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It turns out, though, that the worry about eugenics is now out-of-date.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.

Nothing healthy in the health care 'debate'

The US government has shut down because a group of right-wingers doesn't want the Affordable Care Act to go into effect.  Indeed, as even they, amazingly, say, there's a danger that people might actually like it! So, these right-wing radicals want to save us from ourselves.  They know better!  They don't want us to get addicted to, well, a lesser version of what Congress has voted for and long enjoyed itself: guaranteed free (to them) health care provided by the taxpayer.  Despite the fact that we've had elections which have been, in effect, referenda on Obamacare, and a Surpreme Court decision ruling that it's constitutional, the Tea Partiers have decided they know best what the rest of us need and want.  Would it help if the issue were framed differently, or is this primarily a divide based on racism and other similar considerations?  Let's try reframing. 

Insurance: what is it?
Everyone who owns a home or a car must have insurance, if they want a mortgage or a driver's license.  The Tea Party and other ignoriscenti are not out in the streets protesting these forms of insurance.  Yet such forms of insurance does just the same thing that health insurance does: they are not 'free' and they distribute risk and cost across the whole pool.  Yes, we are paying car insurance premiums in part to cover the accident or home-fire costs mainly of somebody else!  And those somebodies may not be of the right color or ethnicity or even religion (they might even be atheists!).  But the reason we accept this awful implication is that if by some fluke our house burns down or we rear-end someone or run down a cyclist, others will help pay the cost--so we don't go into bankruptcy and have to live on food stamps (if, that is, the government still provides them).

The same is true for health insurance.  It's not free, even under the Affordable Care Act!  The law requires that we all pay in, sick or well, so that everyone is paying a lower average fee.  That way, people who happen to draw the disease short straw don't end up bankrupt and having to live on food stamps (perish the thought!).  Yes indeed, we are all paying for those lazy louts of the wrong color or language or religion to actually have surgery if they get cancer.  If we're lucky, we'll personally never have a Big Bill to pay and we'll be lucky to end up in a pine box just having helped our neighbors with their surgery bills.

BUT, if we do happen to draw the short straw, somebody else is going to help us cover our costs. And that somebody else is everybody else. 

We bear the costs already!
As things now stand, something that even Republicans should be able to understand (or have the decency to state clearly to their Tea-slurping masters), we already cover each other (even those of the wrong color or religion or neighborhood). When people without insurance go to a hospital emergency room, not only do they get ad hoc care often too late and with no follow-up, but the cost is something like 3 times what it would be in a doctor's office or if they'd had preventive care.

The hospital has to cover that cost somehow.  The government subsidizes some of it (via our taxes), but not all by any means, so the hospital must compensate by charging those of us who are insured more than the cost of our own care to cover the rest. And, of course, your and our taxes pay for elders, military--and Congressmen.  The current state of affairs buries this unsavory, inefficient and costly sharing, so people somehow think they aren't already involved. 

Living and dying with imperfection
No major social system is without its problems.  Health care is complex and a mix of guesswork, knowledge that's imperfect, bureaucracy and fallible personnel.  People in countries with nationalized health care, whether private or publicly financed, always complain about its imperfections.  Any such system will have imperfections.  But they would not give up the idea that they're covered, one way or another.  Rather, complaint leads to improvement in any complex system.  Even, we hate to say it, universities have imperfections (but professors, at least, don't want to close them down for that reason). 

Could we as a public be educated somehow (it won't, apparently be in universities, given our track record) to understand this, and to realize that our salary is not just for buying a Lexus and very big flat-TV, but for food and health care and other necessities of life?  If so, this debate would not be happening.  We might have public or private health care, but it would be for everybody.  It won't be free.  But no matter who you are, if you get sick, there will be someone to take care of you.

Or maybe that's the not the issue at all
Perhaps if we were told, openly and honestly, what insurance actually is, and how it works, this debate could move on. Though, if it's in fact a thinly disguised racism or other form of intolerance, there's little hope of moving beyond.