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Don’t Get Hooked by the Obamacare Debate

So, Congress is locked up again around health care. Large portions of the Affordable Health Care for America Act are set to go into effect in the next few months, and many Republicans aren’t standing for it. Threats of a government shutdown are being made. Texas Republican Senator Ted Cruz is currently speaking on the Senate floor in a quasi-filibuster attempt to derail the legislation. And all of this is going on in the wake of proposed, drastic cuts to the SNAP, or federal food stamps, program.

What we are seeing is some serious old hat. A manufactured budget crisis, followed by a strong dose of poor people hatred, along with efforts to slash through whatever social programs might be benefiting folks. The same “leaders” pushing food stamps cuts, for example, had no trouble providing in the same legislation nearly $200 billion in agriculture subsidies, which primarily go to large, corporate farms. This is normal behavior in Washington: making the rich richer, while demanding the poor make do with even less than they had before. And while the current discussion focuses on Republican actions, don’t be fooled. Both major parties have been doing these kinds of things for decades now. Yes, the two parties aren’t exactly the same, but on the whole, the Democrats and Republicans are owned by capitalism. Furthermore, they’re both driven by the narratives of colonialism and “American exceptionalism” that have brought so much oppression and suffering into the world.

As such, while it’s easy for many of us concerned about the lives of the financially poor and marginalized to get whipped up into a frenzy about Republican attempts to cut social programs, I think it might be wiser to pause and take a look at the bigger picture.

For example, lost in the battle around “Obamacare,” as the health care bill is popularly known, is the fact that it is mostly a giveaway to the insurance industry. And that all attempts to even get a public mention, let alone a fair debate, about a single payer alternative was thoroughly scuttled by both major parties. I get it that many folks on the left feel that Republican threats to block Obamacare are an assault on the poor and working class. However, as more of the bill is rolled out, and more complications directly impacting poor and lower middle class folks come to the forefront, I have to question the idea that this is legislation worth fighting for.

The health care system is riddled with abuses and injustices. Patterns of systemic racism frequently lead to poorer quality care for people of color. Gender and sexual minorities face not only access barriers, but also everything from “confused” treatment efforts to outright discrimination.  The pharmaceutical industry’s stranglehold on mainstream medicine has made difficult, if not impossible, efforts to elevate and promote numerous alternative therapies, including herbalism, energy work, and indigenous forms of medicine. And the list goes on and on.

Odds are that Obamacare will do little to address these larger issues in the health care industry. The fact that we call it “an industry” points to two of the main problems – the commodification of human health for profit and the belief that there’s a single, most worthy approach to addressing our health issues. Both of which will be maintained under this legislation.

Given that the main audience here are folks interested in addressing social issues from a spiritual practice perspective, I’d like ask some questions about how we might be approaching big social issues like health care.

To those who support and feel compelled to fiercely defend Obamacare, how much of that effort is coming from a generalized fear of increased oppression and suffering, as opposed to genuinely supporting the legislation?

To those who oppose the legislation, is your opposition mostly driven by a genuine desire for a better approach, or are you operating – at least in part – out of something like reflexive political party affiliation or total rejection of the mainstream political system?

To everyone, regardless of your interest in the health care debate, how much of your political activity and positioning is coming out of reactions to the “social and emotional upheaval” of the day, and how much of it is based upon more reflective, longer views of social transformation?

I bring all this up because even amongst Buddhist folks who are socially active in the world, I see a fair amount of reactionary thought and action. I’m working on this myself, watching for when the impulse to say something, or do something about social issue X is coming from a place of rapid fire rejection of what’s present, and/or in an attempt to defend what’s present.

Not only is doing this kind of paying attention, and learning to abstain from reactionary talk/action helpful for your sanity, but I’m convinced that it’s necessary for truly overturning systems of oppression and injustice. Because the elite are damned good at manufacturing crises, and tripping our triggers on all sorts of issues, all in an attempt to keep us plucking at the leaves of their invasive trees, instead of coming together with our spades and clippers to expose and remove the roots.

Sometimes is necessary to defend certain leaves or branches on what ultimately is a rotten tree over the long haul. I tend to think that keeping the food stamps program intact for now is worthy effort, for example.  Just as in our practice lives, we learn it’s sometimes helpful to keep around minor “negative” patterns until we’re ready to confront and uproot the major issues below.

