A lot has changed since February 1980. We are different country. We have not been the underdog in a long long time. Ronald Reagan swept into power with his vision of the shining city on the hill. The Soviet Union collapsed from within leaving the the United States as the unparalleled, unquestioned world hegemon. Exponential economic growth has positioned America as the wealthiest nation in recorded human civilization. To what extent we have squandered our unprecedented bounty will be debated by historians decades hence. But we are certainly no longer the underdogs. Our military bases range across the globe. We have been in a near-permanent state of war, both formally declared and otherwise, since the end of WWII. We are the only nation to have dropped a nuclear bomb. We have invaded and occupied lands far away, under pretenses both misguided and outright false. During the post-9/11 era, we even embraced torture, indefinite detention, and the surveillance of domestic communications as reasonable uses of state power. We became bullies, asserting our will in ways our Founders never would have imagined.
In meantime, much fell by the wayside on our own shores. The wealth and prosperity boasted about in our increasingly financialized and unregulated economy failed to materialize at the local level. Wages stagnated. Incomes tailed off. Jobs disappeared. Factories shuttered. Small towns in Ohio and Kansas and Illinois went into a long irreversible decline. Supply side trickle down theories of the Reagan years were empirically repudiated. Neo-liberal centrist policies focused on globalization during the Clinton era resulted in off-shoring and free trade deals that hurt the vast heartlands of America. Income and wealth skyrocketed for the tiny select few while, for the mass of average, blue collar Americans, real living wages and income did not keep pace with the costs of living. A gap developed which soon widened into a vast canyon between the haves and have-nots. The wider the gap, the easier it is to fill with resentment, tribalism, nativism and anger. The talented demagogue knows this quite well. Take a man's job, his means of providing for his family and you take his dignity. Compound the error by lecturing to him about how he needs to stop being so racist and misogynistic and trans-phobic and he will turn as fast as you can say "Danton" to a Strong Man who promises to make everything "great again". The very personification of the bullying nature the country has cultivated since Lake Placid, the Great Leader will come to punish those namby-pamby language police in academia and all those corrupt pigs at the trough politicians in Washington DC who made careers out of betraying their own constituents for personal enrichment. And here we are.
I try not to dwell too much on these themes. I have a busy life and I have to stay focused, not get too bogged down with patriotic despair. But then I see a tweet from the current Speaker of the House like the one below and my blood just goes into full boil mode.
Freedom is the ability to buy what you want to fit what you need. Obamacare is Washington telling you what to buy regardless of your needs.— Paul Ryan (@PRyan) February 21, 2017
Former President Barack Obama presided over the passage of the Patient Protection and Affordable Care Act (PPACA) 7 years ago. Known as Obamacare, even before it was actually passed, the act was met with unprecedented opposition from the GOP. Which would have been fine, as far as that goes in politics, if the opposition party had only put forth their version of how health care needed to be reformed and, accordingly, the two sides could have hammered out some sort of Obamacare-weighted compromise bill . But there was no alternative bill. Beyond a few tired and worn out bromides about "health savings accounts" and "opening up intra-state markets" and, of course, "decreasing regulations", PPACA was countered with nothing but vitriolic rhetoric and opposition. This, for a bill that, to a large extent, was a direct descendant of ideas hatched in conservative think tanks and tried out with some success as a pilot project in the state of Massachusetts under the governorship of Mitt freaking Romney.
And let us be very frank: health care reform was inevitable. Nearly 50 million Americans were without health insurance in 2008. Insurance companies run by CEO's earning 8 figure salaries could deny insurance to people with pre-existing conditions, could cap yearly and lifetime benefits, and could cancel your policy at any time. Health care costs were exploding; the United States was spending 17% of its GDP on health care sector alone. Employer-based insurance, long the backbone of the American health care system, was feeling the pressure of an aging population and higher costs and so transitioned to offering more high deductible plans, shifting those cost burdens on those who could least afford it. Health insurance with a $5-15k deductible is not insurance. Change was needed. It was almost a matter of national emergency.
