“Wellness” may actually be a thing, but if it is, the United States hasn’t any at all

When I was on the train from Denver to Chicago a few months ago (the day after Inauguration Day, in fact), I overheard a gentlemen tell his associates, “Niggas be on rent control. Niggas be thinking they ill.” As the white cop from Sanford and Son would surely say, gosh, I hope they feel better; maybe they should see a doctor if they still feel ill in a day or two. By the way, I didn’t mean to be sarcastic about the guy on the train; he seemed very much a gentleman, although if he construed the niggas in question to be exclusively Community members, I know enough San Franciscans to assure him that he’s very much mistaken. Native San Franciscan O. J. Simpson has no cause to complain that the rent is too damn high (and Nevada has many such cases), but many of those who moved to his city in the aftermath of his departure do, and as we’ve discussed in these pages before, the City is becoming a less and less hospitable community for the Community.

That was all coherent, regardless of whether it looked it. If you want something incoherent, look at American health policy. That isn’t just sic; it’s literally, powerfully ill. If there’s any subtle coherence to it, it’s a thoroughly evil coherence buried in the thicket of evasion and bad faith and lies that is crucial to convince the non-psychopathic majority of those active in national politics, as elected officials, activists, formal observers, and voters alike, to go along with any of the evil shit. The federal sausagemaking process doesn’t allow leaders with evil designs to get anywhere by professing their intention to throw the poor, the sick, and the otherwise vulnerable into the lion pit for moral edification and profit; that’s too crude and obvious not to rile up a silent majority of decent Americans and sandbag the entire campaign.

Unfortunately, Congress is full of creeps who are too smart and devious to do anything that clumsy. To a scandalous extent, we’re represented by crafty operators who know how to establish what the CIA likes to call plausible deniability. Of course these creeps would use a CIA-derived intellectual framework and operating system in their official work; they’re high-functioning psychopaths whose main offices are inside the same Beltway as Langley. Certainly the prospect of Dennis Hastert crossing paths with the blackmail squads at Langley or, to evoke Washington’s most famously fabulous blackmailer, the J. Edgar Hoover Building is, to rectify that odious CIA term, plausibly undeniable. Put me in, Coach! I’m ready to play! *AS HE SAID.* Nah, given that that sorry old has-been couldn’t even wheel himself into FMC Rochester without bumping into the curb, it’s hard to imagine that he’s joined the Juice in our country’s venerable tradition of coaching the boys in baseball on the yard.

And no, I can’t imagine why anyone would ever think of wrestling as somehow being gay.

That was quite gross, but again, we’re talking about Washington. The train where I learned about the niggas who be thinking they ill on account of their rent control went through Yorkville, allowing me to feel a few minutes of snickering superiority over the Accidental Speaker, what with his court-ordered cool change in that Mayo Clinic satellite campus and my being at liberty on a bitchin’ ride. Why take part in the Bureau of Prison’s shabby socialism when you can take part in Amtrak’s fine-ass socialism? Why be governed by the iron fist of the law when you can ride that iron horse? Of course, any of this is better than a tropical getaway to Iron Prison. *Very Andrew Chan voice* I’ve got a hole in me now…. Indonesia is an ally. Why in hell? Maybe it has something to do with statecraft in the Hastert-as-puppet tradition. They (construe as you like) have been blackmailing our politicians for decades. Harry Truman complained pointedly in his private letters about the deep state using sexual gossip as leverage over elected officials, and the monumental blackmail record of that fruit in the dress at the FBI is infamous to anyone familiar with any but the most sanitized histories of the federal government.

Some of it is surely more prosaic than that. Simple bribery–trapping flies with honey and all that–can be awfully effective. Kamala Harris is reputed to have sold her official services to crooks in the FIRE sector for $2,000; Spiro Agnew was ridiculed in his own time as the first politician who could be bribed with a bag of groceries. There is much slush sloshing around Washington, and it sloshes into many funds. A frank mercenary presumably has fewer potential downsides and needs less handling than a blackmail case with a kiddie-diddling history. It’s one thing to be a den of crooks, but when someone like Hastert comes along for the ride, the organization hosting him turns into a den of crooks who are also perverts. Congress may be able to withstand its own reputation for fraud, but does it really want to look like Penn State? WE ARE!

No, Pizzagate isn’t that crazy. The precedents are there, and let’s be honest, John Podesta looks way the hell creepier than J. Denny Dundiddly ever did.

