Street art by Farid Rueda
Street art by Farid Rueda
BLU in Colonia, Germania
Photo Credit: Shutterstock.com
When senators Bernie Sanders and Ted Cruz debated the merits of the Affordable Care Act of 2010, aka Obamacare, on February 7, Sanders had a dire prediction: “We are moving into an era where millions of people who develop terrible illnesses will not be able to get insurance, and God only knows how many of them will die.” The Vermont senator, who favors a single payer or “Medicare for all” system, was right to be concerned. It remains to be seen when or how Republicans in the U.S. Senate and the House of Representatives will repeal the ACA; Sen. Rand Paul has been complaining that repeal is taking much too long and that fellow Republicans don’t appear to be in a hurry to repeal it. But the Urban Institute estimates that if and when Republicans do repeal the ACA, “The number of uninsured people would rise from 28.9 million to 58.7 million in 2019, an increase of 29.8 million people”—and Sanders has predicted that “36,000 people will die yearly as a result.”
Sanders is not exaggerating about the potential death toll; if anything, he is being optimistic. In 2009, a pre-ACA Harvard Medical School/Cambridge Health Alliance study found that almost 45,000 Americans were dying annually due to lack of health insurance. Shortcomings and all, the ACA—according to Gallup—has reduced the number of uninsured Americans aged 18-64 from 18% in 2013 to 11.9% in late 2015. And that includes millions of Americans with pre-existing conditions such as diabetes, heart disease and asthma. The ACA has not only made it illegal for insurance companies to exclude people due to pre-existing conditions, but it has also emphasized preventive care and screenings, which can prevent chronic conditions from developing or at least treat them after a diagnosis. Without those protections, it stands to reason that diabetes, heart disease, cancer and other potentially life-threatening illnesses will be on the rise.
Here are several diseases that are likely to increase or have much worse outcomes if Republicans succeed in abolishing Obamacare and render millions of Americans uninsured.
According to the American Diabetes Association, 30 million Americans suffer from diabetes, while another 86 million have prediabetes. For those 116 million Americans, access to health care is crucial; diabetes, if not managed and controlled, can lead to everything from amputations to heart disease, stroke and blindness. And when prediabetes is managed, patients have a much better chance of avoiding full-blown diabetes. Bearing those things in mind, the American Diabetes Association sent members of Congress a letter in December warning them how dire the consequences could be for Americans with diabetes or prediabetes if the ACA is repealed without a suitable replacement.
“The ACA,” the American Diabetes Association told Congress in the letter, “ended fundamental inequities in access to adequate and affordable health insurance that separated Americans with diabetes from the tools they needed in the fight against the horrific and costly complications of diabetes, including blindness, amputation, kidney failure, heart disease, stroke and death. Repealing the ACA will create huge access barriers for millions of Americans, especially if no fully defined replacement is put in place immediately to meet the health care needs of individuals with chronic health conditions like diabetes.”
In 2016, medical researchers Rebecca Myerson and Neda Laiteerapong examined the ACA’s possible effects on diagnosis and treatment of Type 2 diabetes. The physicians found that 23% of American adults, aged 18-64, with diabetes lacked health insurance in 2009/2010, but said it was “likely that a significant fraction became insured in the subsequent years due to ACA provisions.”
Jennifer Kates, director of HIV policy for the Kaiser Family Foundation, has described the ACA as a “watershed moment” for Americans living with HIV, and the Centers for Disease Control called it “one of the most important pieces of legislation in the fight against HIV/AIDS in our history.” Kaiser research has indicated that 200,000 HIV-positive Americans may have gained coverage through the ACA, and according to the AIDS Foundation of Chicago, the ACA brought insurance to 12,000 HIV-positive Illinois residents.
With HIV treatment, one of the goals is avoiding full-blown AIDS. In a recent article for The Advocate, Carl Schmid, deputy executive director of the AIDS Institute, warned that ACA repeal could be devastating for Americans living with HIV and that access to treatment can be a matter of survival.
“If Congress repeals the ACA without simultaneously replacing it with programs that ensure comprehensive health coverage for the same, if not more, individuals, the private insurance market will become unstable—and people with HIV and others would lose access to the care and treatment that they rely on to remain healthy,” Schmid said. “People with HIV, who depend on a daily drug regimen, cannot risk losing access to their health coverage—not even for a single day… We cannot afford to go backwards by eliminating or destabilizing the health care that the ACA provides.”
