Rationing and Race

The current health care debate has echoes of politics long played. There is a despicable ploy that is being dusted off again because it is so damn effective. When you hear the word "rationing" used to scare those who are now employed and healthy, explicitly think race because that is what they are trying to get you to think subconsciously.

The man who is perhaps the most responsible for the disgusting state of contemporary political discourse is Lee Atwater. With Nixon's Southern Strategy well in place, designed to break the traditional Democratic coalition between northern liberals and southern conservative whites, the going started to get difficult. Overtly racist attacks had worked well for a while, but eventually it began to appear unseemly to openly advocate for white power. The solution was not to surrender racism as a foundation for your politics, but to become appropriately subtle about it. It is not a problem of morality, but merely one of etiquette. Here's how Atwater put it,

You start out in 1954 by saying, "Nigger, nigger, nigger." By 1968 you can't say "nigger"—that hurts you. Backfires. So you say stuff like forced busing, states' rights and all that stuff. You're getting so abstract now [that] you're talking about cutting taxes, and all these things you're talking about are totally economic things and a byproduct of them is [that] blacks get hurt worse than whites.

And subconsciously maybe that is part of it. I'm not saying that. But I'm saying that if it is getting that abstract, and that coded, that we are doing away with the racial problem one way or the other. You follow me—because obviously sitting around saying, "We want to cut this," is much more abstract than even the busing thing, and a hell of a lot more abstract than "Nigger, nigger".

Racism has to be in there, but you need to code it. At first, the coding will be wink, wink, nudge, nudge, but eventually it will almost disappear from view.

And so Ronald Reagan announced his candidacy for President in Philadelphia, Mississippi extolling states' rights. Cute. And we saw this develop in many other places. Affirmative action was not about leveling the playing field so that the old boys network didn't continue to give plum positions to cronies, but about those lazy, undeserving black people taking the jobs of honest better qualified white people. Anything that allowed us to be our brother's keeper was seen as "big government waste" and merely an opportunity for "welfare queens" to cheat the system. Of course, the stories Reagan told about those welfare queens were made up lies, but what was crucial is that we all know what color they are, even if we are barred by the political correctness police from saying it.

And so racism became a part of our discourse in a way that allowed us to be abstract and not explicitly appeal to race. As such, it is not merely a Republican tactic. Think back to the last Democratic primary and Hilary Clinton's appeal to "hard, working, honest, real Americans" or listen to virtually anything that came out of the mouth of Chris Matthews. This implicit racism of Lee Atwater is still poisoning our well.

And so it is with the rationing scare tactic. The whole argument is that if we do what every single other industrialized nation has successfully done and make sure that everyone in this, the most prosperous nation in history, has a basic level of health care, then there will be health care rationing, in other words you, the hard working, honest white people will no longer get the health care you are used to. There is a finite amount and it will be redistributed so that your share goes to someone else. Of course, it remains unsaid, but we know who that someone else is...and what color they are...

It is regularly pointed out that we ration health care right now only we do it on the basis of income. But this is an utterly ineffectual rhetorical strategy because those who benefit from the system either are selfish asses who don't care that the system is unfair as long as it is unfair in their direction or -- and this is the evil genius of Atwater's work -- who don't see it as rationing, but as a legitimate distribution of a social good to those who deserve it. Those who have coverage have it because they deserve it. We work hard and play by the rules and so we are given health care as a just reward. Those who are uncovered are uncovered because of lifestyle choices that make them undeserving. If they were good hard working white people like me, they would have the same health insurance I do. They don't deserve it and so don't take away something I have rightfully earned.

Of course, the sad irony is not only that it is false and self-serving, but that those who think they are protecting their self-interest by not wanting to help others are in many sad cases screwing themselves. One in five, twenty percent, of insured cancer survivors have to file for bankruptcy because of medical bills. Now we try a second order Atwater here by saying, "well, they must have been smokers who deserved the cancer," but of course, we really know better. Ovarian and testicular cancers, colorectal and skin cancers, cervical and brain cancers appear without warning across the board.

Add to that the practice of rescission, where insurance companies try to figure out ways -- legitimate or not -- to deny coverage to their policy holders in order to reduce costs, even if it means that you die after dutifully paying your premiums, and what you get is a game of Russian roulette that we are talked into playing by an insurance lobby who preys on our invisibly racist and deeply class insecure society. The head shakes sadly looking at the town hall meetings where the ones who most need protection are the ones screaming the loudest and craziest. It reminds you of the Presidential campaign where those who went nuts over "redistribution" were exactly the ones who would benefit most from it. Lee Atwater's ghost lives on in a way that takes race and embeds it in our social insecurity in a way that gets those most at risk to not only think that the treatment is worse than the disease, but to not even realize that there is a disease. He exploited -- and the health insurance lobby continues to exploit -- a weakness in our cultural immune system, racism and fears about downward class mobility, as entry points for an illness that figuratively destroys our economy and moral integrity and literally kills many of our fellow Americans.