A Battle Worth Fighting

Marty Levine

June 1, 2022

The business of government is done in the dry words of lawyers and bureaucrats, words that belie their real-life consequences they have on our lives and our frayed social contract.

“As a result of the continued consequences of the Coronavirus Disease 2019 (COVID-19) pandemic, on this date and after consultation with public health officials as necessary, I, Xavier Becerra, Secretary of Health and Human Services, pursuant to the authority vested in me under section 319 of the Public Health Service Act, do hereby renew, effective April 16, 2022, the ​January 31, 2020, determination by former Secretary Alex M. Azar II, that he previously renewed on April 21, 2020, July 23, 2020, October 2, 2020, and January 7, 2021, and that I renewed on April 15, 2021, July 19, 2021, October 15, 2021, and January 14, 2022, that a public health emergency exists and has existed since January 27, 2020, nationwide.”

These words were the words of “govermentese “ needed to authorize states to expand their to provide access to Medicare while we lived through the pandemic. In a nation that fails to ensure everyone can get the medical services they need; this was an important action as this once-in-a-generation disease made us all vulnerable. According to research conducted by the Kaiser Family Foundation because of this action by our government, “Medicaid Enrollment is Expected to Grow By About 25 Percent, or 22.2 Million Enrollees, From FY 2019 Through FY 2022.” But, come July, unless the Biden Administration performs this ceremony again, “between 5.3 million and 14.2 million low-income people could lose Medicaid coverage following the end of the public health emergency and federal continuous enrollment requirement…” Those millions will again be on their own, be forced to find other ways to get needed care, or just suffer on without it; these are millions of people who will be back in the often-cruel reality of our nation’s very frayed safety net,  forced, at best,  to choose between housing, food, or medical care.

In comments reported by The Guardian, Dr Eric T Roberts, assistant professor of health policy and management at the University of Pittsburgh, described this action’s impact.  “Medicaid provided invaluable coverage to individuals during the pandemic. And there’s evidence that it helped insulate people from loss of coverage that is associated with job losses, especially in the early stages of the pandemic. Now, we face this unwinding of those provisions and a lot of confusion to beneficiaries and the public about how individuals will navigate that process and the schedule on which they will be required to do so. I think the great concern is that people lose their coverage without really knowing it, until they need it.”

The Federal Government’s words unlocked more than sufficient additional funding to pay for serving these formerly uninsured folks. “KFF analysts also project that from the fiscal year 2020 through the fiscal year 2022, states will have collectively spent $47.2 billion to cover additional people enrolled in Medicaid because of the continuous enrollment requirement and will have received $100.4 billion in new federal funds to cover those costs and provide general fiscal relief through enhanced Medicaid matching funds.”

That is right, all together states made a $53 million profit. Yet, when the emergency is deemed over, States will be able to return to their past practices and remove medical coverage from millions. They will have the ability to redirect these excess funds to other purposes.

This is a glaring example of what is wrong with our national approach to health care and to our overall social welfare system. Rather than a national system in which we are all equally served we rely on a complex network of individual and workplace private insurance, government programs (Medicare, Medicaid, Veterans Administration,) Emergency Room, and charity care to get health care into our society. It is a system that has so many different approaches that we all struggle, no matter how we receive care, to understand what we are entitled to and what it will cost us. It is a system that provides marginal quality to too many; and even at its huge cost (>$4 trillion/yr.) it leaves millions out, uninsured, and unable to afford what they be asked to take out of their wallets.

The millions of men, women, and children who face the loss of affordable and accessible medical care in July are just one more example of how much we, as a nation, are willing to pay, in dollars and in human suffering, to maintain our deluded belief in individuality and self-responsibility. At the beginning of this year, we were willing to allow the expanded Earned Income Tax Credit to expire, throwing millions of children back in a life of poverty. This is no different from our keeping the definition of poverty artificially low to avoid having to see how many of our neighbors cannot afford a decent standard of living. And our failure to be humane.

