If you want to know what the Lord God thinks of money, look at the people to whom he gives it. Thomas Guthrie
For truth in disclosure, let me start this essay with the declaration that all my adult life, I have been a fervent advocate of socialized medicine. This means that I believe that every person in our world, rich or poor, old or young, in the rich or the poor countries of the planet, everyone should have access to free and qualitative health care. In other words, I believe with thousands of other writers and thinkers that access to health care is a human right which, in the years and decades ahead will eventually become a fact, a reality of social existence everywhere on our planet. To call this by a term – socialized medicine – in order to deny its implementation is, in the long view of human social development, a retrograde act. But what does this have to do with the subject of this essay?
Well, in the current war raging between Obamacare and Trumpcare in the United States, socialized medicine is known as the so-called “single payer” option and neither Obamacare nor Trumpcare would have anything to do with it. Indeed, with the exception of a tiny minority of leftist politicians like Senator Bernie Sanders who came close to clinching the nomination of the Democratic Party for the presidential election of last year, nobody is thinking about socialized medicine, let alone talking about it. If this is the case, the question arises as to why there is such a bitter, seemingly irreconcilable difference between Obamacare and Trumpcare. Welcome to the extreme absurdity that is the world, the ethos 21st century American medicine!
In case this last declaration seems gratuitous and unwarranted, let me say that as I write these words on Friday, July 28, 2017, the latest attempt of the Republicans in the U.S. Senate to ram Trumpcare through the legislative process for instant ratification into law by president Donald Trump has just been defeated. This defeated bill tells us a lot about the essence of Trumpcare. In the first year alone, it would have taken health insurance away from16 million Americans covered by Obamacare. Additionally, it would have immediately increased payment for premiums by 20%, making health insurance unaffordable for millions of Americans not included in the 16 million who would not be covered under the terms of the defeated bill. What is perhaps worse, what is simply unbelievable is the fact that this defeated bill was the mildest, the “kindest” of the three bills proposed by the Republicans to repeal and replace Obamacare. If these words that I write seem an exaggeration, readers are welcome to view YouTube videos of demonstrators and protestors in the US Congress this past week shouting slogans like “Kill the Bill, Don’t Kill Us! Kill the Bill, Don’t Kill Us!”
At this point in the discussion, a word or two is perhaps necessary to provide some contextual and discursive clarifications about the opposition between Obamacare and Trumpcare. Concerning the former, perhaps the most pertinent thing to say about Obamacare is that it is not socialized medicine, not in the least! Rather, it is a structural package of market-driven forces in combination with subsidies provided by the American government intended respectively to help the old (Medicare) and the poor (Medicaid) get health insurance coverage which they would otherwise find too costly and out of reach for their meagre economic circumstances. In other words, Obamacare for the most part leaves the organization and running of the American medical system to powerful private economic and financial forces concentrated in the pharmaceutical, insurance and health care delivery industries. In this respect, most analysts calculate that the American medical system constitutes about one-sixth of the country’s national economy. Within this sector of the economy, government subsidies for the costs borne by the poor and the elderly are way behind the profits, the surplus value derived from payments made by wealthy individuals and private and public employers.
In other words, Obamacare essentially constitutes a minimum of protection for poor people and old retirees against market forces that respect only those who can pay, without reference to the ability to pay. As a matter of fact, long before Obama became president, many national and local leaders of the Republican Party had advocated programs similar to Obamacare as a means of keeping socialized medicine completely out of the equation. Indeed, it was Mitt Romney who was defeated by Obama in the presidential elections of 2012 and who, as Governor of Massachusetts, first introduced the model of mixed heath care delivery system that would later become Obamacare. Against this historic and political background, the question that arises is this: why are the Republicans so hellbent against Obamacare to the extent that they are willing to take away health insurance coverage for tens of millions of poor, elderly and young Americans? Are Republicans so inhuman, so evil, so blinded by the inviolability of market forces and money that they care not one jot for the health, the lives of the poor and the elderly who cannot meet the dictates of the market? Are they the kind of people that Thomas Guthrie had in mind when he wrote the words of the epigraph to this essay? Here’s the epigraph: If you want to know what the Lord God thinks of money, look at the people to whom he gives it.
