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It turns out, though, that the worry about eugenics is now out-of-date.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