The Right-Wing Plot to Control Your Health Care

Much has been written the past few months about the conservatives' assault on women's autonomy: the intrusive battery of new laws designed to forcibly insert the right-wing's political and religious agenda into the most intimate conversations between women and their doctors.

What's less well understood is that this same effort is also a full frontal attack on the future of government-paid healthcare, and by larger extension, on Americans' trust in their public institutions, and our confidence in government's ability to solve problems the market can't handle.

As I've written recently, busting our trust in democracy is a central goal of the Republican Party as it's currently configured. Killing our will and ability to provide good healthcare to every American is central to this enterprise: If we get the idea that we can do this much good for this many people through government, we might regain faith in our civic competence to do a whole lot of other things, too. It's the last thing they want.

So they are, quite simply, out to break the social agreements that would enable such a system to exist at all. And there's a lot in these "war-on-women" bills that achieves this other goal as well.

Who Gets to Choose?

Americans already support several government-paid healthcare systems. One, Medicare, is a single-payer system on the Canadian model. Another, the VA system, is pure British-style socialized medicine. There are a vast number of other systems as well -- child health programs, active-duty military health services, the systems that serve Native American reservations and prisons, and so on. Through these systems, we pay the bills for our seniors, troops, veterans, kids, disabled people, and others to receive healthcare.

But we've also very clearly understood, throughout the many decades of these programs' existence, that paying the bills does not give us the right to choose what care people get. Americans, by and large, stand by the idea that the fundamental right to make medical decisions should remain with us and our doctors to the greatest extent possible. There's a strong cultural belief that politicians, bureaucrats, bean-counters, well-meaning friends, religious busybodies, and your mother have no business in deciding how you should manage your health.

In fact: the thing that pisses us off the most about private insurance is the way those systems allow accountants and shareholders into the mix -- two groups of people most of us are firmly convinced have absolutely no business making decisions about our care. And we're equally suspicious when government tries to "ration" care (which is why our default has been to leave rationing to the free market, which does an ugly and brutal job of it).

We've also been pretty hostile to the idea that taxpayer-funded healthcare should ever be an open invitation for pecksniffers to run around commenting loudly on people's diets and recreational activities. Yes, we're paying their bills. And we can do what we can do -- build parks and trails, mandate good food labeling -- but beyond a point, that's it. When it comes to what any given individual does, that's between them and their doctor, and our job is to butt out.

This goes to the heart of what Americans adore most about the promise of government healthcare. We love the way it guarantees our individual freedom to pursue life, liberty and happiness, while also recognizing that we can't pursue those goals freely unless we're also covered for the very real risks that pursuit entails. If freedom means being able to quit your job to go back to school, start a business, travel the world, or raise your kids, the prospect of losing your health insurance may be the biggest obstacle there is to true American liberty, investment and self-improvement.  

It's that promise of personal freedom and opportunity that beckons us in the direction of single-payer healthcare. It's also the promise that conservatives are doing their damndest to break.

Breaking Faith With Our Doctors

Right now, Republicans in Congress and in legislatures around the country are asserting -- for the first time in the history of government-paid healthcare in America -- that politicians, religious leaders, bosses, and bureaucrats have an express legal right to meddle in our personal medical affairs. If this campaign succeeds in opening those doors, we'll end up with a public system that we can trust even less than we trust private insurers now.

Among the radical new ideas that will shred the ability of public healthcare to function going forward:

  • They are asserting that the opinions of politicians trump both your right to patient consent and the scientific judgment of your doctor.
  • They are establishing the principle that the government can require you to undergo -- and pay for -- specific treatments (like the transvaginal ultrasound) for purely ideological reasons that contribute nothing to your health.
  • It's not just government that's slipping through this door. So-called "conscience clauses" are also expanding the rights of other non-MDs -- particularly pharmacists, nurses and employers -- to insert themselves into people's personal medical decisions for reasons that have nothing to do with ensuring good evidence-based care.
  • They are encouraging all the rest of the country's panty-sniffing moralizers to believe that they are qualified to judge who is entitled to what kind of care, and to make the delivery of that care a political issue. If this continues, it's not hard to imagine future laws that allocate healthcare on the basis of who is deemed most "deserving" by their neighbors.

This is a dangerous step away from science-based medical practice -- and from our basic rights to liberty and privacy. Worse, once policies like this fall into place, there will be no limit to the amount of future political, bureaucratic and religious tinkering with our medical care that will become possible. Ultimately, the Right is trying to create a two-tiered system in which the only people who have complete privacy and freedom of choice in their doctors' offices are those rich enough to pay out-of-pocket for it themselves. The rest of us will have to accept whatever Congress, our boss, the bean-counters, and the Catholic bishops think we deserve.

And they will have conclusively proven their argument that we can trust government even less than we can trust corporations. Just as they've already done to our Congress and our economy, it'll be yet another case where they willfully break effective democratic systems -- just so they can then complain loudly to anybody who'll listen about how broken they are.

If we want to make sure that our medical decisions remain between us and our doctors, we need to stop this now. What's at stake goes far beyond even the horrors of state-mandated physical and emotional rape of women seeking abortions (though that's horrible enough). If this crusade is allowed to succeed, every detail of our healthcare stands to become a political, economic, bureaucratic, and theological football forever after -- and we will grieve for the good old days when our medical care was a personal, private decision made just by us and our doctors behind the exam room door.

It's now or never. Because once they've broken it this way, the odds are slim that we'll ever get it back.

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