Individual mandates

Paying for my own health insurance has thrown me into uncharted financial territory. It’s enough of a hardship that I’d probably drop the coverage, or never have arranged for it in the first place, if I weren’t under pressure verging on duress from my parents to maintain it. There’s a very small but very real chance that I’ll need major medical care, and I don’t want to have to explain why I dropped the coverage after the fact, no matter how poor or nonexistent my return on investment is now, so here I am.

It’s been six and a half months so far, and I’d like for this hardship to come to an end. If I’m not mistaken, I’m paying slightly more per month than my parents were paying for my old policy per quarter. I got grandfathered into something closer to truly catastrophic coverage and managed, barely, to avoid getting kicked out into the garbage “marketplace” over a Kafkaesque inquiry into my state of residency after my parents and I all moved out of Pennsylvania. Some bottom-rung clerk in Wisconsin told me over the phone, in a call that my dad had badgered me to place over an unrelated matter, that I’d probably be okay as long as I didn’t file claims for suspicious amounts of out-of-state medical care, say, in Oregon. This would be a real what-the-fuck scenario to any halfway reasonable person. In spite of this scare, I managed to hold onto this coverage, at no cost to me and at low cost to my parents, until Assurant Health (a pretty telling name, I dare say) withdrew from the market at the end of last year, claiming that it was losing money as a health insurer. I received government-mandated refunds for about $250, i.e., less than one month’s premium for my current Kaiser coverage, having to do with an actuarial analysis of how much Assurant had paid out to its insurance pool over the course of my own policy, or something to that effect. Whatever voodoo they had done, I was not of a mind to turn down some unexpected free money in a month when I had been forced, and I truly mean forced, by my tight finances to delay the payment of my Kaiser premium until several days into the grace period.

This is why Canadian-style cradle-to-grave Medicare has the support of something like two thirds of the American public. The current system is a god-awful, intractable kludge that originated as stopgap measure enabling industrial employers to work around wartime wage controls three quarters of a century ago. The sorry-ass, borderline third-world history of robber barons and doctors’ pressure groups sandbagging every attempt at all-ages single-payer health insurance since then, with the help of whatever Bircher muscle they could marshal, doesn’t reduce the actual popularity of single-payer on the ground, among genuine ordinary Americans, as opposed to self-dealers and wingnuts who proclaim themselves ordinary Americans in a campaign to silence everyone else.

It’s very easy to explain the minority that supports the current Rube Goldberg disaster: direct and secondhand beneficiaries of the looting of medical care (minus quite a few clinicians who enjoy a modest financial benefit at the expense of their own practices, which have been trashed to hell by MBA’s); a somewhat larger outer cohort of social climbers and conformists who are still affluent, stable, and sheltered enough not to be personally ruined by the current system or have been sucked into the fray of the ruination of those close to them; and a tiny, marginal fringe of extremist useful idiots who would be utterly inconsequential on their own. The first constituency of this coalition has an amazing ability to piss off its colleagues in medicine, nursing, and the like by being incompetents and mercenaries who don’t give a damn about their patients, make work life hell for clinicians who do give a damn, and constantly getting in the way. The second constituency is dwindling and increasingly resented by its fellow citizens on account of the secular collapse of multiple Western economies. Aspirational behavior that was more or less respectable from the mid-eighties to the mid-aughts, when there were generally jobs to be had, is much less respectable now, when there generally aren’t. The third constituency, the useful idiot reserve, is available to the other two to be trotted out as proof that there are in fact principled anticommunist arguments to be made against universal health care, not just the self-dealing of an elite minority and the timid conformists trying to ape it in the hope of taking full delivery of goods from their cargo cult.

These useful idiots serve the additional purpose of making the poor look stupid, i.e., deserving failures in the meritocracy that is America. To the right, they’re salt-of-the-earth real Americans, until they stray off the reservation and vote for Trump; to the left, they’re the certifiably idiotic and insane who obviously need to be wards of the state and sources of full employment for their meritocratic betters. In point of fact, they’re local color, increasingly representative of no one but themselves, but the Cathedral pays its technicians the big bucks to amplify them into commonsensical distillations of flyover country.

These things need to be spelled out for BoBo Democrats who insist that the poors keep voting against their own interests. First of all, it’s well established that the poor have abysmal turnout at the polls, so much of this vaunted heartland conservatism is the product of bourgeois and wealthy voters catfishing as down-t0-earth local yokel good ol’ country boys and girls. An examination of households that actually own farms in the Midwest and on the High Plains these days, for example, shows that many of these households are fucking loaded. These are family farms more in the sense that Menard’s is a family business, not in the sense that Hezekiah over in Bird-in-Hand has another five acres of hay to cut this afternoon. An entire PR industry is devoted to preying on the ignorance of Americans who are not familiar with the actual socioeconomics of these communities. If I wanted to be an English Donald Kraybill for my people, I could agsplain this shit full time and still have an unfathomable about of work to do.

