially single payer*. Everyone is insured, and insurance premiums are a percentage surcharge on your (progressive) income tax. It features draconian price controls and negotiating prices with drug companies.

That's why medical care here is 1/3 the US cost per patient.

*: It's actually four systems: one for individuals who don't have insurance through work, one for folks employed by larger companies, one for public servants, and one for the elderly (this kicks in at 75, I think).

Rodrigo Singer said...

Eugenics a "Darwinian" idea? Sure? Serious? Please, be careful with such affirmation. It was Francis Galton, not Darwin, that championed such an idea.

Ken Weiss said...

I would say very much a 'Darwinian' idea. I didn't say "Darwin's idea", and certainly I would not attribute such views to Darwin in the sense you are suggesting I do. I know very well that Galton started this in the explicit modern form (it goes back to Plato, at least). But such ideas were widespread conclusions from Darwin's work and he was, I think, often cited directly or indirectly by eugenics advocates. See E Carlson's book The Unfit for some discussion. But here are two quotes from Darwin himself, that show the nature of the thinking:

[We have escaped from natural selection and now] ‘‘do our utmost to check the process of elimination. . . we institute poor-laws; and our medical men exert their utmost skill to save the life of every one to the last moment. Thus the weak members of civilized societies propagate their kind. No one who has attended to the breeding of domestic animals will doubt that this must be highly injurious to the race of man.’’

And this from Descent of Man: ‘‘In every country in which a large standing army is kept up, the finest young men are taken by the conscription or are enlisted. They are thus exposed to early death during war, are often tempted into vice, and are prevented from marrying during the prime of life. On the other hand the shorter and feebler men, with poor constitutions, are left at home, and consequently have a much better chance of marrying and propagating their kind.’’

I think we need not attribute any evil motives to a man who was, to my knowledge, personally good in essentially every respect. But he was a Victorian product of the Empire, and it shows (e.g., clearly in Descent of Man). And his theory that all is due to ruthless natural selection was and still implicitly and even explicitly is used to justify inequity, not to mention the worst forms of cruelty that Darwin himself never would have committed much less advocated. Even Galton was mainly for 'soft' eugenics (restricted reproduction rather than Hitlerian methods).

Rodrigo Singer said...

As a wise australian researcher told me years ago: "Yes, but I don't buy it". I am sorry Ken, but you wrote "Darwinian idea", that's the fact. I agree Darwin was a XIX's century man (meaning among other things that he didn't believe all men are equal) but he didn't champion the idea of eugenics. Creationists have always tried to tie Darwin to nazism via eugenics. Please, do not pay "lip service" to them. Best,

Anne Buchanan said...

Actually, happy as I am to have Ken take the blame, I wrote this post! And, please note I wrote "darwinian idea", not Darwinian. There's a difference. To me, "darwinian" does not directly quote Darwin but instead has come to imply the idea that natural selection and adaption explain every trait. It's a quick jump to eugenics from there, whether or not Charles Darwin himself was a eugenicist. I agree with Ken that he certainly believed in a hierarchy of human cultures, and of hierarchy within cultures, though whether or not he would have thought that eugenic policy was a good idea, I cannot say.

Ken Weiss said...

Well, I'll end by just saying that the idea justifying eugenics was explicitly derived from Darwin's theory of natural selection, that we wise scientists could now apply the way agricultural breeders did, so to speak. That is the sense I was using the word 'Darwinian' and doesn't mean he himself applied his evolutionary theory in that way.

So while I see the point you are making, and I agree with you that 20th century eugenics etc wasn't what Darwin advocated, I do think it is widely thought that applying selection by policy would be 'Darwinian' in the sense of his theory being the source of the rationale, that while Darwin was not a eugenicist, eugenicists were Darwinian.

Anyone reading the post and the points raise and my explanation of the wording we used, should now understand. And let's leave it there.