Wednesday, March 24, 2010

Today's Healthcare Reform Is Not Enough

The right-wing wants change to come hard, or not at all

Yesterday, 14 Republican state attorneys general sued the federal government to block implementation of the healthcare reform law that President Obama had signed just minutes earlier. Though their legal arguments against the law are unlikely to prevail, the attorneys general, and Virginia Attorney General Ken Cuccinelli, in particular, have found an expensive, time-consuming way to mainstream the anti-government grievances of the extreme right. This is one of the many Catch-22s of democracy; one or many can access numerous institutional forums designed to facilitate democratic expression and use those forums to broadcast an ideology that opposes the funding and efficient operation of those forums.

This should come as no surprise to anyone. After all, up to 1952 the platform of the Republican party called for the repeal of Social Security. The initial Republican argument against Social Security was based on the frame that it taxed younger workers in order to pay older ones not to work, ignoring the obvious point that until older workers got out of the way, younger workers couldn't find employment. When they did finally get jobs, the social security tax was an initial condition for young workers, a relatively light tax shared across the board.

Now, more than 70 years later, the original premise of social security, tweaked occasionally to maintain the viability of the fund, still works. It would work better, however, if social security payments were more generous and healthcare was more comprehensive, more universally accessible and more affordable for retired workers. If these conditions were met, more good-paying jobs would open up for younger workers.

But we have not yet arrived at that happy state. The political struggle to make small improvements in healthcare, social security and other important social programs must continue in the face of tactics that stall implementation of good social policy (e.g., filibusters by Republican senators), and impose higher costs on government (e.g., lawsuits by Republican state attorneys general).

While Ken Cuccinelli's deputies were filing his lawsuit against healthcare reform, a friend of mine was combing the phone directory, looking for a D.C.-area dentist who would pull the two impacted wisdom teeth that were causing her great pain. She was doing her searching and her phone calling while she worked her job as a cashier at a local health food store. She has no regular dentist because she has no health coverage of any kind. She has lived, for years, in the constant hope that she would continue her lucky streak of no major health problems.

Of course, all lucky streaks come to an end and, in the case of postponed health and dental care, generally with severe consequences. Unfortunately for Lakeisa, she couldn't just walk into an emergency room and get her teeth pulled. And, though she could pay several hundred dollars in cash if that was what it would cost her, no dentist would take her. I hung around the store for over an hour trying to encourage her, but I should have gone home to get my car and offered to drive her anywhere she needed to go. When I left, she was near tears and feeling desperate, but still working. As far as I could tell, most people she waited on had no idea that she was in pain.

It strikes me that Lakeisa is one of millions of Americans who can legitimately hope that one day the government will expand the effort to make health and dental care so accessible and so affordable that she won't have to suffer through a day like yesterday. But nothing in the healthcare bill President Obama signed into law is going to help her anytime soon. The thing is, if Virginia Attorney General Ken Cuccinelli has his way, the government of the United States will never help her.


  1. What reason(s) did dentists give Lakeisa for refusing to take her?

  2. Hey, David, Lakeisa got a variety of different responses. They weren't taking new patients, or they wouldn't take an emergency case from someone who wasn't a regular patient. She reported to me that some offices seemed uninterested in helping as soon as they found out she didn't have insurance. Some of this is her interpretation based on impressions, not actual statements. "We're not taking new patient," may not be true; it may be that they just didn't want someone whom they thought would not be a reliable payer. Who knows?

    It would take a lot more healthcare reform, of course, before Lakeisa would be able to obtain regular health and dental care that would prevent problems like hers, care that would include regular check ups and x-rays. Nothing in the reform package or likely to develop any time soon would address problems structural problems like regular increases in the cost of basic care, and too few doctors and dentists.

    On the latter problem, Dean Baker and the Center for Economic and Policy Review have a lot more to say, for example, a piece on the way trade and immigration barriers drive up the cost of healthcare (and restrict the supply of doctors and dentists) at

  3. I spoke to Lakeisa again yesterday. Her face was swollen and she's still in pain, but she was happy to report she has an appointment with a dentist this morning. They will examine her and take x-rays, then quote her a price on what they think she needs.

    In the meantime, she's been rinsing repeatedly with hydrogen peroxide and warm salt water. The rinses help.

  4. One way to see if what Lakeisa was told was true or not is to do what we do at the Fair Housing Center -- test. Lakeisa calls and is told, "Sorry, we're not taking new patients." If you, a white man with insurance, call with the same complaint -- you have an impacted tooth that needs immediate care -- but you're told to come right in, then you've got evidence of discrimination. Frankly, if Lakeisa still knows who she called, it's not too late to do testing.

  5. You Fair Housing Center guys, always wanting to tell a story based on actual evidence. But, yes, it would be worthwhile to develop real proof of that kind of discrimination, I'm just not the one to do it. You know, at Jim M.s urging, I contacted a fair housing group in Chicago to try out working as a tester. They sent me to a rental housing complex near Michael Reese Hospital. After my visit, I wrote up a report on the way I was treated. I thought it would be a snap to get it right, but they kept having me revise it, trying to squeeze my opinionated voice out of the report. Eventually, they gave up and didn't ask me to do it again.