Health Care Politics Are Scary

I just got over a health scare. I don’t mean a big splinter under my fingernail or a stuffed nose. To me a health scare means believing that some serious bodily problem might ruin or end your life.

The “might” is important. It’s scary to be unsure if this bad health moment might have disastrous consequences. So much of health care recommended by doctors and practiced for ourselves by all of us is about probability.

Some things are certain. The doctor was certain I had ruptured my spleen playing football when I was 17 and certain that the internal bleeding had to be stopped right away. That was a health scare I didn’t know about until afterwards, when the surgeon told me, “You could have died.” He was just trying to cheer me up.

Lots of medical issues are more speculative. Doctors consider the probabilities that particular symptoms mean this specific disorder and that certain medical and pharmaceutical steps will help this patient. We the patients weigh our options, based on what we know and don’t know, using our own set of intuitive needs, beliefs, and probabilities.

My doctor helped me recover from this current scare by telling me, “Something else will probably kill you.” He and I both understood the value of frank talk about the future.

My scare was not at all about money. I knew I’d have to pay something for the visits and tests and more visits and tests. But I knew it would be affordable, because I have good health insurance. Like nearly everyone my age, Medicare is my primary insurer, the biggest health insurance organization in the US. Medicare is bureaucratic, but reliable. They will not go bankrupt, like my parents’ long-term care insurance provider did.

Medicare is incredibly cheap. In fact, coverage for hospital visits, so-called Part A, is free, with a deductible of about $1300 for each hospital stay. Not bad when the average hospital stay costs about $10,000. You only have to pay something per day if your hospital stay is longer than 60 days, meaning the total cost has probably gone well above $100,000. Medicare coverage for doctor visits, tests, and other services, so-called Part B, is not free – that costs about $1600 per year for anyone with an income under $85,000, that is, for most people. That’s cheap, too.

All my probabilities would change if I didn’t have good health insurance that I could count on until something else kills me. That puts me in the minority of Americans. Health problems become health crises for most Americans when they worry, “How are we going to pay for this?”

My doctors’ recommendations were based on careful scientific studies of tens of thousands of cases over many years. My political representatives’ recommendations about health care are based on self-interest and dogmatic political ideology, designed to misinform me and everyone else. The discussion of health care and health insurance in this country is worse than useless, it is often deliberately misleading. How can average Americans judge health probabilities when our politicians constantly threaten to upend our health insurance system?

Democratic politicians created an imperfect system which drastically reduced the probability that an American family would be uninsured. I think that’s great. Democratic politicians have been arguing for a long time over whether some version of “Medicare for all” would be even better for most Americans. We need that debate.

The Republican contribution to our national health discussion has been, “We will destroy that system and tell you about a much better system later.” If they really had developed another system, we would know about it by now.

Conservatives hated Medicare when Democrats created it in 1965. They have never stopped complaining about it and have never done anything to make it better. House Speaker Paul Ryan announced in December that Republicans wanted to cut spending on Medicare. A few months ago, the White House budget proposed cutting $554 billion from Medicare over the next 10 years. In June, the trustees of Medicare, who are mostly Republicans, like Treasury Secretary Steven Mnuchin, reported that Republican policies have hurt Medicare’s financial prospects.

Nobody knows what our President, Cabinet, or Republican majority in Congress will do about American health care tomorrow, next year, or any time in the future. That makes all of our health care probabilities worse by increasing the financial uncertainties of all Americans. Nothing they have done so far has made anyone’s health better. That is a national health scare.

I hope that something else kills me before any Republican health care plan goes into effect.

Steve Hochstadt

Jacksonville IL

Published in the Jacksonville Journal-Courier, July 24, 2018

Immigrants, Refugees and Racism

My father arrived in the US as a refugee in 1938. But he was the wrong kind, because he was a Jew. Although thousands of Jewish refugees from the Nazis were able to enter the US, official US policy did not welcome them. The State Department put so many barriers in the way of Jews trying to escape from Nazi Germany that the official yearly quota of immigrants from Germany was not filled from 1933 to 1938. That quota itself was part of the long American history of distinguishing between “good” and “bad” immigrants based on race.

