Written on the road: matters of definition.

[alexandraerin]

Whenever liberal judges or politicians bring up the state of justice overseas in discussing the laws here, a certain segment of the far right tends to go into a tizzy.

"New World Order!" they say.

"One World Government!" they say.

Pish, I say.

We're just taking stock of the world and our place in it. If we happen to notice that we're engaging in a practice that only countries Bush 43 identified as members of an "Axis of Evil", we wonder about the company we're keeping, you know?

We're not interested in giving up our sovereignty. We're interested in using it... using it to better ourselves as a nation, to form a "more perfect Union"... more perfect today than it was yesterday, we hope, and possibly even better still tomorrow.

And at its heart, that's what this health care debate is about: how we define ourselves as a people, how we define ourselves as a nation.

Is it enough to be a free people and a powerful nation? Does it not matter what we do with our power and freedom?

Is it enough that America is great?

My thought is that greatness is okay, so far as it goes, but it's better to be great and good than the alternative.

Those who are against reform say that there's an effort underway to change America, to redefine what America is and take it away from our roots and traditional values.

Folks, that's going to happen anyway. It's happening anyway.

A shining beacon on the hill? Not when we lag behind every other developed nation in how we treat our citizens.

A Christian nation? Not with how we do unto the least of us... and I don't know exactly who shall know us by our works, but probably not anyone we'd want to be seen with.

The land of opportunity? Face it, we've had a mixed record on that one. Unavoidable, really... if success doesn't bring rewards then "opportunity" is worthless, but if the rewards are meaningful then the rich hold advantages over the poor that carry across generations, resulting in unequal opportunities.

But even if we've never been perfect in an area, we can still do better or worse and right now we're doing much worse than we should be. The rising cost of health care shackles people to jobs by making a lot of traditional opportunities... entrepreneurship and education, for instance... too risky for the rewards.

The land of the free and the home of the brave? It's hard to be brave when you have to choose between food, rent, and medicine. It's impossible to be free when your choice is death from untreated but preventable conditions or a lifetime of onerous debt.

America is redefining itself by degrees. Like a satellite in a decaying orbit, the great and soaring dream of the world's first Democratic Republic will come crashing down if we're too afraid to make some necessary course corrections. We will become a third world country with scattered pockets here and there of breathtaking privilege. Within one hundred years, we may not be one nation indivisible, but two nations divided: a permanent underclass of workers who find that both the simple necessities of life and the opportunities for advancement are rigidly controlled and rationed in order to keep them in bondage, and an upper class that pats itself on the back and congratulates itself on having "made it" while exhorting the teeming masses to pull themselves up by their bootstraps.

(Hopefully somebody among the underclass will be educated enough to appreciate the irony when the ruling class identify themselves as John Galt and claim the millions whose labor supports them are parasites and looters.)

And you know what? Eventually I think the underclass will pull themselves up... and it will be ugly. When our descendants some centuries hence read about "The American Revolution", they won't be reading about George Washington and Thomas Jefferson. They will be reading about something that would make the Bolsheviks blush and Robespierre go "Oh, my."

Because that's what it would take to upend a social order that entrenched in a nation so large, so great, and so powerful.

And with that, the redefining of America will be complete.

Call this speculation. Call this hyperbole. Call it a bit of fiction dreamed up by a purveyor of the same.

But don't be afraid to look at the path we're on and see where it's leading... not where you want it to lead, not where you think it should lead, but where it actually is leading: the gap between the rich and poor... the increasing barriers to opportunity... the almost pathological gutting and cutting of any tool we give ourselves to use our collective might and wealth and freedom to help our fellow citizens.

Making access to our leading edge health care system a public concern, a national concern isn't so much about "redefining America" as it is about examining our existing definitions and seeing how we measure up.

I think we can do better. I write this without irony: we can put a man on the moon. We can split the atom. We wrapped a continent in bands of iron and a world in bands of information.

Anybody who says we can't provide health care is underestimating us. Anybody who says we shouldn't... well, with as much respect as I can muster, I disagree with their definition of America.

Comments

[alexandraerin.livejournal.com]

As I understand it, a HSA is a health savings account; i.e., a place where you can stick X dollars or N% of your paycheck away tax-free to save against unexpected/unpredictable medical expenses.

They are darned handy, in certain situations.

However, they are not silver bullets.

Actually, they sort of are... insofar as they embody the idea that people who have silver are less likely to be killed by the monster under discussion.

HSAs are paired with high-deductible health plans. What you tout as a feature ("I only have to pay a maximum of $3,000 a year in medical expenses!") is a bug for most people ("I have health insurance, but I have to spend $3,000 out of pocket to cover the deductible before anything is covered.")

To them, the HSA is a much-chewed over bone they're being thrown: if you can scrape up some money every paycheck in addition to the premiums you're already paying, then you have some tax-free earnings you can throw down the gaping black hole of the massive deductible.

If.

The system that works for you is still broken in general.

Edit: I'll add that in cases where people encounter horrifically high expenses, a high deductible plan beats the alternative of a plan where everything is paid for up to a certain amount and then it's out of pocket... but the situation where these are the only two choices? It's an intolerable one.

If you have the income to sock away in an HSA and you're able to swallow $3,000 a year out of pocket then the one plan is clearly superior to the other, but for many other people it's a choice of "Do I want to make my bad situation worse now or risk making it catastrophically worse later?"

We can and should be offering more choices than that.

[bisquick-deh.livejournal.com]

The premiums are much lower for HSAs. In a lot of cases, even if you hit that max out of pocket, you end up spending less than you would with a traditional plan over the course of the year. Many people do not ever come close to that max out of pocket, or if they do, it is generally a one-two year timetable. I'll admit it does require more effort to manage. As for expense, I chose to sock away the difference between my old insurance premium and my new premium in the HSA which was about $40 a week. There was no change in my take home pay, except that I had that $40 a week that was going into an account for me to use on my medical expenses. It earns interest, and if God willing, I'm healthy until retirement, I can withdraw what I put in as income just like a 401(k) or IRA. I call that a win.

[alexandraerin.livejournal.com]

Yes, you can call that a win... you who don't have any compelling use for that $40. The system works for you. Other people, though, look at the difference in premiums and they think, "Good, because I need that money now for [food/clothes/child care expenses/halfway decent pre-school program for my kids]."

And then they get in a situation where they need medical care and the evil fucking pricks who designed the system that works so well for you sneer down at them for making poor financial decisions and not being able to plan for the future.

To put it in simple terms, what you are saying is, "I can afford healthcare so the system is fine."

[alexandraerin.livejournal.com]

By the way, I had such a plan at most of my corporate jobs and they did work well for my needs. At the time, I wholeheartedly supported nationalized health care. In other words, this isn't sour grapes on my part... it's a simple recognition that rather than being a solution to the problem of the Have/Have-Not divide this system works to reinforce it.