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Who’s Left to Love?

February 15th, 2010 No comments

This depressing article in today Philadelphia Inquirer relates a familiar tale: The poor are being vilified for taking government money, blamed for having made bad choices, called “breeders” for having kids they can’t support (with an icky overlay of moral disapproval for having many of these children out of wedlock). As the story points out, much of the anger is diffused and untroubled by facts: welfare rolls have been slashed mercilessly since the so-called Welfare Reform Act of 1996; the payments are so meager that no one would seek this as a viable means of support (and it lasts five years, max, anyway); most of those receiving assistance are children.

The anger is sometimes startling, as when South Carolina Lt. Gov. Andre Bauer recently compared the poor to “stray animals who breed,” or when pandering, no-nothing politicians make symbolic shows of making life even more humiliating for people who can’t get by:

Pennsylvania State Rep. Garth Everett (R., Lycoming) has tried for a year to pass a law that would have [Temporary Assistance to Needy Families] recipients drug-tested and fingerprinted, a practice in some states. “People’s wallets are tighter these days, and they don’t want funds going to folks with drug problems,” he said.

Asked to back up his claims, Everett said, “I don’t have evidence that people are using it [TANF money] to buy drugs. I do get feedback from a significant part of my constituency that they have the feeling that folks on welfare are using drugs.” He added that his proposed bill “is not going anywhere” because Democrats oppose it.

His constituents “have the feeling” that folks are using money — some of the very generous $403, per month, for a mother and two kids — to buy drugs. That’s enough for Everett, who can make a political show of his solidarity with the angriest elements of his constituency without having to deal with the consequences. Among them is the likelihood that the money spent on drug testing and fingerprinting would far outweigh any cost savings from denying benefits to those using drugs, and thereby end up costing the state more money. As a bonus, it would feed into the discredited view that  drug addiction is a matter of choice and not a medical, public health issue that requires complex intervention.

Given that the poor take such a tiny percentage of the state’s money, the anger isn’t really about the money. It’s more the product of a deep and justifiable frustration by the broad swath of the increasingly left-behind middle class that they’ve done everything right, but can’t get ahead. Like a tire skidding endlessly on ice during our tundra-like winter here in the Mid-Atlantic, they work harder and harder and fall further and further behind. So to them, anyone who gets anything for “nothing” is bound to be the target of some vitriol. But would they change places with those they condemn?

No, they’d rather change places with the Wall Street bankers and financiers whose complex machinations were a significant contributing factor in the national and global meltdown that continues apace. But they know that’s not possible, and they’re too beaten down — and realistic — to think that people as well-connected as these modern-day robber barons (there! I said it! let the angry responses begin) will be brought to heel, or even asked to cut back by one yacht. Government is detested, but there, too, the problem seems too big and complex for them to have any effect.

This culture of fury and jealousy, whatever its understandable origin, isn’t healthy. I might want to blame right-wing talk show hosts like the morbidly obese Rush Limbaugh who, without apparent irony, recently wailed about how food stamp recipients are spending their money on unhealthy choices (including the outright lie that some of it is going to booze; it can’t), but the most accurate thing to say is that they’re only amplifying resentment and confusion that’s already out there. (If you want to make a symbolic stand against the worst (and most effective) offender, join this Facebook group).

As Sarah Palin understands (and she doesn’t understand much), there’s a fortune to be made in tapping into this anger. Obama, meanwhile, has the more difficult responsibility of connecting with our deeper but often less accessible sense of community and collective responsibility. He’s not always done this effectively, unfortunately, but this is the area in which we really need that “hope-y, change-y” thing. Otherwise, I fear that “the centre cannot  hold.” While I’m on Yeats, here’s a tired but apt close:

The best lack all conviction, while the worst
Are full of passionate intensity.

Town Halls, Tea Parties, and My Further Adventures in the ER

August 15th, 2009 3 comments

Apparently, my kidneys are manufacturing stones like cheap Chinese toys. Last night, I found myself back in the ER with another stabbing pain. This is now what I look for in home sale ads: “Charming Victorian house in diverse neighborhood. Walking distance to emergency room. Must see!”

This time, I thought that a CT scan did make sense, but that wasn’t going to happen for several hours, because all of the CT staff was out sick. So, doped up on morphine, I walked home in the sticky dawn. I then took advantage of my pain-free state to sleep for several hours, but now I’m awake and uncomfortable. Hence, this post.