There were no immigration restrictions in the new American republic, but only the good kind of people could become citizens – white people. Slaves were excluded from citizenship by the Constitution. In 1790, Congress restricted new citizenship to “any Alien being a free white person”.

Blacks who were already free were barred from entering the Southern slave states. Whites in Illinois, like many northern states, did not want African Americans either, so they not only denied the citizenship rights to blacks already in Illinois, but also discouraged slaveowners from freeing their slaves in Illinois.

A new kind of bad people began to pour into the US in the 1840s, 2 million Irish fleeing the famine. About the same number of Germans immigrated to America in the middle of 19^th century, but the Germans were mostly good Protestants and the Irish were bad Catholics. A popular movement developed to fight off the Irish hordes under the banner of patriotism. In 1849, a secret society of Protestant men in New York called the Order of the Star Spangled Banner sought to recreate an America of “Temperance, Liberty and Protestantism”. They grew into the American Party, often called the “Know Nothings”.

In 1857, the Supreme Court pronounced what it hoped was a definitive statement about bad immigrants in the Dred Scott case: descendants of slaves brought to the US could never become citizens, because black people were “so far inferior, that they had no rights which the white man was bound to respect.” That ruling lasted only until Lincoln promulgated the Emancipation Proclamation in 1863 and the states passed the 14^th amendment exactly 150 years ago.

Almost immediately another dangerous foreigner threatened white America, Chinese laborers imported to construct the transcontinental railroad in the West. California laws prevented Chinese immigrants from becoming citizens, and popular sentiment was whipped up against the Chinese by labeling them sexual predators taking jobs away from white Americans. Congress in 1882 passed the first immigration act targeting a particular ethnic group, the Chinese Exclusion Act prohibiting all immigration of Chinese laborers.

Racist immigration restrictions are typically fearful reactions to changes in actual immigration. At the end of the 19^th century, floods of immigrants from southern and eastern Europe, including millions of Jews, brought a backlash of demands to stop such bad immigrants. Congress eventually responded in 1917 with an “Asiatic Barred Zone” which excluded all Asians, except for Japanese and residents of the US colony of the Philippines. In 1924, a more comprehensive quota system favored good immigrants from western and northern Europe; not-so-good immigrants from southern and eastern Europe were limited, and all Asians were barred. The quotas were designed so that 86% of immigrants came from northwestern Europe and Scandinavia.

The Immigration Act of 1924 remained in force through World War II, although extralegal restrictions had to be employed to prevent too many Jews from Germany from entering the US. This and the entire history of immigration restrictions accurately represented American public opinion, at least among the white majority, where racist stereotypes of dangerous non-white foreigners mixed with fears of job competition. A Gallup poll in November 1938, two weeks after the Nazis destroyed Jewish synagogues, businesses and homes, and sent 30,000 Jews to concentration camps during Kristallnacht, asked Americans: “Should we allow a larger number of Jewish exiles from Germany to come to the United States to live?” 72% said, “No.”

The human disasters of World War II, including but not limited to the Holocaust, changed American opinion about refugees. Jewish refugees were admitted in increasing numbers after 1945, and the Immigration and Nationality Act of 1965 abolished nationality quotas. For the first time in our history, American laws reflected the sentiments inscribed on the Statue of Liberty: “Give me your tired, your poor, Your huddled masses yearning to breathe free”. Congress overwhelmingly passed the bipartisan Refugee Act of 1980, declaring the “historic policy of the United States to respond to the urgent needs of persons subject to persecution in their homelands.” Since then the US has taken in 3 out of every 4 refugees resettled across the world.

Donald Trump began his campaign by insulting Mexicans and promising to ban Muslims. He is leading the reversal of American openness and a return to our earlier racially-based immigration. Although we still accepted more refugees than any other country in 2017, for the first time we accepted less than the rest of the world. Canada, Australia, and Norway accepted more than five times as many refugees per capita as the US.

The pulling apart of asylum-seeking families is only the most inhumane aspect of this repudiation of what has made America great. We are retreating to the worst aspects of our history. The richest nation on earth will no longer be the most generous.

