TJ | 22nd Dec, 2017

A Tax Cut Christmas Carol

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Were the Ghost of Christmas Present to mysteriously appear in our bedrooms Christmas Eve, what sights would it show us? If the spirit truly wanted us see what the Republican Counterrevolution has done to our society it would take us to the one place where sooner or later the real victims of the recent tax cut will end up – a large urban public hospital, perhaps in Washington, D.C. The notion that tax cuts for the rich and corporations will make all our lives better is no more absurd than in the waiting room of an inner city public hospital emergency room.

In a Dickensian way the spirit would use the moment to remind us the tax bill that has the President and his allies gloating was accomplished by cutting insurance from some of the most vulnerable while the Children’s Health Insurance Program (CHIP) received only temporary funding. The spirit might also slyly note in accordance with CDC policy everything pertaining to what we might learn is based “on science in consideration with community standards and wishes.”

Christmas Eve in the ER

Usually located in parts of town that the affluent do not regularly visit unless they have to, the emergency room is often the last refuge of those who have already endured lives most of us cannot imagine. Some will never leave this place except in a hearse.

The ER is nothing like the television ERs with photogenic actors, fancy sets and soap opera scripts. The only similarity between reality and fantasy is that your first impression is of chaos. That impression is not softened by the uniformed police officer standing outside one cubicle or the traffic that flows up and down the corridor like a rush-hour freeway, even on Christmas Eve.

In the face of death what is alive here is hope. Sometimes hope is all the dedicated people who work here have to offer and on this evening they seem more determined than ever to make that gift. The eyes of patients have that strange mixture of fear and uncertainty that comes only to those who know the string has played out and now they may come face to face with the great unknown. A few patients have a look of anger and resignation after being kicked so many times that they are not sure what they will do the next time it happens.

The Ghost of Christmas Present points out patients holding sick babies who cry incessantly or sit there coughing with some malady that has gone on too long and now makes each painful hack sound like a death rattle. Others hold bandaged limbs, white clotted with dark red. Behind drawn curtains lie the hard cases who already have crossed over to that place where they have become a passive receptacle for enough tubes and wires to qualify them as cyborgs.

The Robert Wood Johnson Foundation conducted a study of these patients in New York City found:

There were large differences in patients’ health outcomes depending on which provider they typically used.

Patients who receive their care in hospital outpatient departments or hospital satellite clinics have much worse outcomes than patients obtaining care in private physicians’ offices or other settings.

Low-income patients frequently use emergency rooms for conditions that do not require immediate treatment or for conditions that could be treated in a primary care setting.

A Ticking Time Bomb

On this Christmas Eve in the ER there sits a ticking time bomb far deadlier than the 9/11 attack, unnoticed by anyone for the threat she represents. On the outside she does not seem all that different from the others, perhaps even a little better dressed than most, outwardly appearing neither as ill nor injured.

Staff conduct the initial triage workup, recording vague signs of discomfort and a slight fever and erratic heart rate. Unknown to them what looks like a bad cold or the flu is something none of them expect–and these people have seen a lot. Inside her body microbes so tiny they must be identified by a high-powered microscope are doing their mysterious, deadly work, multiplying at a furious pace, insinuating themselves into every organ as they cruise the veins and arteries without attracting the attention of any enforcement agent.

It may be the next Dengue Fever, the next Ebola, but whatever it is it will be something no current drug will stop. And our hopes and the hopes of all civilization that we will never have a repeat of the 1918 influenza epidemic ride on people who already have lost too much sleep and seen too much suffering. To catch those microbes, those treating this patient require the one thing besides money that is in short supply–time. They will need time to assess that patient, time to ponder what they find, time to seek out other opinions, and time to do the right tests and get the right samples to the right technician in the right lab–all this on Christmas Eve.

Connections & Questions

Here all the connections and questions of the last half century come to a head. Some might maintain the above scenario could not happen in the vaunted American health care system, but the system is not as vaunted as we believe, for economic injustice means some receive health care no better than they would in a third world backwater. States trying to pinch pennies have cut the benefits of the working poor, so the victims of this social triage cut back on primary care that might catch illnesses early.

We all know how hard it is even for the middle class to afford expensive prescription drugs that might knock out a deadly infection. We, too, have wrestled with the bureaucracy of our wonderful private insurers, where executives fresh out of business school make medical decisions based on charts spewed out by a computer. Knowing the true cost for a procedure requires a degree in fine-print reading.

Meanwhile ER staff are overworked, underpaid and understaffed due to cuts that have driven many public inner city hospitals to the brink of bankruptcy. The rich do not come to these places except in extreme circumstances where a few minutes might mean the difference between life and death. As for the poor, they get shaken down with all the skill of a back-alley mugger. The research that might have identified the threat of this still unknown disease also has been the subject of cuts and blatantly political decisions made with a Bible not a medical textbook.

A Systemic Impact

As for the patients, the tax cut will have a systemic impact. Lack of adequate funding for education–especially in inner city schools–means the patients may have little of the knowledge they need to understand or communicate what ails them (translators are another group that has suffered cutbacks). Reductions in college loan deductions mean fewer students can afford the long, costly road they must follow to become a physician or the even more expensive path to certification in a specialty. Meanwhile ideological rigidity has infected every aspect of the system.

The lack of media fairness probably means what little knowledge many patients have comes from commercials. In the era of Fake News and Faux News some no longer trust what they hear after years of false scares and biased reports. And if the event really occurred, it would become entangled in partisan rhetoric that causes people to deny the threat as they have with global warming. Just recall the coverage of smoking or obesity and you already have the templates.

Voting rights may not seem to impact an inner city ER, but they represent an often overlooked problem. Redistricting aided by cluster research already has diminished the clout of urban legislators who now fight for hospital funds with the suburban mediplexes that have become the direct counterparts of mega schools and upscale malls.

In a section titled “Congress Favors the Organized,” the American Political Science Association report “Inequality and American Democracy” observes that Congressional pork now feeds relatively narrow factions:

Members of Congress have directed government funds coming into their districts to specific geographic areas that vote at higher rates and provide their greatest support.

We all know who those are. Moreover, since many in the underclass no longer vote, have become cynical about the results or are deliberately prevented from voting, the desperate voices crying for help with those most basic of needs–their health and nutrition–have little impact. At a national level we need only see what drug and insurance companies have done to health care and prescription drug reform.

The Veils of Death

The most frightening part of this scenario is that one partner in the GOP Counterrevolution might actually welcome it. As any reader of the Left Behind series knows, plagues and pestilence appear as prominent features of the Last Days. They do not mark the failure of a system or a tilting of the playing field or even an inexplicable disaster, but instead signal that time when true believers shall be saved while the rest of us will be consigned to eternal damnation.

The deaths that might result from the ER scenario are at this point imaginary, but the spiritual death that is already occurring as the playing field continues to tilt is not. The Raucous Right that has so deftly inflamed this Era of Bad Feelings, likes to think anger represents a vote of confidence in their agenda. But even they must know they are riding a tiger and everyone knows tigers do not like to be ridden. In America, something wild and uncontrollable has been let loose, and no one knows where the New Year will take us.

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