But if too much energy and emotional entanglement goes into that kind of work, we never get at the major efforts towards liberation. So, in these days of continued and renewed attacks on the poor, I urge you all to maintain watch over what you’re giving your energy to any why.

Whatever our disagreements over the leaves and branches, let’s keep our eyes on the roots, and our hearts on the prize.

*Photograph by author, Madeline Island, Wisconsin.

Comments (9)

  • Jeff

    There’s no doubt that the Affordable Care Act is a deeply flawed piece of legislation. Rather than providing low-cost comprehensive health care for all Americans, it extends partial access to our faulty medical system to only about 1/3 of the current 48 million US citizens who are entirely without health insurance. As Nathan points out, it does so by subsidizing the for-profit insurance industry, thereby tightening its stranglehold on what should be a basic human right. And it does nothing to control the spiraling costs of US medical care, which are vastly greater than those of any other developed country (for consistently poorer public health outcomes) and the primary driver of our budget deficit.

    Is there anything good about Obamacare? Well, it does limit some of the most egregious private insurance abuses such as denial of “pre-existing conditions,” caps on benefits, and excessive spending on non-health-related items like advertising. It does expand eligibility for Medicaid and offers premium support for low-income folks buying insurance on the exchanges. Those gains are worth preserving if the alternatives are going back to the status quo or further privatization of health care as envisioned by the right.

    But framing the debate about health reform as “Obamacare vs. usual care” is patently deceptive. The health advocacy groups I organize with are calling for the enactment of bills like HR 676, which would establish a universal single-payer health care system, in essence, an expanded and improved Medicare for all. In fact, even Obama endorsed this model during his campaign for US Senate in Illinois in 2003 before he learned not to piss off people who make the big contributions.

    In response to Nathan’s suggestion that we question whether our political engagement comes out of “reactions to social and emotional upheaval” or from “longer views of social transformation,” I think most successful activism combines a deep analysis of social injustice with immediate responses to the urgent needs of real people affected by it. So, for example, with regard to the health care debate, I will continue organizing for universal health care while opposing the defunding of Obamacare, because I work with uninsured patients every day, and I know that having no health insurance quite simply kills people.

    And yes, ultimately even having Medicare for all will not bring universal health to this country, given that most illnesses are accelerated by endemic social conditions such as poverty. The interconnectedness of health, employment, education, racial equality, etc. simply makes it more important that we each begin where we live or work to collectively challenge the ongoing attacks by our corporate rulers on the many. Learning the balance between short-term survival goals and long-term visionary strategy will constitute the art and science of political and spiritual change for the 21st century. We’re just getting started.

  • nathan

    ” I think most successful activism combines a deep analysis of social injustice with immediate responses to the urgent needs of real people affected by it. So, for example, with regard to the health care debate, I will continue organizing for universal health care while opposing the defunding of Obamacare, because I work with uninsured patients every day, and I know that having no health insurance quite simply kills people.”

    I agree with your teaming of deep analysis with responding to immediate, urgent needs.

    It’s interesting, though, in this case. I’m not sure how best to respond to Obamacare and/or efforts to defund it. I’ve been uninsured for a good decade now. Have been mostly fortunate healthwise, only incurring a couple of “smaller” bills for services. I’ve lived the panic of not knowing what to do with a health condition, and choosing to delay or treat issues naturally (with herbals, etc.), hoping that will work. Which is usually the case, but obviously nothing is fool proof.

    I find, though, that I’m resistant to the personal mandate. It’s an awful precedent to set, and I question whether opting in is wise or not. It pains me to see folks with chronic conditions or ill health having to choose between no coverage, and getting something that might end up providing a false sense of security, while possibly costing too much. The poverty line cutoffs are brutally low. I might qualify for a full subsidy today, but if I added a part time job tomorrow, I easily could end up where I was a few years ago. Making a modest salary that just barely covers expenses, but wouldn’t cover the additional cost of a health plan.

    Perhaps these “health exchanges” being set up will make it all somewhat more affordable. But I also honestly don’t have much faith in them. High deductable plans are virtually worthless, unless you’re in a catastrophic situation. The insurance companies basically bank on us reacting to this fear, while peddling “low income options” that offer little or no preventative care access.