And so for 7 years we have heard over and over, ad nauseum, about the "disaster" that is Obamacare. How it is a job killing, innovation and entrepreneurial stifling government take-over of the health care sector of the economy. For years, it was the one constant theme in elections from the local level on up; Republicans would fight to repeal Obamacare. From day one.
Now, I personally have some major issues with Obamacare. There still remain some 20-25 million Americans without health care. The cost control mechanisms are just a hodgepodge of pilot projects, the overwhelming majority of which won't work. It mandated electronic health records without ensuring inter-operability between competing EMR's in different health care systems. Too much of it hinges on the expected good will of governors of red states for the Medicaid expansion. The mandate is too weak. The exchanges were poorly conceived. There are better ways. The Germans and French and Japanese have figured out better ways, without resorting to single payer goverment-run health care. (Hint: you need universal citizenship participation to ensure better risk pools and you need to mandate that if your sickness funds or insurance carriers are to be privately run, then they must, by law, be non profit entities) But it was a needed first step. Something to build upon. To be tinkered with, added to, improved.
But Paul Ryan wants none of that. Yes, with his AHCA bill, he declares he will keep most of the regulations banning the denial of coverage and rescission and benefit caps. But he's just cherry picking the universally loved components of PPACA for political gain. There's no actual replacement plan in the bill--- just a series of measures that will weaken or outright eliminate over time most of the structure of Obamacare without supplying the necessary scaffolding to prop up what's left. It's terrible and cynical and hollow-minded.
For so many years Paul Ryan has represented the "intellect" of the Republican party. He has always been the "smart as a whip" policy wonk lending a thin patina of intellectual legitimacy to Tea Party angry hollering. But he's revealed himself to be a fraud. This bill, this AHCA is a fraud. It cuts the legs out of Medicaid expansion. It is a gargantuan tax cut for the wealthy. It will lead to death spirals for the non-Medicaid, non-employer based health insurance exchanges. For too long, we have heard nothing but platitudes about "free choice" and "getting government out of the business of healthcare" and that plays well as a series of sound bytes on the Sunday shows. But where is the nuts and bolts of actual governance? Where is the framework for a system that will work? If for too long, you spend all your time just articulating talking points and ideologies without having to worry about the practicalities of implementation, at some point the words just become...words, drained of any meaningful context, devoid of pragmatic utility. Less a mode of communicating concrete policy meant to assuage human suffering, and more just a means of signifying where one stands on the continuum of socialism vs capitalism, collectivism vs individualism. And so words became barren.
In the above tweet, Paul Ryan reveals this idea, to an almost embarrassing degree. The Emperor without his clothes, on social media. Freedom? Freedom to do what, exactly? Not buy insurance? As if health insurance is some sort of tangible elective product one can either choose to buy or not buy at Target or Wallmart? To paraphrase Dr Gawande from his most recent New Yorker article, we all have a pre-existent condition. It's called mortality. It's the one thing where we can say, with unvarnished truth, that we are all in it together. For all of us, it's a matter of time. Paul Ryan's bill represents a complete disconnect from the actual lives of actual Americans, their struggles and worries. As if what keeps the average 52 year old man in Iowa up at night is disquietude over whether or not he will be able to forego health insurance for the coming year since his only health problem is "a little bit of the gout".
Our country seems split at the seams right now. We've been in this boat before. We even turned our guns on one another, cousin against cousin over the right to own other humans as property. We have become two countries again, speaking over and around one another like blinded prophets wandering in the same forest. Tribal partisanship and mutual suspicions have poisoned the arena of productive discourse. I fear the chasm this time may be too broad to bridge.
But alas we all will face decline and sickness, pain and suffering. Like Falstaff, we all "owest God a death". It pauses for no mortal. That we cannot alter. But we can take care of one another. We can do that for God's sake. We can ensure that, at least within these borders, no man or woman will face financial catastrophe or be forced to choose between health and some other base necessity. We can ease the downward fall. We can choose to do this. We have the means. We have the principles embedded in our culture, our manifold religions, our shared history.
I remember that night in Lake Placid, watching Herb Brooks' boys take down the Soviets. I watched it by myself but I remember exactly how I felt. Pride, solidarity. Hopefulness. I felt that I was not alone.