Tag Archives: health

Sanders’ lost opportunity in appealing to California

As Hillary Clinton’s delegate count creeps towards a hard fought win, Bernie Sanders’ campaign has increasingly hung their hopes on one state alone – California. It might seem like a curious choice. Racially diverse and a part of the Democrats “blue wall,” California seems more comparable to Illinois, New York, or Pennsylvania – all states Hillary Clinton won. Sanders’ support has largely come from more predominantly White states, both within and outside of typical “blue states” with his wins admittedly coming from places as socially different as Oregon and West Virginia.

In spite of breaking the pattern so far, there’s a certain logic to it, particularly if Sanders returned to the rhetoric he used when first launching his campaign. California was initially touted by many as a success story for the implementation of Obamacare, but the longer term frustrations with putting it in place have created an untapped political market in the state that could be decisive if addressed well.

Like all states, California’s experience with Obama-era health care reform boils down to effectively three big picture changes:

  • Health care providers and health insurance companies face greater obligations to their patients and customers, but in exchange those customers are required to have coverage.
  • In order to help people who would have trouble paying for that coverage, medicaid and other assistance programs are given greater resources and more people are deemed to qualify for their assistance.
  • In order to make accessing and assessing insurance plans easier for everyone who can pay for that coverage, those plans will be helpfully listed on online-accessible exchanges.

That seems simple enough, right? At first, California avoided most of the pitfalls and hangups that other states experienced with putting together those initiatives – the state didn’t drag its feet to expand Medi-Cal or leave it to the federal government to build the online exchange’s website. The system worked. The public health care available was enough of a carrot and the threat of a tax penalty for lacking coverage was enough of a stick, and so in 2014’s open enrollment alone 1.9 million people applied for coverage through Medi-Cal and 1.3 million people purchased insurance through the exchanges.

Hopefully you noticed the discrepancy there. People too poor to afford insurance asked the state to provide it for them, and waited a decision. People with enough wealth to buy it bought and had it, end of story. This wasn’t an abstract demonstration of class inequality. This was about access to health insurance, at times to cover chronic or vital health problems. People died from lack of care while the wait list ballooned into the thousands.

Worse yet, the exchanges and Medi-Cal application system – although tied together into one system – would permit people to apply for Medi-Cal, and only that program, if they met the income standards to do so (see answer 9). Lower income people were literally obligated to wait, and denied access to expensive care in the name of protecting them from the cost. Meanwhile, the question of whether they would be liable under the tax penalties for lacking coverage while waiting for an answer from the state remained hanging in the air.

For all its horrifying flaws, with court rulings and administrative decisions this privatized public health insurance model has seen some improvement. Many Californians do, at the end of the day, want to retain the Covered California system, but there is a sizable chunk of the electorate that could stand to hear some talk about how to shake up the system for the better. Looking at the numbers of applicants and enrolled, as a raw number it’s probably a bigger one that is open to criticism of it, even while wanting the system to exist in some form. That’s a tricky place to articulate, where we need this public system but with different ideas underpinning it, but whoever describes it first could become surprisingly popular in California.

Bernie Sanders seemed prepared to be that candidate and speak in that way towards the beginning of the primary campaign. His messages on how he envisions health care policy still speak to many of the fundamental problems a “success story” like California has seen under Obamacare. Health care, under the PPACA, has not become an essential human right that the state must guarantee, but only a public good it will guarantee you if you demonstrate adequate need. The practical application of that – that by the thousands people have to wait for that assessment to occur – is a nightmarish reversal of any talk about inalienable rights, which the Sanders campaign continues to use. In short, the implication in some of Sanders’ statements, that he would reduce or even dismantle the application process for publically-provided health care, taps into the precise flaws and frustrations with the system as is in a place like California.