In January, Gregory Cooper and his colleagues at University Hospitals’ Cleveland Medical Center in Ohio released a study that compared access to cancer screenings before and after the ACA, which they found was making it easier to obtain mammograms but needed to do more to encourage colonoscopies. Cooper, reflecting on GOP plans to repeal the ACA, stressed that the U.S. needs more cancer screening, not less, saying, “If you take away people’s health insurance and they’re going to pay out of pocket for health care, are they going to get a mammogram, or are they going to buy food? People are going to do what gives them the best benefit in the short term, which is food and shelter.”
Amino, Inc., researching 129 insurance companies, has offered some estimates on possible out-of-pocket costs for cancer screening in a post-ACA environment; in Alaska, for example, the costs could be almost $500 for a routine mammogram or $2,565 for a colonoscopy. And as Cooper pointed out, Americans will put off or avoid potentially life-saving tests when they become cost-prohibitive.
4. Blood Pressure and Hypertension
In 2015, researchers at George Washington University School of Public Health released a study on the effect the ACA was having on hypertension, a major factor in heart disease and stroke. The researchers reported that 78 million Americans suffer from hypertension and that “lack of insurance coverage is a critical barrier to better treatment of hypertension,” and they predicted that if ACA expansion continued, it “would lead to a 5.1% increase in the treatment rate among hypertensive patients.”
5. High Cholesterol
In 2015, the Harvard T.H. Chan School of Public Health published a study that linked the ACA with better outcomes for three conditions: diabetes, high cholesterol and high blood pressure. The study found that uninsured people suffering from any of those conditions were much less likely to find out they had a problem, whereas insured people had a 14% greater chance of finding out if they had diabetes or high cholesterol and a 9% greater chance of finding out they had high blood pressure. And for those who those who were diagnosed, the Chan School found, being insured greatly improved one’s chances of controlling blood sugar, total cholesterol or systolic blood pressure.
Joshua Saloman, a senior author of the study, said, “These effects constitute a major positive outcome from the ACA. Our study suggests that insurance expansion is likely to have a large and meaningful effect on diagnosis and management of some of the most chronic illnesses affecting the U.S. population.”
But instead of insurance expansion, Republicans could significantly reduce coverage. Even John Kasich, right-wing governor of Ohio and one of the many Republicans who lost to Donald Trump in the 2016 GOP presidential primary, sounded a lot like a Democrat when he said that while there is “room for improvement” with the ACA, he was worried about what would happen to “these people who have very high cholesterol” if it is repealed without a solid replacement.
Before the ACA, the term “pre-existing condition” as defined by health insurance companies was far-reaching; anything from multiple scleroses to kidney disease to anemia was grounds for rejecting an application for coverage. For people with asthma, obtaining health insurance was difficult or impossible. 17.7 million adults, according to the Centers for Disease Control, suffer from asthma in the U.S., and when asthma is not treated or controlled, it can become life-threatening (in 2014, CDC attributed more than 3600 deaths annually in the U.S. to asthma).
In 2013, a Harvard Medical School study cited lack of health insurance as the main reason asthma care for young adults deteriorated when they turned 18; emergency room visits became more frequent, and medications often became cost-prohibitive. But with the ACA’s implementation, young asthmatics could stay on their parents’ health plans until 26—and asthmatics, regardless of age, could not legally be refused coverage because of their condition. With full ACA repeal, however, it could once again become legal for insurance companies to deny coverage to asthmatics. And even partial ACA repeal could make asthma care cost-prohibitive.
While ACA repeal is likely, it remains to be seen what, if anything, Republicans would replace it with. Rep. Steve King has made it clear he couldn’t care less if the ACA is repealed without a replacement. However, Rep. Tom Price, President Trump’s nominee for secretary of the U.S. Health and Human Services Department, has proposed replacing it with a plan that would eliminate Medicaid expansion, thus making coverage more expensive for Americans with preexisting conditions. And President Trump has promised that after the ACA, Americans can look forward to more comprehensive coverage at much lower prices. But it’s an empty promise because he has yet to offer any specifics.
In other words, Republican plans for an ACA alternative range from terrible to woefully inadequate to nonexistent. To make matters worse, Rep. Paul Ryan is still pushing for Medicare privatization, meaning that Americans who suffer from ACA repeal could be facing additional hardships if they live to see 65. With Republicans going out of their way to make access to health care difficult or impossible for millions of Americans, the future looks grim for anyone suffering from cancer, HIV, hypertension or other potentially deadly illness.
Street art by Farid Rueda.
Street art, Shangaï by Millo
Bristol Street Art
SATURDAY, FEB 18, 2017 09:00 AM PST
One way to understand what we are witnessing, amid the national humiliation of Donald Trump’s presidency, is to see it as the total collapse of conservative ideology. That might seem like a strange claim in a year when the far right seems ascendant throughout the Western world, and when the Republican Party nominally controls the White House and both houses of Congress for the first time in a decade. But I think it’s accurate, and all the breathless Ayn Rand fanfics hidden away in the hard drive of Paul Ryan’s Windows Vista PC don’t make it less so. (It does not follow, by the way, that “liberal” ideology is in such great shape either, and the two phenomena are not unconnected. Topic for another time!)