The reason we fail to care for each other is not that building a society that provides us all with health care, or a guaranteed income or adequate housing or childcare is too expensive,  if that were the reason we would be focused on how we might find the money, as we do each year when we “find” the funds we need for the Department of Defense and for the additional funds we always seem to find to pay the extra costs of the wars we choose to fight. We have the system we have, the one which allows millions to suffer because we reject the fate of all of our neighbors as our collective responsibility. Despite the noble words of our founders, our national policies are built on a foundation that we are all individually responsible for ourselves. We can have the resources that we need if we work hard enough, study hard enough, and preserver. Not being able to put food on the table or pay the rent or pay for a needed medication is just a sign of personal failing.

And, for the architects of this national embarrassment, providing a strong safety net is harmful,  contributing to the moral failing of those struggling to make it. When we do not help them, they believe, are actually helping them when we pull assistance away. Their pain and suffering will prod them to do better if they choose to do so and if not it is not our problem to fix.

If we personally want to help someone in distress, we can make the personal choice to be charitable, but it is not our collective responsibility through our government to ensure our collective welfare. It is a personal choice; we can be charitable or not; we can be charitable to our fellow citizens who are in distress, we can give money to those ensuring our dogs are not hungry or we can give our money to the politicians we believe will protect our personal wealth and power. All are equally ok because it is just a personal choice.

As I write this on Memorial Day, a day of remembrance of the fallen soldiers who died to protect this Nation and its values, a memorial that President Biden said  “must not be just a day when we pause and pray. It must be a daily commitment to act, to come together, to be worthy of the price that was paid,” I wonder if this nation we deem to be so exceptional is just about ensuring we can continue to battle for survival, some of us succeeding and others left to bleed in the dust? Is that really what we want our society to be?

Franklin Delano Roosevelt, in his January 1941 State of the Union Address just days after the bombing of Pearl Harbor,  laid out the vision of a nation that was worth fighting for, what many of those who we honored this Memorial Day gave their life for. “Equality of opportunity for youth and for others. Jobs for those who can work. Security for those who need it. The ending of special privilege for the few. The preservation of civil liberties for all. The enjoyment . . . the enjoyment of the fruits of scientific progress in a wider and constantly rising standard of living. These are the simple, the basic things that must never be lost sight of in the turmoil and unbelievable complexity of our modern world. The inner and abiding strength of our economic and political systems is dependent upon the degree to which they fulfill these expectations. Many subjects connected with our social economy call for immediate improvement. As examples: We should bring more citizens under the coverage of old-age pensions and unemployment insurance. We should widen the opportunities for adequate medical care. We should plan a better system by which persons deserving or needing gainful employment may obtain it. I have called for personal sacrifice. And I am assured of the willingness of almost all Americans to respond to that call. 0] A part of the sacrifice means the payment of more money in taxes. “

More than eight decades later, FDR’s words ring hauntingly, a vision still unfulfilled and a vision that seems far away from a nation that in weeks will abandon millions back into the purgatory of our safety net and its health care “system.”

 If FDR’s vision is still part of what you hope for then we have a fight on our hands, a fight we are now losing. The conservative forces that have driven our nation, from Nixon to Reagan to Bush to Trump, have pulled us further and further away from those aspirations. They have tilted the political spectrum to make individualism seem reasonable even as so many people struggle and suffer. They have convinced their loyal base that others are taking from them when by creating equity and equality. To combat this, we need to recognize that compromise is not our goal, saving lives and easing pain is. Building that equitable society.

And that vision needs to be clear and loud not masked in politically correct words that belie how difficult and costly the path there will be. If we believe everyone deserves affordable, high-quality health care, we need to demand it and measure any proposed new law or policy against that standard. If we believe everyone should be able to live in affordable, quality housing, we cannot accept half measures that leave thousands of unhoused folks behind. If these programs mean that some will need to pay a higher tax bill then we need to say it clearly. If it means that you will have to pay a higher tax bill or have your community change its restrictive zoning laws you need to be loud and clear that this is what you want.

Compromise with those who do not share our vision of this country is no longer what we should be hoping for. Speaking truth that shocks, even offends is what we need to do. If that is not enough to win the political battle, to create law and policy7 that reflects the nation I want this to be, then we will know we have lived a national lie since 1776. But let us not get there until we have battled this harder than we have before knowing that we are fighting for the core of this nation.