But, as of now, those have stayed just implications. To be frank, it’s unclear how much any president can or would be able to shape a redesigned ACA that would address that problem. Sanders might actually have a greater ability to champion that within the legislature, and to the extent that he has, could rely on replaying clips of that in a last minute ad blitz in California. He has less than a fortnight for that now. Can he pivot back to that discussion and articulate this nuanced point about a flaw within a means-tested public health care system? It might already be too little and too late.

The featured image for this article is of the California State Senate Chamber in Sacramento, California.

Tagged , , , , , , , , , , , , , , , , ,

The lack of space for queerness

Something quite terrible is going on within the struggle for queer liberation. That’s not a new idea. In 2011, Bell Hooks famously said that marriage equality was primarily rooted in expanding the number of couples that could share resources, access to healthcare, and other economic privileges, rather than actively fixing the problem that anyone lacks those resources or the ability to fully access them.

Spurred by the recent court cases in the US involving marriage laws, similar points have come up a few times. A popular response to the cissexist Human Rights Campaign’s campaign on Facebook explained that “marriage is often touted as important because it grants access to immigration, healthcare, etc. but … we really need immigration reform, universal healthcare” rather than a minimal expansion of access. In a similar vein, pictures from older protests have been shared anew which presented mutually exclusive options of legally recognizing queer marriages or dismantling the prison industrial complex.

prison_industrial_complex
(“Now that I can’t plan my wedding I guess I’ll just destroy the prison industrial complex.”)

I agree that these are vital points to make about the limitations of marriage equality. Much like the enfranchisement of male-female marriages, it assists very few people immigrate, access healthcare, or avoid unreasonable incarceration. But when the right of couples to “traditionally” marry (in a romantic sense that’s not much more than a century old) is raised, it’s seldom framed as a solution to systemic injustice with dimensions related to racial, economic, and other hierarchies. Rather, marriage is in part a means of regulating custodial rights, a person’s next of kin, and ceding right of attorney in cases of medical or other emergencies.

It seems necessary to ask why the recognition of (some) queer families needs to be justified by the solution of other broad, discriminatory policies that primarily relate to what we might call other modes of oppression. Should the Civil Rights Act have had to prove that it would have positively impacted queer and genderqueer communities? Should the Equal Rights Amendment have been expected to crack down on extralegal yet widely tolerated police brutality against people of color? The need for policies to acknowledge and examine intersectionality – that is, how a person can simultaneously be genderqueer, queer, of color, and female – is obvious, and policies should be criticized and avoided that reduce inequality in one of those fields but with extreme affects in others. It’s a few degrees removed from that, however, to expect improvements in one of those territories to actively resolve historied and systemic problems in another.

And again: what has created that expectation that legally recognizing same-sex and same-gender marriages is a remotely acceptable replacement for healthcare, immigration, and public safety reforms?

Tagged , , , , , , , , , , , , , , , , , , , , , , ,

Bungling life and death

TW: drone strikes/killings

While it’s astounding that US veterans have now been confirmed to be dying as a result of inadequate and delayed medical treatment from the Veterans Affairs office (VA), it’s perhaps reflective of the entire medical field in the US more than our government. In fact, poor records keeping means that we’re not entirely clear how many “never events” (extreme but often undetected mistakes) occur during surgeries, outside of the fact that the number is worryingly large.

But there is something profoundly unsettling when it comes to the power over life and death that the United States’ government (among other international forces) wields. Looking no further that the recently published description of the drone industry in Der Spiegel, it seems as though part of the problem is how deceptively applied those powers are. We’re told that the use of drones reduces casualties both among the local population of countries essentially occupied from the sky as well as among American ground troops when those are also present. Even if only anecdotally, this report challenges that – with drone operators being unable to determine who they’ve killed on the ground until its already too late and likewise often incapable of warning soldiers of threats.


(Site of suspected drone attack in Northern Pakistan in 2008, from here.)

There’s a lot of death no matter how you slice it, and the government doesn’t seem to be managing it very well.

Tagged , , , , , , , ,