Regardless of what exactly is driving federal healthcare policy, it’s ugly and evil, just as the resulting federal policy is. It’s absolutely scandalous that any political party would take pride in a wasteful, half-assed regulatory capture kludge like Obamacare, especially a party that also takes pride in being its country’s left wing. The AHCA, the Republican House’s repeal and replacement bill, is even worse. It’s bad enough that the House Republican Caucus may have actually overplayed its hand this time. Its members were already getting booed and shouted down at town hall meetings by their own constituents, and now they’re responsible for a monstrosity whose express purpose is the replacement of a lesser monstrosity that, in spite of all its siloing of the electorate and its unfunded individual mandate and its giveaways to vile crooks who have all the moral scruples of organ harvesters on Communist Chinese killing fields, at least got a good chunk of the uninsured population onto health insurance plans under a tightened regulatory regime that finally forced insurers to honor their own policies and stop cherry-picking their risk pools. The House has now passed legislation to replace it with a horror show encouraging insurers to penalize their policyholders, who are quite often functionally indigent, with draconian penalties for lapsed coverage and deny coverage on the basis of a horrifically expansive list of preexisting conditions, threatening people with lifetime ruin for seeking exactly the timely medical care that saves themselves and those insuring them significant long-term expenses by forcibly deputizing clinicians as informants.

The potential threat to public health here should be obvious, since such a hostile, punitive regime will inevitably discourage the sick from seeking treatment for contagious diseases. The sight of this new dystopian frontier being opened by a party of belligerent shitbaggers is awesome, in roughly the sense of watching a Komodo Dragon stalk and pounce on a water buffalo. We’re watching hideous creatures satisfy their hunger in real time; that’s all. The Democrats behind the ACA were, amazingly, C. S. Lewis’s robber barons; the Republicans behind the AHCA are Lewis’s moral busybodies, although they’re also rampaging robber barons. It was wrong of me to be so harshly moralizing towards our dragon friends above: as literal cold-blooded reptiles, they really don’t eat all that much, no matter how dramatic their feasts. The Democrats are mixed up with their own rogues’ gallery of corporate crooks, but they don’t give safe harbor to anyone like Mo Brooks, who has opined that those who lead good lives don’t come down with preexisting conditions, or even anyone quite as intractable as Paul Ryan at combatively operating a free-market fog machine to give the entire party cover for its current ass-raping.

The Republicans have the advantage of pushing this agenda from a position of consistency, in contrast to the cognitive dissonance that Democrats face when they sell out their own base and get called on it. The Democrats are at least a tiny bit chastised by the knowledge that their own base is demanding universal single-payer coverage, generally in the form of Medicare for all, ever more loudly and cohesively. When they get told off at their town hall meetings, it’s by exactly the constituencies that their party mythology celebrates as worthy and valued: modest working men and women (lately expressed as “working families,” presumably on the chance that child labor laws really aren’t that important), the disabled, the indigent, widows and orphans, those living on “fixed incomes” (as with our working families above, on the apparent theory that an income cannot be fixed at a very comfortably high level), the vulnerable and mistreated in general. The Democratic leadership has notoriously been currying favor with credentialed professionals at the expense of workaday voters and trying to hammer them together with narrow identitarian constituencies and underclass client bases (think downmarket immigrants and welfare types) into a ramshackle coalition that’s barely viable enough to win elections pending the glorious mass die-off of the future dead white males, but even the neoliberal Democrats spearheading this agenda are quietly embarrassed, as they should be, to be involved in this mass ratfuck. They know that they’re throwing decent people under the bus. They know that they’re engaging in an epic campaign of treachery against honorable constituencies that were crucial in the electoral and legislative victories of Democrats going back to FDR at the national level and at least Al Smith at the state level. They aren’t quite insane enough not to realize what hypocritical shitwads they’ve become; maybe close, with their Harry Potter and Josiah Bartlett fantasies, but not quite. The shame, embarrassment, and guilt that they quietly feel on account of their treachery and hypocrisy makes them less effective at governing than their Republican opponents, but they’ve turned the Democratic Party into a beast that’s hardly any less worthy of destruction than the GOP, and that takes some doing.

That there’s a constituency for psychopathic public policy like the AHCA at all is disturbing, but the Democrats bear at least as much blame for indirectly empowering this constituency than the Republicans bear for directly leading and representing it. It’s a noisy, belligerent minority that believes any of the worst Republican talking points sincerely enough to want to get its fellow citizens sickened and killed by turning them into law. The Democratic Party is the one that refused to give the silent majority of decent Americans a credible alternative because it was too busy selling out to big donors and the talented tenth. They lose to structural Robert William Pickton not because the American public demands healthcare by Sick Willie, but because they fucking suck. They tell struggling voters to trust them because they keep Nancy Pelosi and Chuck Schumer in leadership positions, and then they publicly make fun of the same voters for being bigots when they don’t vote as instructed.