Steve Hochstadt

Jacksonville IL

Published in the Jacksonville Journal-Courier, July 17, 2018

The Mephistopheles President

The legend of humans making a bargain with the Devil is a thousand years old, dating back to the story of Theophilus of Adana, who supposedly signed a blood pact with the Devil to become a bishop. Theophilus regretted this deal, and by fasting and praying gained the intercession of the Virgin Mary to regain his soul. Since the 16^th century, German writers have produced many versions of the story of Dr. Faust and Mephistopheles, the most famous of which is the play by Johann Wolfgang von Goethe, completed in 1832. His Faust seeks worldly knowledge and sensual pleasure, ruining the life of the innocent Gretchen. He is also saved from damnation by the Goddess, representing eternal womanhood.

The conflict between profane success and moral integrity, represented as a human choice between Satan and heaven, was worked into countless tales in many languages. Oscar Wilde published “The Picture of Dorian Gray” in 1890, portraying moral degradation as transforming the painting of Gray. American versions are the short stories “The Devil and Tom Walker” by Washington Irving in 1824, and “The Devil and Daniel Webster” by Stephen Vincent Benét in 1936. In Benét’s tale, the courtroom arguments of Daniel Webster save the farmer Jabez Stone, who had bargained his soul for prosperity.

The Faust theme was even written into a baseball novel by Douglass Wallop in 1954, “The Year the Yankees Lost the Pennant”, where the Devil helps the Washington Senators defeat the dominant Yankees. “Damn Yankees” brought this story to Broadway the next year.

I think this bargain describes the modern plight of many American Christians, especially evangelical Christians, who have made a deal with Trump – you give us political policies we want and we will accept your anti-Christian character.

Many Republicans have condemned Trump’s character in the harshest terms. During the Presidential campaign, the National Review said Trump was “a huckster” and “a menace to American conservatism”. Other conservatives said he was a charlatan, an American Mussolini, a louse, a tapeworm, the very epitome of vulgarity. Michael Gerson, an evangelical speechwriter for George W. Bush, calls Trump “the least traditionally Christian figure—in temperament, behavior, and evident belief—to assume the presidency in living memory.” David Brooks used the Faust comparison right after Trump’s inauguration.

Trumps’ perverse sexual behavior, about which he has openly bragged, his defrauding of students at Trump University, his use of his “charitable” foundation for personal enrichment, all exemplify his character. He has never shown the slightest adherence to Christian principles and publicly stated his disinterest in Christian virtues, such as humility, forgiveness and repentance. He lies every day and admits it.

The evils represented by Trump are indelibly displayed in his policy of breaking up immigrant families: deciding to start an entirely new policy of separating parents and children; falsely blaming others for his and his administration’s decisions; saying he can’t do anything about it and then stopping it. Yet evangelical leaders and voters have tied their political fortunes to him, because he offers his Presidential help in their political crusades.

Trump did not suddenly lead evangelicals astray. For years they have ignored universal messages about the importance of helping the poor and the unfortunate, and about welcoming the stranger. But they still proclaimed themselves to be morally vigilant. White evangelicals were the most critical of political leaders who “committed immoral personal acts”: in 2011, only 30% said such a person “can behave ethically” in office, less than any other religious or political group. Since Trump came on the scene, nearly half of American evangelical Protestants have changed their minds about morality and politics: just before the 2016 election, 72% said this was possible, more than any other group.

Instead of acting like a religion, firmly based on timeless values of moral thought and behavior, American evangelicalism now resembles a cult. Conservatives who support Trump, like Rick Santorum, and who oppose him, like Senator Bob Corker, both recently talked of a personality cult around Trump. A year ago, Jerry Falwell, Jr., said, “I think evangelicals have found their dream president.”

Not all evangelicals have made this devilish bargain with Trump. 28% of evangelical Protestants identified as Democrats in a 2014 survey. The Southern Baptist Convention, the largest Protestant denomination in the US, resolved last year “That we denounce and repudiate white supremacy and every form of racial and ethnic hatred as a scheme of the devil.” Their new president, Pastor J. D. Greear, has moved the SBC away from identification with the Republican Party.

W.W. Jacobs’ 1902 story “The Monkey’s Paw” reveals the poisonous gifts that black magic can bestow. Trump’s promise that he will allow churches to engage in partisan politics is precisely the kind of bargain that devils make.

Have evangelical Trump supporters bargained away their souls?

Steve Hochstadt

Jacksonville IL

June 29, 2018