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The Affordable Care Act and Social Injustice

Rich Egger

My family and I have spent the past couple of weeks visiting our doctors. All four of us have had our annual physicals, eye and dental exams. Each time I enter a doctor’s office I am grateful that we have access to affordable health insurance. There was a time not long ago, when I was a graduate student and my husband was working full time, that we were uninsured. Like many people in this country, our monthly income barely covered the rent and groceries, let alone “luxuries” like health insurance.  

When I think about that phrase – luxuries like health insurance - I get angry. The words luxury and health insurance are not compatible. The advances made in medicine and public health over the past half a century are truly mind-boggling. Diseases that once claimed thousands are now treatable and sometimes preventable. Yet there are many in our affluent nation - not to mention the world - who can’t access these advances.     

The Obama administration’s signature legislation, the Affordable Care Act, aka Obama Care, is an attempt to introduce parity into an inequitable health care system. Our current system values ability to pay over need. According to Paul Farmer - medical doctor, anthropologist and co-founder of Partners in Health - we don’t think about equity because we have all been anesthetized. Under anesthesia (which is great when you are having a tooth pulled) it becomes easy for us to ignore that we live in a violently unequal world. There are the overt violent acts that we witness like war and genocide, but then there is more subtle structural violence that accompanies poverty, sexism and racism.  

Congress, whose first responsibility among the enumerated powers in the Constitution is to pass spending bills that fund the government - can’t agree on a spending plan for the new fiscal year. House Republicans insist that any new spending bill include provisions that either defund or alter Obama Care. House Democrats aren’t going for that. And while Obama Care isn’t directly tied to funding the government – it’s already a law - it's being used as a bargaining chip. A small group of Republicans believe the president's attempt to bring equity to an inequitable system is so bad for the country that it is worth disrupting government funding to undercut it.  

I don’t know whether this small group truly believes that health care for all is “too costly” or “too complex to deliver” or whether they are simply experiencing a monumental “failure of imagination” - another phrase I’ve borrowed from Paul Farmer.

What I do know is that we cannot continue to operate as if our world hasn’t changed. Our country is more economically divided than it has been in the last 80 years. From the end of World War II through the late 1970s, our economy doubled in size and almost all Americans benefitted. In fact, those on the bottom fifth of the income ladder saw their earnings more than double. Americans experienced upward mobility on a grand scale.

Yet for the last three and a half decades, the middle class has been losing ground. When adjusted for inflation, the median wage of male workers is now lower than it was in 1980.

Moreover, all the mechanisms we’ve used over the last 30 years to lessen the effects of this descent — women pouring into paid workforce in the 1970s and 1980s, everyone working longer hours in the 1990s, and then borrowing against the rising values of our homes — are now exhausted. And guess what? Wages are still dropping — the median is now 4 percent below what it was at the start of the so-called recovery.

Our politicians are exhibiting what medical doctors refer to as insanity – “the unsoundness of mind or lack of ability to understand.” We all need to wake up from our anesthetic haze and begin to work together to make life better for all Americans – not just those who can afford to pay.

Heather McIlvaine-Newsad is a Professor of Anthropology at Western Illinois University.

The opinions expressed are not necessarily those of WIU or Tri States Public Radio.