If they had any principles at all, they’d marginalize their own crooks and sleazeballs for fear of causing scandal before the electorate and causing the election of deranged reactionary bigots. There is a frightening sadistic streak in the American public, as witnessed by our rather slowly dwindling support for capital punishment, which until recently was the stance of a consistent majority of Americans, but the Democrats won’t even tolerate anyone within their ranks who advances a pocketbook platform compelling enough to convince law-and-order authoritarians and reactionaries to put aside their differences on criminal justice and vote for the reliable delivery of the goods. This isn’t rocket science; it’s how the screeching segregationist George Wallace won a supermajority of the black vote for the Alabama governorship against a staunch integrationist Republican with a libertarian streak. That, and he was known in well-connected circles for sincerely respecting the black people in his own personal and professional life. Convincing voters through back channels that their public ugliness is all for show is the last thing today’s establishment Democrats can be expected to do. I have one degree of separation from Nancy Pelosi, and that degree of separation, who was party to a regional roundtable policy meeting including her, told me that she seemed totally insincere and uninterested in anything that the group was discussing. One of the matters under discussion was mental health care, so, yeah, we’re in really fucking good hands there and it absolutely is not just Pelosi’s hands wandering into our pockets.

The Democratic Party has set its own social agenda back decades by indulging in this bullshit. We can’t know for sure what would have happened to the death penalty abolition movement starting in the mid-seventies had the party not started catering to yuppies, and it certainly ran some tone-deaf, gaffe-prone idealists in its later upstanding days, but it’s telling that the Democrats progressively entrenched their reputation for not caring about the interests of anyone but the very rich, the intelligentsia, and the very poor starting no later than the Reagan Administration, and that the main interlude in the midst of this reputation collapse, the Clinton Administration, featured constant triangulation, hard rightward moves on social and economic policy that were rarely offset by moves to the left, and a renowned aura of scandal. By some accounts, Monica Lewinsky and her mostly blue dress saved Social Security from Bill Clinton and Newt Gingrich. Kenneth Starr as white knight for the social safety net is a pretty appalling thought, but we all go to war with the dork army we have, not the handsome jock that our loyal dork fights to depose from his palace. And of course, Ricky Ray Rector’s thoughts on the Big Dog, if any, may have been different from ours; they presumably weren’t ones that a man would want to contemplate over dessert.

If we must go to war by other means with the Democratic Party we have, God help us. The profound lack of principle and courage shines through. It can’t help the party electorally. On some level, voters must respect its opponents just for having the balls to stand for something, even something evil. The expectation that the Democrats will provide jack shit for representation and constituent services complements their moral spinelessness nicely. Elections are won by building coalitions, and the Democrats suck ass at building coalitions, so here we all are.

But the GOP’s talking points about health policy don’t have the same reptilian appeal that its talking points about punishing criminals do. They can’t credibly argue that, had they been in full power, they would have fried Jeffrey Dahmer before his yardboy got the chance to do in the iron age what they would have done in the electric age. Verily I say unto you, serve man, and ye shall be served. They can’t credibly argue that they’re out to get psychopaths like Charles Manson so that he doesn’t get to grow old at taxpayer expense. (The hilarious thing about that fucker is that he was set afire by his fellow not for being a remorseless thug, but for dissing the Hare Krishnas.) With healthcare, they can’t help but betray their intention to kill your child in an act of cosmic punishment for getting cancer. Or your spouse, or your mother. There go all the sincere religious conservatives. For a party that counts on supermajority support from religious breeders who adopt special-needs children, the AHCA is one dumb move. We’re already watching this stunt backfire in the town hall meetings.

Maybe I feel a touch of schadenfreude watching this dumpster fire, but mainly I feel a sense of relief at the increasing likelihood that the Republican Party is joining the Democratic Party in shooting itself in the foot. It’s about time.

There are two viable paths for healthcare in the United States to take. The less viable one is to revert to an independent, perhaps even underground, patchwork of solo-practice doctors, nurses, social workers, and whoever else has the wherewithal to set up shop as some sort of medic, with or without training. This is already the reality in some ghetto neighborhoods whose residents are afraid of arrest by warrant troll squads from their police departments if they seek care in nearby hospitals. A less dystopian version of this is the country doctor who accepts payment in cash on the barrel head, a chicken, a bushel of pickles, porch repairs, or God knows what else country folk are theoretically able to provide as payment that would possibly be of use to the doc. This Norman Rockwell-ass piece of fiction for submission to Country (the magazine of pornographic nostalgia, not the geography) might work for hangnails and limb fractures, but it doesn’t explain what will happen when some poor bastard tries to pay an oncology team with the last haggard old cow left in their backyard for their child’s leukemia treatment. Anyone who isn’t an idiot knows that it’ll be either charity care or chaos.