    This is an issue that has been in my face for a long time now, and I’m not an ally or supportive bystander. I have a great stake in it all. And honestly, I think there might be other ways to deal with survival issues. Such as working to get more “free” or very low cost clinics funded and supported that work at least partly outside of the system. Or figuring out ways to more broadly finance and underwrite alternative treatments (like acupuncture, herbal consultations, etc) for poor folks.

    To me, the kicker is always crisis care. The thing allopathic medicine really does well. Accidents, strokes, heart attacks, conditions that need immediate surgery. These seem to be the lynchpin because they’re so expensive, and often out of reach (or dangerously delayed reach) for folks without coverage. I see this as that place where Obamacare might be useful. But if most of us uninsured folks opt in and the whole thing works just well enough to not be a total disaster, how much harder will it be to advocate and get single payer legislation?

    What I’m mostly saying here is that we need to open the box around “survival” in the short term. Because how that gets answered )or not) impacts the long term.

  • mel lozano

    i am one of the many people in this country who is directly impacted by this….Yes indeed. i cannot afford medical insurance though the law requires me to have one (how does that actually work, BTW- it’s like forcing people to own a car regardless of whether you can afford one or not, in my mind…lol)…….i still do not understand what the hell is this debate about. It is utterly ABSURD in the 21st century, in a powerful, industrialized society to even be debating whether or not we can “afford” to provide ‘free’, accessible, adequate healthcare to all our people (all residents, not just citizens)…just as it is being done in Canada, in the UK, and many other progressive countries. I like what Michael Moore had to say in the film- “Sicko”….and one of the main things that should stick in the minds of most Americans was when he mentioned that we have an educational system (albeit one that is severely lacking in support, and only up through High School), a police force, fire departments, libraries that are all ‘free’- at least in the sense that they are not-for-profit……they are NOT free in the sense that Americans pay taxes for those things to be provided for us- same as in Canada, the UK, Sweden, France, etc……So if my home is burglarized or I am stabbed, or if I need to borrow a library book, or if my house is on fire……I can call someone for help and not worry about it costing me anything……but god-forbid i should be a diabetic, or have cancer, AIDS, or have a heart attack or one of my loved ones gets one of these or become ill and desperately need medical care- you better have some money and be able to afford it By Golly…..or your luck may just have run out. lol Universal Healthcare- one of the signs of a genuinely civilized and compassionate society that cares…

  • Jeff

    Couldn’t agree more, Mel!

    Nathan, your mixed-but-mostly-negative feelings about Obamacare reflect my own. I see it basically as a last-ditch effort to divert health care reform in the US from the path toward universal coverage that every other developed nation has taken. And in that it has succeeded: written by Big PhRMA and health insurance conglomerates, it basically pushes people into the private insurance “marketplace” to buy policies underwritten in a slightly less avaricious manner than they have been up until now. Despite fear-mongering rhetoric from the usual right-wing liars, this is less a “government takeover of health care” than a makeover that applies a few cosmetic regulations to private industry as it continues to bleed profits out of what should be a public service. Unfortunately (and probably deliberately), the enactment of Obamacare has shifted the discussion away from formulating rational public health policy to a “for-or-against” argument around a costly, complex, half-hearted remedy for our critically failing medical delivery system.

    Even though it seems designed to be the worst of all compromises, one that makes nobody happy, we should recognize that attacks on the Affordable Care Act by the Tea Party branch of our government seek to put more power and profit back in the hands of industry in the name of “individual liberty” (corporations now being regarded as especially privileged individuals). Perhaps the most important reason to defend the ACA (for the time being anyway) is that it allows states to create alternative models that can replace the exchanges as long as they provide at least the same benefits as federal law now mandates. In my mind, that alternative should be a health program that covers all residents for comprehensive, lifelong services, is publicly accountable, and is funded progressively with no out-of-pocket costs. Vermont has already legislated such a single-payer plan and will be eligible for a federal waiver to eliminate profit from health insurance in 2017. We are organizing hard in California toward the same goal. I can assure everyone that nothing short of this will work “just well enough” to keep Americans healthy and out of medical bankruptcy in years to come.

    Can low-cost clinics providing acupuncture, herbs, nutritional supplements, and other complementary therapies substitute for traditional medical care in poor communities? Should we expend the personal and political energy to set them up, fund them, staff them, and keep them running through thick and thin? (because people’s lives will depend on us now) Setting aside questions about the efficacy of complementary therapy for our most prevalent serious illnesses such as hypertension, diabetes, and cardiovascular disease, I am always glad to see folks who wish to avail themselves of these modalities take the initiative to make it happen. This may be the best way we have of gaining much-needed information about resulting clinical outcomes until large, unbiased scientific studies are undertaken, as I think they will be eventually.

