Conversations About Health Care

Everybody’s talking about health care. But it’s not because of the incompetent ideological circus playing in Congress. That offers a fascinating look into the Republican soul, but few of my conversations about health care mention politics. Talk about health care is mostly about the health of my family, my friends, and my friends’ families, and the care they need.

As a healthy youngster, my input to health care discussions at home was usually, “I’m fine.” I probably said that to my mother while I was soaking in a tub full of hot water after playing touch football. She didn’t believe me, so I got on the operating table soon enough to stop the bleeding from my ruptured spleen.

In college, I remember a lot of conversations about whether we should do something that was obviously bad for our health. I leaned toward caution, not popular then, but looking better in retrospect.

Then my parents and my friends’ parents got old. Then we got old. Now most conversations with friends and family begin right after “hello” with talk about health care. “How are you?” is not a meaningless greeting, it’s an earnest question.

There’s no cure for old age, and I don’t care. I do care about how many people close to me are dealing with forgetfulness, blood tests, pain, and walkers; with health problems of mothers and fathers and ourselves; with nurses, doctors, hospitals, and insurance companies.

Longer-lived women are taking care of men who are sinking, along with many but fewer cases the other way around. Baby boomers like me turn into caregivers, managing doctors’ visits and prescription drugs, making nursing homes a second home.

Times have changed, too. The earnest TV commercials for cough medicine, and aspirin and “Preparation H” have turned into ubiquitous ads for medicines that might make you sick or kill you; for lawyers who will sue your doctor; for hospitals that will treat you, and insurance companies that might pay them.

It’s hard not to think constantly about health. Those thoughts can be difficult, sad, perplexing, and inconclusive. Joys are recovery from illness, the kindness of health care professionals, health scares that are false alarms. The sad stuff can last a long time, changing into something different but permanent at the end.

And we talk about money. It costs money to live and maybe more to die. Whose money will pay for the health care of people I love? That’s not the first thing we talk about. It’s not the most important thing most of the time. But it’s one of the most perplexing.

When I get a bill from a doctor, I have no idea who is going to pay what. Will Medicare pick up the tab? Will my insurance company pitch in and for how much? What will I pay at the end? How much of my deductible have I used up?

Should I get long-term care insurance? Or should I have gotten it 10 years ago? Should I save money on insurance premiums by taking a high deductible? Or is that a risky bet?

Nobody can take away such worries. Ignorance doesn’t help, either from those who shouted “Keep your government hands off my Medicare,” or from our President, who says he doesn’t care what happens to the rest of us, now that he didn’t get his way.

I believe that we have a right to get help with our health care from our government. We all need that help, every day, to prevent con artists from lying to us about miracle cures, to prevent the pharmaceutical industry from selling untested drugs, to prevent insurance companies from kicking the sickest off their rolls, to sponsor research which can save lives.

Our government got into the health care business to save lives, and it has been doing that, more or less successfully, for nearly two centuries. In my home town, Jacksonville, the state of Illinois long ago created institutions to care for people with health problems: a school for the deaf in 1839, a school for the blind in 1849, a hospital for the mentally ill in 1851.

Progressives around Teddy Roosevelt advocated for universal health coverage before World War I, at the same time that our government began to try to prevent disease by inspecting meat packing plants, and prohibiting adulterated drugs and false therapeutic claims.

The creators of our nation believed that “Life, Liberty and the pursuit of Happiness” were the most important universal rights to be protected by government. It’s not clear what led Thomas Jefferson to elevate the pursuit of happiness to an inalienable right. If that phrase means anything, it must include government participation in our efforts to stay healthy. How can anyone be happy who can’t pay for health care they need?

There’s no such thing as a right to good health. But as Americans, we have a right to get collective help, if we need it, to stay healthy. That means government protection from poisons in our food, air, and water (see Flint, Michigan), from false claims by drug producers, and from medical malpractice. In today’s world, it must also mean assistance in paying for medical treatment for those without resources.

So says the Declaration of Independence.