To give a useful response to this question, please think of the following facts, dear reader. America is not Nigeria; it is not a developing country whose health care delivery system is so undeveloped and inefficient that its elites have to be flown abroad if and when they fall dangerously ill. America not only has one of the best physical infrastructures for medical practice in the world, it is ahead of most of the nations of the planet in research and development in medicine in virtually all the fields of the profession. Here in the part of the state of Massachusetts in which this article is being written, there is a concentration of first-rate medical hospitals and institutions that is perhaps second to none in the world. Well, so much for the good part, the rosy picture because, dear reader, this is not a place where you want to fall sick if you are poor and elderly and without insurance coverage. Why? Because the only condition in which you will get treatment if you suddenly and dangerously fall sick is if you’re rushed to the emergency section of a nearby hospital. And even then, beyond immediate treatment or service to stabilize your condition, you will not get the services, the care you need to restore you to full health. Obamacare was/is the minimum that the United States as a nation, as a society has been able to do to alleviate this mother of all scandals of the 21st century. And it is this Obamacare that the Republicans are hellbent to completely do away with. Why? What is their reasoning, their justification?
In responding to this question, let us briefly and summarily dispose of one obvious but rather tangential factor, this being the appellation “Obamacare” itself. As is well known, the name, the prefix, Obama in the term is the sign, the trope for everything that the base of electoral support for the Republican Party deems not only unamerican but also anti-American, especially with regard to race, ideology and social policy. I have stated earlier in this piece that Obamacare is not socialized medicine, that its essential contents were first put in place by Mitt Romney, a Republican. Thus, as absurd as it may seem, for the Republicans what is wrong with Obamacare is the fact that it is Obamacare and not, say, “Romneycare”. Had it been the latter, they would in all probability simply have tinkered with it, not completely reject it. In this respect, the Republicans are caught in the trap of their own discursive totalitarianism: since they have driven themselves into a prison house of language in which anything having to do with the name and the term “Obama” is anathema, they would rather send millions of Americans into the emotional and psychic wilderness of uninsured and uninsurable patients than do anything at all to salvage the workable, beneficial parts of Obamacare.
But that is not the heart of the matter. This is because beyond discursive and linguistic reification, the Republicans are caught in a social contradiction in which they find themselves making a last-ditch defense of health care delivery as a commodity and not a right. The absurdity of their position can be grasped by the deployment of the following syllogism: all commodities are for sale, not for distribution as a right; like food, health care is a commodity; ergo, health care is for sale as a commodity, not for distribution as a right. Of course, this is only in the world of abstractions, the universe of reifications; in the real world, health care is both a commodity and a right. Indeed, as many of the demonstrators and protestors have been saying in their descent on the Capitol this past week, all the members of the US Congress, the Senate and the House of Representatives, enjoy very generous health care benefits paid for by taxpayers as a right that cannot be taken away from them!
The reader may have noticed that in the title of this piece I use the phrase “the wealth and poverty of nations”. As a matter of fact, the phrase is borrowed from what is generally regarded as the bible of modern capitalism, The Wealth of Nations by Adam Smith. In that classic outline and defense of modern capitalism, Smith persistently talks of both the wealth and the poverty of nations. This is because he saw quite clearly that as wealth is created in all modern nations, so also is poverty created in its wake or at it flank. In other words, Smith saw quite clearly that capitalism is not only a terrific productive machine for generating wealth on a colossal scale, it is also a whale of a structural contraption for distributing wealth unfairly – that is if unrelenting social engineering is not done to alleviate the effects of this fundamental contradiction.
We are of course far from the time and the world of Adam Smith when his analyses and warnings about the consequences of not reducing or alleviating poverty and its effects were routinely ignored. But not for the Republicans in the U.S. and not for the barawo pseudo-capitalists in Nigeria! In the most progressive and liberal nations and zones of contemporary 21st century capitalism, socialized medicine has been solidly put in place, usually after turbulent social and political struggles by the poor and those who stand with them. This is true, for instance, of Canada which is just across the border from most of the northeastern and northwestern states of the United States where, incidentally, drugs and medications are generally much cheaper than in the U.S. To see the Republicans’ war against Obamacare in the light of this long view of capitalism is to see that that they are on the wrong, losing side of history. Whether they like it or not, Obamacare has come to stay, if not in its current incarnation, then in other improved and expanded versions.
Biodun Jeyifo
bjeyifo@fas.harvard.edu
