Monday, December 2, 2013

Medical Transfer Payments



Obamacare was advertised as a way to make sure all Americans have access to affordable health care.  It has become increasingly clear, however, that it is one more way of transferring wealth from the haves to the have-nots.  Notice I did not say from the rich to the poor because most of the confiscated assets will come from the middle class.
During his first campaign for president, Barack Obama reluctantly admitted to Joe the plumber that he found nothing wrong with redistributing resources.  It has since become apparent that this is one of his principal objectives.
What has likewise become apparent is that this strategy cannot work.  It simply cannot achieve what its architects hope.  In my book Post-Liberalism: The Death of a Dream, I argue that liberalism not only will not work, but cannot.  The Affordable Care Act provides one more example of why.
During a recent debate about Obamacare at KSU’s Marketplace of Ideas Day, I further contended that merely providing the poor with more expensive health insurance will not necessarily improve their health.  There is, I said, a difference between making a service available and accomplishing what was intended.
Afterwards, a member of the audience chided me for being hard on the poor.  I responded that this was so and for a politician would have been poison.  But I am not a politician and therefore can afford to voice uncomfortable truths.
The fact that the poor are frequently the authors of their own misery is indeed a painful truth.  Liberal sociologists term this “blaming the victim,” but it is no more than looking reality in the eye and calling it by its rightful name.
The poor, because they are poor, see the world differently.  Their social situation, not their biology, influences what they believe possible and therefore what they attempt.  Given their sundry handicaps, they are frequently fatalistic and consequently either passive or oppositional.
During the debate my opponent suggested that if provided with the proper resources and opportunities, the poor would flock to start new businesses.  I scoffed at this then; I scoff at it now.  While some of the poor may be entrepreneurial, the vast majority is too disorganized to make such efforts.
With respect to medical care, this orientation manifests itself in several ways.  First, the poor, even if they have insurance, often do not seek help.  Doctors, whom they regard as of a higher class, make them uncomfortable.  As a result, even when they have Medicaid, they tend to stay home.
Second, when they do see a physician, they are inarticulate when explaining their symptoms.  Both intimidated by the doctor and generally inartful in expressing themselves, they make poor reporters of their own conditions.  But since self-reports are a physician’s primary means of initiating a good diagnosis, understanding what is wrong becomes problematic.
Third, the poor don’t enjoy being pushed around—by anyone, and that includes doctors.  As a result, they are less apt to follow medical directions.  Perhaps they do not get off their feet when so advised or they refuse to take a prescribed medication.  In either event, their health is less likely to improve.
Fourth, the poor often have unhealthy lifestyles.  They drink too much, smoke too much, and eat too unwholesomely.   Oddly most do not even exercise sufficiently.
In other words, we can transfer money to upgrade the health insurance of the poor, but we cannot transfer good health.  Whatever the intension of liberals, if they refuse to accept these hard facts as facts, they can scarcely arrive at viable solutions.  Merely punishing the well-off to compensate for the liabilities of the poor helps no one.
This does not mean, however, that we should be insensitive to the plight of the poor.  Rather it means that if we are to help, we must help in ways that work.  Simply increasing the dependency of the poor is not one of these.  Insisting on shared efforts that promote social mobility is.
Melvyn L. Fein, Ph.D.
Professor of Sociology
Kennesaw State University

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