Steve Hochstadt

Springbrook, WI

Published in the Jacksonville Journal-Courier, July 25, 2017

The Republican Way of Governing

Lately I worry that our political system is threatened. One of the basic ideas of our democracy, pushed especially by conservatives, has been that Americans at the local level should be able to control local issues. Of course this idea has limits. Local school districts should not be allowed to discriminate on the basis of race, because the Constitution says that is illegal. State laws should not discriminate against women, because that is also illegal. But what about trying to deal with plastic shopping bags? Are communities allowed to require that local construction contracts include local workers?

Republican-dominated state legislatures have passed laws preventing communities from controlling these and many other issues as a way of preventing many policies they don’t like: adding gender identity to non-discrimination laws, setting higher minimum wages, restricting the height of cellphone towers. Later this month, a special session of the Texas legislature will consider proposals to block cities from regulating trees on private land and restricting cellphone use while driving. Iowa Republicans want to take away control from local water boards. Many states with Republican majorities are forbidding local control: Michigan, South Dakota, Ohio, New Hampshire, Idaho, and Arizona. The non-partisan Legislative Fiscal Bureau counted 128 measures recently passed by the Republican legislature in Wisconsin that restricted local control. Twenty-five states have passed laws preventing localities from raising their minimum wages.

Republican legislatures have backed up these so-called “preemption laws” with a big stick. If a local government in Arizona is found to have acted against the wishes of the legislature, it could lose all of its state aid. Many states now have laws which personally punish local legislators for not obeying preemption rules.

Both parties have long traditions of abusing our political system for partisan ends. Gerrymandering election districts by creative redrawing of boundaries is a key example of parties subverting democracy. Republicans have gone further than ever before in abusing their power to redraw boundaries based on their dominance in state legislatures. In Pennsylvania in 2012, Republicans lost the popular vote, but won 13 of 18 House seats. Wisconsin’s gerrymandered districts will be reviewed by the Supreme Court, which threw out North Carolina Republicans’ efforts to concentrate minority voters in the fewest number of districts.

The Senate filibuster is another undemocratic method by which a minority tries to rule. Again, both parties have used the filibuster to stifle the majority, but Republicans took this tactic to unprecedented extremes to try to prevent President Obama from nominating judges. Eventually Republicans threatened to filibuster every judicial nomination made by Obama.

In recent years, Republicans have so distorted our government structures that our democracy is threatened. Republican Senators refused to consider Obama’s Supreme Court nominee in 2016. North Carolina Republicans are trying to remove normal powers of their Governor, a Democrat. And now Republican legislatures are forbidding voters in Democratic cities from controlling their local politics.

When Senator Joe McCarthy tried to use hysterical fears of communism to attack all liberals, he was following a playbook used by both Democrats and Republicans. When Richard Nixon tried to corrupt our governmental structures to elect and then protect himself, I didn’t think his dishonesty was especially Republican. But the current “anything we can get away with” method of governing appears to have become standard Republican practice.

Our political system is not perfect. Changes in its structure are certainly worth discussing, such as doing something about the Electoral College. But structural changes should come out of debates about principles of good governance.

For all my life, conservatives have argued for local control, for example when they wanted to preserve segregated schools, as opposed to “big government”. Republicans constantly quote Thomas Jefferson: “Government closest to the people governs best.” Reagan did it in 1967. The Oklahoma Republican Party has those words on its website. Chapters of College Republicans use it as part of a “Republican Oath”. But when local government does something that Republicans don’t like, they forbid it.

Such principles appear to be merely window-dressing, designed to distract us from Republican partisan efforts to invalidate legitimate election results which favored Democrats. Republicans are twisting our Constitution to create the “permanent majority” that they can’t win at the ballot box.

What will Republicans do next? And will enough Americans care as our institutions are subverted from within?

Steve Hochstadt

Springbrook WI

Published in the Jacksonville Journal-Courier, July 18, 2017

Why Americans Voted for Trump

I have been reading about why so many Americans voted for Trump. Simple ignorance is a partial answer. Many Medicaid recipients who voted for Trump did not know that their benefits were due to the Democrats’ health care legislation that he vowed to repeal.