    My plan for short-term health care survival? Hold our government accountable for its legislated promise to make medical services affordable and available, which means calling out the already widespread corporate dodging and loophole-finding to avoid paying their fair share and shift costs back to us as patients and taxpayers. And as Obama’s Band-Aid inevitably begins to peel off our wounded system, keep up the pressure to enact truly universal medical care. Given the political and financial strength of the pharmaceutical-insurance complex, it will take millions of us to force this through, but when you think about it, everyone does really need good health. An idea whose time has come?

  • Nathan G. Thompson

    ” Perhaps the most important reason to defend the ACA (for the time being anyway) is that it allows states to create alternative models that can replace the exchanges as long as they provide at least the same benefits as federal law now mandates. In my mind, that alternative should be a health program that covers all residents for comprehensive, lifelong services, is publicly accountable, and is funded progressively with no out-of-pocket costs.” This is fair, and I definitely support efforts to make what Vermont is doing much more commonplace.

    At the same time, I think it’s easy to get lost in defending the table scraps of plans like ACA. And get consumed in things like electing/re-electing corporately owned politicians who speak in favor of keeping said table scraps. Losing the energy/momentum on things like spreading what’s happening in Vermont.

    As for complimentary medicine, there’s plenty of good research on efficacy out there for many therapy modalities. Herbal medicine research has been suppressed in the U.S. for much of the past century due to the AMA/BigPharma/Insurance power base. Research on massage, acupuncture, elements of the Ayurvedic system and more are also plentiful. But much of it is being done outside of the U.S. because the stranglehold of allopathic medicine is probably strongest here. Certainly, more work can be done in that area, but in my view, the continued calls for “proof” that these practices “work” come most loudly from those who want to maintain the allopathic monopoly.

    And in terms of these questions:

    “Can low-cost clinics providing acupuncture, herbs, nutritional supplements, and other complementary therapies substitute for traditional medical care in poor communities? Should we expend the personal and political energy to set them up, fund them, staff them, and keep them running through thick and thin? ”

    People are already doing so. Formally and informally. It’s just not terribly supported well. A fair amount of medicine practices in recent immigrant communities, for example, are informal in the sense that mainstream American society doesn’t recognize them as “legitimate.” How much of good health is tied to preserving longstanding cultural practices? Where does efficacy lie, or what prompts healing exactly in other words?

    I witnessed regularly in immigrant communities here in the Twin Cities was a pressured split between “traditionalists” who mostly used indigenous medicine practices, and others who rejected most or all of that in favor of embracing “the American way” – seeing it as better. Seems to me that these all or nothing reactions are responses to being in a society that elevates one model as “the truth” and suggests everything else is either secondary, or quackery. Even the terms we use – complimentary and alternative – maintain the allopathic model at the center. Whereas in my view, we’d all benefit from upholding diversity, and putting more efforts into the collaborations that have started to happen between different groups.

  • bezi

    what’s (tragi) comedy to me is the way almost nobody utters a mumblin’ word (thanks Bro. Cornel) about the TRUE origins of “Obamacare” – which lie in the HERITAGE FOUNDATION (!!?)

    http://krugman.blogs.nytimes.com/2011/07/27/conservative-origins-of-obamacare/

    So the next time a right-winger gets in your mug about mandated health insurance, YOU can be the proud owner of a smug smirk as you direct their attention to their OWN damn ideologues as the architects of this travesty! BooyahKah!

    don’t get hooked indeed…

  • nathan

    The Democrats have been repackaging old Republican ideas circa Gingrich era for a good decade now. It’s one of the jokes of the whole two party circus.

  • Inge

    Thank you Nathan for addressing so clearly what we really need when it comes to healthcare. My friends think its great. Me — not so much. I just couldn’t express my concerns as well as you just did. We shall se how things shake out over the next year…

    I think it maybe started out as good intentions but looks like another bait and switch.

  • bezi

    “The Democrats have been repackaging old Republican ideas circa Gingrich era for a good decade now. It’s one of the jokes of the whole two party circus.”

    you and I know that. Perhaps the majority or everyone in this forum knows it… but my impression is that it’s pretty well hidden and unknown to the vast majority

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