So if we’re to avoid a horror show in which the poor and middling must either limit themselves to primitive primary care or pin their hopes on the inscrutably arbitrary whims of medical GoFundMe campaigns and hospital charity care (as with kitchen gunshot removal in the ghetto, already an existing lifestyle in many US communities), we’re left with the second option: single-payer care or some close variant of it. As I’ve mentioned a number of times before, single-payer has enjoyed consistent majority public support for decades, although this is in no way reflected by the negligible level of support that it enjoys in Washington and in the mainstream media. The goal of universal single-payer care is to expand Medicare, an extremely popular existing program, from the elderly to the entire population. It’s a hell of a lot more straightforward and less distressing than dealing with private insurance companies and the “Marketplace” that so enchants the small class of bureaucrats and think tankers who make a living talking about such insipid, Kafkaesque bullshit.

Finally doing on Capitol Hill what Tommy Douglas did in Saskatchewan most of a lifetime ago is rabidly opposed from the right in the name of liberty (or, in the case of the thoughtlessly ignorant, freedom and liberty). It doesn’t help that the United States has an exceptionally well organized and funded lobby of Christian dominionists who define liberty in the most grotesquely Orwellian fashion imaginable, truly as slavery to their doctrines or the next thing to it, but they have no trouble making common cause in this particular campaign with free marketeers, secular starve-the-beast agitators, and corporate propagandists.

The pertinent question to ask, then, is how the campaign to protect hospitals and health insurance carriers from all duty to patients, policyholders, and the public is possibly consistent with the big three inalienable rights that the US Constitution explicitly declared sacrosanct: life, liberty, and the pursuit of happiness. It’s considered worthy in patriotic circles to be familiar enough with these three inalienable rights to recite them from memory, so let’s look at what it would take to uphold them concretely in our healthcare policy.

Life: easily lost as a consequence of untreated disease.

Liberty: impossible in any meaningful sense for a person who has been thrown into crushing lifelong debt by medical bills that were assessed using secret chargemasters, retail cost markups worthy of a supermarket in Venezuela, discharge scheduling tricks, and bad-faith network-shopping.

The pursuit of happiness: impossible for a person who is sick, injured, or disabled and unable to get treatment.

What I’ve just proposed would give Congress’s self-declared constitutional conservatives mass aneurysms. Try to imagine Paul Ryan not talking over me if I argued for this program on behalf of the general welfare, which the Constitution also charters the US government to promote. Now try to imagine the Speaker taking the floor to argue that the same limited government dictated by the Constitution forbids congressional appropriations and protected sales franchises for pharmaceutical manufacturers. You might as well imagine that you live among Harry Potter and his wizard friends. Shit, the Democratic Party’s educated base already does that. Fuck. It’s a fun joke, but I forgot that it isn’t just a joke. As Firehat said, The West Wing is what Lenin had in mind when he said that the intellectuals are not society’s brains, but its shit.

The Democrats aren’t unable to completely flip the script on the Republicans over health policy, as I just did over five minutes in a fucking Starbucks (one of the few bougie status platforms that I am not embarrassed to share with the shitheads); they’re unwilling to flip the script. It’s their script, too, you see. Does the market fetish sound like it possibly came from the grassroots? Does anyone normal use “marketplace” in conversation? I guess I might use it to say that I stopped listening to Marketplace so often after that salty Texan who talked about being able to tell who was swimming nekkid when the tide went out retired from his regular chitchat position opposite Kai Ryssdal. I remember vividly where I was that day: driving through Fallon an hour or so before sunset on my way to Reno and whatever pile of filth awaited me in Oregon.

The Democrats don’t talk like the rest of us. The Republicans sometimes do. What a fucking disaster. We’ve got hundreds, no, thousands of people on Capitol Hill who should be on public assistance. Shit, they’re already drawing public salaries even when they pull a Chaffetz and wheel into the chamber on a knee chair a few hours post-op to vote to throw peons who need knee surgery into the gutter, to fend for themselves like good upstanding Americans. Why should I or some loser who plays video games all day in his secret place or some single mother on food stamps be ridiculed as charity cases and not that smarmy, goofy son of a bitch from Los Gatos?

Put them on welfare and that Section Eight. Give them a thicky trick, for all I care. From where we’re starting, we can hardly do a thing but save money by putting these fuckheads on the regular dole.

On the sunny side, though (hey there, Chesterfield!), we’re looking at a Democratic Congressional majority starting in 2019 the way things have been going this year. Maybe, if we don’t become totally derelict in the meantime, it won’t be a shitty one this time around.


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