Some voters just believed Trump’s promises to help Americans who suffered economically, even though there was no evidence in his history or the history of the Republican Party that he actually help cared about them. Many former Obama voters who switched to Trump thought that Democrats were more likely to enact policies that favored the wealthy. Now that we can see what Trump and congressional Republicans want to do about taxes and health care, it’s clear how wrong they were.

But support for Trump is about more than ignorance or deluded hopes. An extensive analysis of white working-class voters, about one-third of Americans and a group who favored Trump by a 2-1 margin, shows their unhappiness with today’s America. About two-thirds of them believe “American culture and way of life has deteriorated since the 1950s.” That time frame coincides with the civil rights and women’s movements that have shifted power away from traditionally dominant white men. They express this idea by saying that the US is losing its identity, that immigrants threaten American culture. They believe that America’s best days are in the past. No wonder Trump’s slogan about making America great again had such resonance.

Perhaps related to this pessimism about their country is a tendency to favor authoritarian leaders. A remarkable 56% of white working-class evangelical Protestants were rated as “high authoritarian”, another explanation for supporting Trump. An earlier survey confirms the authoritarian tendencies of Trump voters. People who wanted to raise their children to be “respectful, obedient, well-behaved and well-mannered” were much more likely to be Trump voters than those who wanted children to be “independent, self-reliant, considerate and curious”.

Although the views of the white working class are often labeled racist, I think this misses the mark. About half of them believe that discrimination against whites is as bad as discrimination against minorities, with older people even more sure of this idea. Nearly half of white working-class seniors believe that Christians face a lot of discrimination. This is nonsense, as shown by every study which actually compares treatment of white versus black. But it has this kernel of truth – black Americans and non-Christians have more power than they did in the 1950s. This may be the source of white belief that America has lost its identity and American culture has deteriorated.

A survey taken more than a year ago during the primaries already showed these characteristics of Trump voters: nearly all of them agreed that “my beliefs and values are under attack in America”. The label of “values voters” for white evangelicals was perhaps never accurate. Their votes for Trump, whose personal life represents a rejection of these values, show they are better named “nostalgia voters”, whose vision of a white-male-dominated America no longer represents reality.

A more complex comparison of presidential votes and moral beliefs shows that Trump voters were likely to be motivated by ideas of group loyalty, respect for authority, male dominance, and traditional social norms than by compassion for those who are suffering and desire for equal justice.

The other side of Trump supporters’ worries about fading white male power is their disparaging attitude about people different from them. The calls at his rallies to lock up Hillary Clinton and attack journalists, the desire to deport millions of immigrants, the anger at the legalization of gay marriage are signs of a meanness of spirit that Trump himself exemplifies.

Here is a local example of meanness. Catholic Bishop Thomas Paprocki in Springfield issued a “Same Sex Marriage” decree in June: people in same-sex marriages may not participate in communion or receive a Catholic funeral. Paprocki’s decree does not punish adulterers, thieves, liars, or those who disobey their parents. His isolation of gay couples is political malice, unique among American bishops. Bishop Patrick McGrath of San Jose explicitly rejected Paprocki’s nasty version of religious intolerance.

It is possible to value self-reliance and hard work without trying to cut food stamp aid to poor families. One can believe in the virtue of raising oneself out of poverty without trying to cut Medicaid for poor people in bad health. Taking a hard line on punishing criminals does not require assuming that all immigrants are law-breakers. We can deplore terrorists without discriminating against Muslims.

Too many Trump supporters take their beliefs in what is right as license to be hateful toward people who are not like them. Combine that with nostalgia for a time when blacks had to defer to whites, men could grope women, and gays stayed in the closet, and you have a Republican Party which cuts health insurance for millions of Americans, which keeps foreign students from returning to their American universities, which cuts federal programs for Americans in need. So far these attempts have failed, but Trump and his allies show no signs of letting up.

That’s what I call mean.

Steve Hochstadt

Springbrook, WI

Published in the Jacksonville Journal-Courier, July 11, 2017

Gay Equality is Coming Quickly

Usually public opinion on important and emotional subjects shifts gradually. The realization that discrimination against African Americans and women was wrong came very slowly. For more than a century, Americans spoke out against sexism and racism. In the 19^th century, they were considered radicals, advocating unpopular political positions against traditional beliefs in white male superiority. By the 20^th century, opinion in America was split and some discriminatory laws were changed, but common practices based in prejudice persisted.

