Medicare For All Meets Kafka

*Updated below.

Although 70 percent of Americans now favor Medicare For All, the Knowledge Class is warning us to hold our horses for at least another couple of decades, by which time many of the uninsured and underinsured will be prematurely and conveniently dead. If climate change doesn't get us, untreated disease and despair should do the job in the efficient manner so beloved of the neoliberal thought collective.

That's because Medicare For All doesn't really mean Medicare For All. None of the various and sundry Democratic (read: Gentry Party) proposals has the aim of providing immediate relief to the tens of millions of people who lack coverage. On the contrary. There is no sense of crisis in any of them. With perhaps one exception, the proposals are incremental at best and purely profit-driven at worst. Even Bernie Sanders is only proposing an initial Medicare buy-in beginning at age 55. This is negotiating from a position of apologetic weakness, with the ultimate victory possibly being a compromise of getting Medicare by aged 60 rather than from birth.

Rather than honestly admitting this to the 70 percent, or 200 million (and counting) people who want government sponsored single payer health insurance, not a few of the politicians and corporate-funded think tanks claiming to favor Medicare For All are actually adamantly opposed to it. They just can't come right out and say it, lest their popularity suffer and their greedy inhumanity be exposed. They cannot acknowledge that their real constituents are corporations and wealthy people, who equate universal health coverage with an actual plague, and who are used to getting what they want from their servants in government and the media.

 So instead, Democrats are falling back on the tried and true Kafka-esque method. They'll talk and they'll talk and they'll talk, and they'll gaslight us and guilt-trip us over Single Payer's "winners and losers," and they'll warn us about the costs and the dangers of achieving health care as a basic human right. And the Republicans will get to do their part by accusing these neoliberal corporatists of being Marxists-Leninists-Socialists. 

And the technocrats will draw up their dozens and dozens of colorful pie charts to aid in the glazing-over of the eye and the melting of the mind. Everybody will become so exhausted and confused, the hope is, that Medicare For All will eventually die of its own wonkitude. (For the merest hint of the assaults yet to come, refer if you dare to the latest Vox explainer.)

This was the theme that Franz Kafka explored in most of his writing, in the economically depressed years between World War I and the rise of fascism. Even the most mundane tasks are fraught with such unnecessarily complex difficulties that they never are completed. Since there is no such thing as a simple problem, there can never be a solution. True to his own philosophy, Kafka didn't even complete several of his own stories, and even ordered that most of his work be burned upon his premature death. Thankfully his friend and executor, Max Brod, did not honor this request.

The only reason that (unlike the neoliberal wonk class) Kafka is not a complete downer, and remains popular nearly a century after his death, is that he had a wicked and humorous sense of the absurd, a sense that (making the neoliberal wonk class quake in fear and loathing) we ordinary slobs are all in this together and that our condition is pretty much universal.

This solidarity and unity are the exact opposite of what the political duopoly mean when they long for the good old bipartisan days, when Democrats and Republicans supposedly got along so well. To them, everybody must be divided between conservative and liberal, or more recently, between rural- deplorable and urban-enlightened. It's the main reason why they are so flummoxed by the Gilets Jaunes ("Yellow Vests") movement in France. Here are ordinary people acting, not out of ideology or identity, but in recognition that this is a class war, and it's global. They're emerging from their ordained isolation, and their unified anger is absolutely terrifying the ruling class.  

Well, sort of terrifying them. French President Emanuel Macron hasn't gone so far as to repeal his infamous repeal of the wealth tax. He is doing an imitation of his friend and early booster Barack Obama by calling in the "fat cats" (les chats grosses) for a friendly gross chat in the Elysee Palace and mildly "browbeating" them into a voluntary relinquishment of a smidgen of their obscene profits to their employees. Whether, like the duplicitous Obama, Macron also claimed he was the only thing standing between them and the pitchforks, is not known. 

But back to Kafka. The pretend-architects of a "Medicare For All" simulacrum are like the doorkeeper in his fable Before the Law. The supplicant (let's say it's for health care coverage) is told that he can't gain admittance just quite yet, but that if he's reasonable and patient, it's possible that he'll be allowed in later. As a gesture of good faith,  he's even allowed a glimpse inside. And as he peers into the hope and brightness, 

The doorkeeper laughs and says: "If you are so drawn to it, just try to go in despite my veto. But take note: I am powerful. And I am only the least of the doorkeepers. From hall to hall there is one doorkeeper after another, each more powerful than the last. The third doorkeeper is already so terrible that even I cannot bear to look at him."

The supplicant wheedles, bribes and begs, and the doorkeeper teases and promises. Only at the very end, when the seeker is near death, does the doorkeeper inform him that nobody could ever be admitted because "the gate was made only for you. And now I am going to shut it."