I’m now in favor of some kind of “cap and trade” program for kidney stones. I’m also in favor of major changes to the health care system. Today’s lesson is that the pieces don’t move especially well together. ER docs, my doc on call, the urologist I’m supposed to see next week — my experience suggests that they won’t check each other’s notes thoroughly enough (if at all), and that there are lost efficiencies all over the place.

But don’t take  my word for it: Here’s what some academic physicians had to say about the cost issue in a recent op-ed piece in the NY Times. Their many useful suggestions include reconsidering the “fee for service” model, which encourages overutilization of procedures. In a given year, for example, the number of CT scans done exceeds .2 per capita (62 million for 300 million people).

In a recent interview on NPR’s Fresh Air, Lisa Sanders, who writes the fascinating (to me and other worry warts) “Diagnosis” column for the Times, picked up on related point with her pithy insight that doctors are reimbursed for “doing” — not for “thinking.” One morning, she explained, she had some twelve patients, who represented the mine run of what internists encounter on a typical day: colds; bronchitis; flu symptoms; pain. Her final patient needed an ingrown toenail removed. Doing that brought Dr. Sanders more reimbursement from the insurance companies than everything else she’d done all morning, combined. Fee for service combined with heavy compensation for procedures, rather than diagnosis, may explain a good part of our current mess.

You may have heard that the evident need for some kind of health care reform hasn’t exactly resulted in universal acclaim for President Obama’s initiative. To an extent, the responsibility rests with the White House for failing to engage and to make clear exactly what’s being proposed, what would happen as a result, and so on.

Obama’s Town Hall Meetings have been a belated corrective to the more vitriolic incarnations of the format that have caught many people, including me, by surprise. Listen in and you’ll hear comments that are only sometimes about health care itself. In this story, one woman complains broadly and emotionally about the death of American exceptionalism. It seems to me that Kai Wright, senior  writer for the Root who was interviewed for the story, is exactly right in saying that health care has provided a convenient flash point for broader anger and anxiety: “What is my place in a vastly changing culture and a vastly changing economy?” is the question he suggests underlies whatever is actually spoken.

Wright also blames right-wing flame-fanners — especially Glenn Beck — for provoking this anger. In the chain of distribution, Beck is the wholesaler, and people like John Stahl, President of the Berks County, PA Tea Party Patriots, are the distributors who work on the local level. Reading about Stahl’s criticisms of “Obamacare” at Arlen Specter’s noisy town hall meeting, I did the only sensible thing: I called the guy. (His phone number is on his organization’s website.)

Stahl, who’s about to turn 65, doesn’t plan to turn down Medicare. This would be an easy but unfair ground for calling him on hypocrisy; as he pointed out, Medicare is a contract on which people (presumably including “John Stahl”) have relied upon. But it’s broke, he says, and so is the whole system. He doesn’t exempt insurance companies from blame for what he acknowledges is a problem with our health care system but puts the lion’s share of blame on lawyers and med mal suits, illegal aliens (and legal ones, too!) using the system, and the insufficient number of doc being graduated  from medical school.

A staunch libertarian (but one who critizes Obama and his staff for being “ideologues”), Stahl favors the free market solution (which I’m convinced won’t work in the case of health care insurance), opposes any kind of “counseling” of people about their legal options regarding end of life care (not the role of government, he says), and even put on a retro, Steve Forbes wig to call for the “flat tax, ” an idea that no one will ever be able to drive a stake through. The flat tax should fix the problem, he says, along with an unspecified dose of tort and immigration “reform.”

Stahl’s positions aren’t radical, and he stressed the need for civility in debate. But his idea of civility is broad enough to include even Claire McCaskill’s notorious Town Hall Meeting, which he defended. See what you think:

At the risk of engaging in amateur social psychology, Stahl seems to me very much to fit within Wright’s questioning classes. Laid off from his job in his mid-sixties, a conservative Christian seeing his world changing at a vertiginous pace, Wright has seized on an issue in which he’d seem to have little personal stake, using it as a prism through which his deeper concerns can be reflected. Obama is “not a good person.”  He’s “not to be trusted,” based on his “background.” He and his ideologues are using the public option as a kind of Trojan horse, to get to their ultimate goal of complete government takeover of health care.

Is this code for a kind of racism? That’s much too simple, because Obama’s race may itself be a surrogate, for some, for what’s making them uncomfortable with change, more broadly. The world is caving in on John Stahl, and it’s not fair.