As a political force, American conservative movement has been morally and philosophically bankrupt for decades, which is one of the big reasons we are where we are right now. Largely in the interest of preserving their own power and empowering a massive money-grab by the class they represent, Republicans have cobbled together cynical coalitions by trying to appease multiple constituencies with competing and often contradictory interests: Libertarians, the Christian right, the post-industrial white working class, finance capital and the billionaire caste. Those groups have literally nothing in common beyond a shared antipathy for … well, for something that cannot be precisely defined. They don’t like the idea of post-1960s Volvo-driving, latte-drinking liberal bicoastal cosmopolitanism, that much is for sure. But the specific things they hate about it are not the same, and the goals they seek are mutually incompatible and largely unachievable.
But behind that political devolution lies the ideological implosion that’s been coming a long time, longer than I can possibly summarize here. It’s safe to say that Edmund Burke and Alexander Hamilton, two 18th-century titans the modern conservative movement likes to cite as forebears, would be horrified by the limited, narrow-minded and intellectually inflexible nature of so-called conservative thought in the 21st century. How those guys would make sense of the fact that supposedly intelligent people who claim to share their lineage have hitched their wagons to the idiocy, mendacity and delusional thinking of the would-be autocrat in the White House — an implausible caricature of the stupefied mob democracy Burke and Hamilton hated and feared — I can’t begin to imagine.
Even so, the final stages of the collapse have arrived with startling suddenness. Just a few decades ago, William F. Buckley successfully appointed himself as the intellectual standard-bearer of the American right, in large part by purging overt white supremacists and conspiracy-minded ultra-nationalists from the mainstream conservative movement. Buckley was a slippery and devious character, and despite his command of classical languages and all that, was more like a guy who plays a first-rate intellect on TV than the real thing. Arguably his decision to drive the troglodytes from the temple was more a matter of political strategy than moral principle (although I believe he was genuinely ashamed of his early embrace of segregation).
In any event, racism, anti-Semitism, xenophobia and other forms of paranoid thought were never absent from American conservatism — as in the “Southern strategy” that got Richard Nixon elected in 1968, and made a big comeback during the great renaissance of the Reagan revolution. Those who expressed such views were expected to keep it clean, so to speak, and to observe rhetorical limits. Ben Carson and Clarence Thomas were welcomed at the country club; Klansmen and neo-Nazis and guys who handed out homemade brochures set in 8-point type about the Bilderberg Group were exiled to the strip mall. Immigration, always the great rift in conservative politics, was politely and pointedly ignored, like the ripping fart laid by the bank president’s wife at her garden party.
It couldn’t last, and it didn’t: The grand bargain the Republican elite thought it had struck with the loonier fringes of the lumpenproletariat came undone in spectacular fashion in 2016. Donald Trump and his pitchfork brigade stormed the country club, chugged all the Pinot Grigio straight from the bottle and then barfed it up on the imitation Persian carpets. Blowhard bigot Steve Bannon is running strategy for the White House, while his crony Stephen Miller — variously compared by late-night TV hosts to “Sméagol in a suit” or a younger Montgomery Burns — dispenses outrageous lies on the president’s behalf.
What’s left of the conservative intelligentsia is either whimpering in the corner alongside New York Times columnist David Brooks or groveling before its new overlords and swearing eternal fealty. Either way, it’s pathetic. Buckley may have been an erudite con artist to a large extent, but he had a coherent worldview, avoided telling outright falsehoods and would genially have agreed that there were some good things about the Enlightenment, and perhaps even about postwar American culture. It’s a long slippery ride downhill from him to this dude, the leading intellectual apologist for the Trumpian counterrevolution.
This is insane. [“This” being continued immigration by “Third World foreigners.”] This is the mark of a party, a society, a country, a people, a civilization that wants to die. Trump, alone among candidates for high office in this or in the last seven (at least) cycles, has stood up to say: I want to live. I want my party to live. I want my country to live. I want my people to live. I want to end the insanity.
I don’t know about you, but when I encounter someone with an expensive education who ought to know better using the term “my people” with no clear point of reference — he does not mean, say, the general population of the United States — I can almost hear the singing and see the flickering torchlight. As Molly Ivins once observed about a famous 1992 speech by Pat Buchanan (which I witnessed live, from the floor of the Republican convention in Houston), that probably read better in the original German.