So why doesn’t the rural proletariat turn out to vote? Gee, could it have something to do with haut bourgeois liberals throwing the New Deal coalition under the bus, and then throwing the Carter coalition under the bus, and now throwing the Sanders coalition under the bus? George Herbert Walker “She’s not be well” Bush claimed to take inspiration from country music, so here’s some inspiration: “But Mr. Roosevelt was gonna save us all….” Oh. Somebody went off-message, y’all. Not to worry, though, the industry has since been made safe for Yankee-ass Toby Keith. But these people knew Mr. Roosevelt, and Mme. Secretary, you’re no Frank Roosevelt. Of course the poors are hesitant to vote for politicians who treat them like shit, double-cross them, and deliver nothing. Of course they’d rather vote for Bernie Sanders as an individual candidate than support a Democratic Party hellbent on marginalizing him on behalf of a megalomaniacal insurgency of yuppies who forty years ago either would have known when to shut up or been Main Line Republicans. Let’s tenderize this horse carcass a bit more (“No, it isn’t. I can still see the marks where the jockey strapped it.): the poors in flyover country turned out this year in support of the two presidential candidates who promised improved safety nets, one sporadically and the other very consistently. They did not turn out in defense of the inalienable American right to employer-based health coverage, which the Clintons angrily defended until Sanders convinced them that they were beclowning themselves and endangering their own political viability.

Because the Democratic Party, nominally the main left-wing party in the United States, has worked so hard for so many decades to sandbag an all-ages single-payer health insurance system of the sort that has been proven successful in countries as similar to ours as Canada–a system, no less, that a majority of all Americans supports–we’re left with absurd, embarrassingly unserious half-measures, including the individual mandate and the option for children (sic) to stay on their parents’ plans until the age of 26. The United States leads the developed world in 25-year-olds who are raising school-aged children, too, but the loudest scolding comes from the elites and their higher subalterns, the ones who orchestrated this bum fight between responsible adults and funemployed grown children in the first place. It has never been harried teen parents who have led the charge to shred the safety net. They’re too savvy and practical to begrudge some adrift grown layabout his Medicare if they and their children get Medicare, too.

The mainstream #TCOT position is that the Millennial Twentager Army needs to sponge of mom and dad’s insurance because it’s too immature, irresponsible, and lazy to get a job, probably because its parents were too coddling. This is bullshit with a tiny, wildly exaggerated grain of truth. The job and housing markets today are mightily fucked, and the kids have been conned to sell themselves down the river with student debt. They’re forced to take whatever they can get from the Boomers because that’s where the money is. Willie Sutton, pray for us. No, the money supply did not end up in Boomer pension funds and 401k’s due to some inscrutable act of God. No, it did not end up there because the Greatest Generation raised Tom Brokaw right. Let’s get real: a large rising cohort of demanding, politically active voters got its gibs, and the luckier, savvier, and more cutthroat among them have been able to ride out the Depression of 2008. Many of these fortunate ones now have grown children whose prospects have been ruined by a combination of know-it-all MBA’s, the ass-kissing and fraud of their own ethics-free classmates, and an uncontrolled reserve workforce of Latin American peasants. If they try to strike out on their own, they face a very real likelihood of ending up in Hooverville or the next thing to it (Ben-Ora, 2016). I don’t enjoy sitting around my parents’ house at loose ends for weeks straight, but I also don’t enjoy sleeping in my car. What the fuck do I do?

This is the sort of decision that young Americans today face. I have to deal with some especially tangled logistics and weird financial liabilities due to the geographic dispersion of my friends and relatives and the extreme dysfunction of my fallback in Oregon, but I’m extremely fortunate to have high gross cash flow and absolutely no debt. Cubicle life circa 1985 or 1995 may have been existentially troubling, but at least the long-term prospects resulting from going out and getting a job looked good to most Americans. People living in the mainstream didn’t face today’s smoldering pile of shit.

The incumbent US government wants to keep playing off Medicaid beneficiaries against the fully employed with employer coverage against the insurance marketplace precariat against the under-the-radar uninsured precariat. It wants to keep playing off SSDI beneficiaries with off-the-books jobs against the aboveboard employed against the unemployed. It wants to keep arbitrarily reshuffling us from category to category as our immediate socioeconomic circumstances shift in the most unstable economy since the first Great Depression. If all Americans and legal aliens had Medicare, it would be harder to split us up into distrustful, resentful, warring factions.

Of course, we now know what Bill Clinton and Loretta Lynch find compelling enough for a meeting: grandchildren and golf. It’s all too emblematic that our officials publicly claim to melt to butter about twee shit while the FIRE sector serially rapes the public and the State Department is pimped out to Saudi Arabia and its moral peers. Of course we’re governed for shit with leadership like that.

A new government can’t clean house soon enough.

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