The moral of this story, as I see it, is that the various wonky policy proposals for Medicare For All are about as artificial as the neoliberal architects who are fashioning them. 

So enough of waiting for politicians to do the right thing. If we want entree to social and economic justice, we have to storm the gates and above all, reject the neoliberal dictum that we're lone economic consumers who must be in constant competition both with ourselves and with others in order to "succeed" in this best of all possible worlds.

But we are already being skillfully and subtly discouraged by the Explainers. If it took the Vox policy wonks (with the help of funding from investors NBC Universal and private equity giant General Atlantic) one whole month to read through all the "Medicare For All" proposals, the subliminal message is, it will take you ordinary people at least twice as long to try and make sense of it all. Meanwhile, they'll allow you to peer in to the turgid brightness for the time it takes to read their "explainer" piece and wade through the complexity of its myriad charts and graphs - if you can even make it through to the end. I could not.

But the basic gist is that if you like your plan you can keep your plan (sound familiar?), especially if you have employer-based insurance. It would be terrible, for example, if your boss were to lose his tax breaks on your premiums because you were selfish enough to enroll in government-sponsored health insurance.

Dash away, dash away, dash away all.

And the fraught, impossible choices? There's Medicare Buy-In For All, and Medicare Extra For All, and Medicare X, and the Choice Act, and Healthy America, and Medicaid Buy-In on the convoluted imaginary menu. Of course, Vox warns, buying into Medicaid doesn't translate into receiving actual care, since it would reimburse doctors at much lower rates than private insurance "typically" pays. 

Other "universal" plans charted and explained by Vox appear to be nothing more than Obamacare with new labels attached to them.

Bait-and-switch is exactly how this eternal Kafkaesque game is played. All of these plans totally sidestep the reality that wealth inequality is the fundamental public health crisis of our time. Forty million Americans live below the official poverty line, and at least half the population are just a paycheck away from outright destitution.

As Dr. Michael Fine lays out in his book Health Care Revolt, Americans spent about 30 percent of total household income on health care and health insurance in 2017 - or about as much as we are expected to pay for housing. That is about $11,000 for every man, woman and child. Of that money, between $1 and $2 trillion is being skimmed off the top by the "market" as pure profit. Fine writes:

It's estimated that by 2025 we'll be spending 50 percent of household income on health insurance and medical services. By 2032, we will spend an estimated 100 percent of the average family income on health care. I hope you understand how that will work, because I don't. Neither does any economist. Think climate change is a threat to our planet? It is but many believe that climate change will take fifty to a hundred years to destroy the planet.  Health care is on track to destroy our economy and our nation within fifteen years.

Donald Trump is not the only denialist in this Kafka-esque mix. 

Franz Kafka also had a prescient thing or two to say about Trump's precious Wall, which I've written about in a previous post. The whole idea of the Wall, just like the Democrats' unnecessarily convoluted health care proposals, is that it will always be "a work in progress" and not something we should ever expect our leaders to actually complete. Gaps and holes are always essential if they are to keep us hoping, dreaming... and compliantly fearful.

They hate it when ordinary people poke holes in their manufactured holes.

*Update, 12/15. Well, isn't this convenient. On the very eve of this year's Obamacare enrollment period deadline, a federal judge from Texas has struck down the entire "Affordable" Care Act, declaring it unconstitutional. Judge Reed O'Connor also happens to an appointee of the newly-sanctified George W. Bush and is a member of the reactionary Federalist Society. Will Michelle Obama still love Junior "to death" and continue accepting candy from him at celebrity funerals after what his appointees and pals continue to do to her husband's precious legacy?

Anyway, here's my comment on the New York Times op-ed on the matter:

While we await the ultimate decision of the Supreme Court, what better time than now for Democrats to take the Medicare For All campaign up a notch or ten?

Look at this ruling as a blessing in disguise. The lucky 20 million or so Americans who have coverage under the ACA are not going to lose it right away, if ever, and meanwhile, the 30 million who have virtually no coverage at all will gain the additional clout to convince their reps that government-sponsored single payer insurance, from cradle to grave, is the only thing that will prevent these cruel and frivolous rulings in the future.

Just let the Supreme Court uphold this insane decision. Just watch the GOP sink when/if their voters are kicked to the curb.

Democratic leaders should finally be learning that negotiating with Republicans to the extent of adopting an actual GOP scheme (from the conservative Heritage Foundation) is not only a crazy strategy, it keeps giving ammunition to the experts who believe -- correctly, in my view -- that requiring citizens to purchase "product" from an essentially predatory cartel of private insurers is the wrong way to go about covering people. These companies skim trillions off the top of US medical care expenditures, making this country's market-based system the most costly and least effective in the civilized world. Better to require everybody to pay taxes, according to their means, to truly cover everybody. The reactionary judges won't have a leg to stand on.