Paranoia is a Pre-Existing Condition (Updated)
Fact #1: I am self-employed American.
Fact #2: I have a severe, chronic medical problem.
These two facts don't mix nicely.
As a self-employed worker, I don't receive the benefits that usually accrue to salaried professionals doing similar work: employer-contribution 401K; paid vacations; and, in particular, employer-provided health insurance. I knew going in that this would be the case and decided that the other, non-material benefits of working for myself outweighed the material drawbacks. For the most part, I can provide the equivalent benefits to myself -- a retirement savings account and money set aside for vacation time.
But not health insurance.
I bring this up not to elicit suggestions or sympathy, but to identify myself as someone with a personal stake in the current health insurance reform process underway in the United States -- and someone who would clearly benefit from that reform's success. I'm following the debates closely, and am thoroughly depressed by what's been going on (which probably qualifies as another pre-existing condition). Opponents of reform have successfully triggered a level of political and social paranoia in a significant subset of the American public that hasn't been seen in years, possibly decades.
Two friends of mine living outside the US -- one an American ex-pat, the other a UK citizen -- both wrote lengthy and smart pieces about the American health insurance reform debate. Their arguments sum up my feelings very nicely, and I want to encourage you to read them both.
Adam Greenfield offers "On Systems, and What They Do," examining the healthcare and insurance process in the US from a systems-thinking perspective, and uses it as a jumping off point to talk about how we make data-driven decisions -- and how easily they can be disrupted.
The collectivites arrayed against the “Obamacare” bogeyman construct the body politic as a zero- or even a negative-sum game. They’ve identified a loophole, a vulnerability in the operating system of American democracy for which as yet there’s no patch. And because their victory conditions don’t require the affirmative production of a workable solution, the challenge before them is much (infinitely!) easier: all they have to do is drive a wedge through that vulnerability and they’ve won. The foreshortened, truncated, mutilated human lives that will result are collateral damage, an acceptable side effect. And the damage to the health and functioning of the republic? That’s a feature, baby.
Charlie Stross, in "Merciless," looks at the US healthcare debate by asking the question, what happened to mercy? It's a quality that seems sorely lacking the US today, and this fact is excruciatingly visible in the arguments around healthcare.
The subjects vary — crime and penal policy, healthcare, don't get me started on foreign policy — but there is an ideological approach in America that is distinguished by one common characteristic: words and deeds utterly lacking in the quality of mercy.
There is a cancer in the collective American soul — a mercy deficit that has in recent years grown as alarmingly as the budget deficit. Nor is it as simple as a left/right thing: no political party has a monopoly on merciless behaviour. Rather, a creeping draconian absolutism has cast its penumbra across the entire arena of public discourse, tainting every debate, poisoning and hardening attitudes across the board.
Calls for revenge on a sick and dying man are part and parcel of the pathology, as are shrieks of outrage against the mere idea of subsidizing healthcare for the indigent or unlucky, or rough talk about "every now and again ... pick[ing] up a crappy little country and throwing it against the wall just to prove we are serious".
It's sad, and frustrating, and shameful. And, for me, it's not theoretical. As I watch this debate happen, I am ever-conscious that when politicians and pundits talk about the mass of people without insurance, they're talking about where I could be in a few months.
I have options; I'm "lucky." I could give up being self-employed and try to find a full-time job, with benefits (emphasis on the try: this is difficult for someone with an eclectic background in good times, but would be near-impossible right now). I could push my wife to leave school and have her try to get a job with benefits. But to the extent that entrepreneurialism and self-improvement through education are supposed to be core to the American ideal, it's more than a little frustrating to have to set them aside simply to be able to continue to walk.
[*UPDATE: I'll be in less trouble than I feared, as I should be able to get a HIPAA policy. It's a grim prospect, though: the rate will be about double what I was paying under COBRA (where I'm paying both employee and employer costs for insurance), and the rules are such that, once I get a HIPAA policy, I can never change it, even if rates go up.]