Only after World War II did majority public opinion shift away from entrenched discrimination, but even then progress was halting. The two Supreme Court decisions that declared school segregation (1954) and laws against mixed-race marriages (1967) unconstitutional were 13 years apart, and they were just way stations along a much longer journey toward equality. In both cases, defenders of discrimination used religious arguments to oppose equal treatment for blacks and women, citing Biblical verses written thousands of years ago to claim that God had declared the superiority of white men for all time.

Change comes more quickly in modern society, as we can see in the technological innovations which replace each other with bewildering rapidity. In 1999, Ray Kurzweil proposed the “The Law of Accelerating Returns”; he believed that change in a wide variety of evolutionary systems, including technology, would come with accelerated speed. We might see this “law” operating in the third great shift in public opinion about traditional discriminatory practices, the acceptance of homosexual people as normal and deserving of equal rights.

Data from the Pew Research Center shows a dramatic recent shift in American public opinion on same-sex marriage, which may be taken as an indicator of more general attitudes about homosexuality. After years of relative stability, in the last 8 years the proportion of Americans who oppose gay marriage dropped from 54% to 32%, as the number who favor it rose from 37% to 62%. That same amount of opinion shift on inter-racial marriage took about twice as long.

The popular shift has been rapid, but not smooth. After Massachusetts became the first state to legalize same-sex marriage in 2003, 12 states passed constitutional amendments outlawing it in the next year alone, and eventually 30 states passed such backlash legislation. The Supreme Court decision in 2015 that rights guaranteed by the Constitution to all citizens included the right to get married came four years after support for same-sex marriage reached majority status.

Like many shifts in social attitudes, this was led by young people. The latest Pew survey shows 18- to 29-year-olds against discrimination by 79% to 19%, while Americans over 72 remain opposed to this change by 49% to 41%. But every demographic group, whatever their attitudes were a few years ago, has shifted towards acceptance. Opposition remains concentrated among white evangelical Protestants, conservative Republicans, and the oldest Americans, groups which considerably overlap. Those who demonize their neighbors who have a different sexual orientation continue to use arguments derived from Christian tradition as justification.

What caused this rapid shift in public opinion? When Pew asked why people had changed their minds, the most common answer was that they knew someone who is homosexual. Visibility has been a significant factor in the increasing acceptance of gays in America. While race and gender are usually obvious, homosexuality was not.

I grew up in an America where homosexuality was queer, meaning strange and unnatural. It was dangerous for a gay person to reveal their orientation, which could cost them their jobs. Homosexual relations were criminal across the country, until Illinois was the first state to decriminalize same-sex relations in 1962. So I didn’t know any homosexuals. I, like most Americans, had no evidence from life experience that gay people were not as they were portrayed in medical practice (sick), in official propaganda (dangerous), and in common talk (weird).

Over the course of 30 years, the proportion of Americans who said that someone they knew revealed to them that they were gay rose from 24% in 1985 to 75% in 2013. Since it is unlikely that the incidence of homosexuality has changed significantly, what did change was the realization that there are gay people in everyone’s social circle.

The end of discrimination against homosexuality is determined by changing public opinion and political practice, which differ from country to country. Germany, in many ways more officially opposed to discrimination of all kinds than the US, just legalized gay marriage last week. A recent poll showed that 83% of Germans approved of same-sex marriage, much higher than in the US. But the politics of the conservative party, the Christian Democrats, who have led the government since 2005, prevented any vote on the issue until now.

Bigots will keep using religion as a cover for prejudice, as in the so-called religious freedom laws. But the shift toward acceptance of homosexuality will continue, as older opponents are replaced by younger advocates. Because our gay relatives and friends do not fit the prejudicial stereotypes, discriminatory impulses will lose their persuasive power.

Happy birthday, America.

Steve Hochstadt

Springbrook, WI

Published in the Jacksonville Journal-Courier, July 4, 2017