That’s the climactic passage from “The Flight 93 Election,” a now-infamous viral essay by Michael Anton, a onetime George W. Bush speechwriter who has more recently been hired as a policy aide by Trump’s National Security Council. Anton published it in September under the pseudonym Publius Decius Mus, a reference so obscure and self-aggrandizing that even Buckley would have found it unbelievably pompous. (The historical Decius was a Roman consul who supposedly sacrificed himself for his troops — and, of course, for the empire.)
Several things strike me about the “Flight 93” essay, the first of them being its sheer propagandistic balls-out bogosity. Anton is a compelling prose stylist in a distinctively contemporary vein: He can turn a phrase and establish a rhythm, is not averse to pop-culture references and Internet-speak, and can deploy big words without getting in over his head. But his arguments are based in shameless Trumpian bullshit; I may be kidding myself, but I don’t believe Buckley would ever have descended to such a torrent of lies. In Anton’s imaginary universe of September 2016, crime was “way, way up” and “rising fast,” the economy was in ruins, Hillary wanted to admit “a million more Syrians” and America was about to be swamped in “a tsunami of leftism” that would unleash “vindictive persecution against resistance and dissent.”
None of that is remotely related to reality, and Anton certainly knows it. What is startling for a leftist reader is the fact that roughly one-third of Anton’s arguments correspond closely to those of, say, Bernie Sanders, as when he excoriates “the sophists of the Davoisie oligarchy” (i.e., the neoliberals) who rationalize “lower wages, outsourcing, de-industrialization, and endless, pointless, winless war.”
On the other hand, like nearly all right-wingers Anton has an enormous blind spot that prevents him from perceiving any difference between mainstream liberalism and “the left.” It’s almost hilarious to envision a world in which Hillary Clinton, of all people — the most conservative and most nationalistic Democratic presidential nominee since approximately forever (since Al Smith? Since Woodrow Wilson?) — could be successfully depicted as a socialist-feminist dictator in waiting. Since that world was our actual world last fall, it isn’t funny at all.
Or maybe he’s just pretending to think that Clinton was Trotsky in a pantsuit. Anton is no neocon, but he speaks and understands the neocon code. As a former Bush administration employee he is almost certainly an apostate to the neocon worldview, which is internationalist and imperialist, enthusiastic about free trade and agnostic on immigration, and eager to minimize religious and racial conflict. (If you haven’t noticed those are all things about recent conservatism that the Trump movement forcefully rejects.) One could plausibly say that it is the remnants of the neocon old guard, like John McCain, Lindsey Graham and their allies in the CIA, who are fighting a last-ditch counterinsurgency against the Trumpian takeover of conservatism.
I would speculate that Anton’s Göbbels-scale lies about virtually everything, although their substance is borrowed from Trump and Bannon, have their ideological roots in the neo-Platonist scare-gospel of Leo Strauss. That legendary University of Chicago political philosopher taught generations of young neocons that selling falsehoods to a gullible public in service to a noble cause is not merely defensible but necessary.
Anton’s gullible public, however, is his fellow conservative intellectuals. He is trying to convince them that their cause is lost and it’s time to try something new. Like most liars, salesmen and writers, he gets carried away by the force of his own rhetoric and reveals more than he means to. The gist of “The Flight 93 Election” is only partly that America faces an invasion of transgender P.C. Islamic terrorism and, like him or not, Donald Trump represents our last chance to eat non-Sharia, non-Communist apple pie without kale mixed into it and chai poured on top of it. Anton himself admits that conservatives say that every four years, and it’s never quite true.
His real point is that conservatism has failed — that the entire 200-odd-year tradition of strategic counterattack against revolution that began with Burke, and was designed to preserve as much power and privilege as possible and carve out a middle way between too much autocracy and too much democracy, has arrived at a dead end. Those on the right who accepted the pre-Trumpian status quo, even if they complained about it, Anton says, had “implicitly admitted that conservatism is wrong. Wrong philosophically, wrong on human nature, wrong on the nature of politics, and wrong in its policy prescriptions.”
Is he trolling his fellow so-called conservatives, or trolling himself? That passage feels to me like a mea culpa and an act of repentance. Anton’s solution to this impasse, needless to say, is not for conservatives to go back to first principles and recover the analytical, conciliatory and pragmatic spirit of Burke. He mocks the Burkean tradition once by name, and several times by implication, which is something like a priest denouncing the pope. Conservatism is wrong; Anton wants “his people” to live, and he sees that life made possible through in a unique revolutionary leader, an “alleged buffoon” who is “more prudent — more practically wise” than all those who opposed him. In other words, he wants conservatives to abandon their failed ideology and embrace a new one. That one has a name too, and many people on the American right were positively aching for it.