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Economists have had fun with off-the-wall theories like the skirt length economic predictor which says that shorter skirts herald economic good times and long skirts bad ones. Despite its sexist outlook this theory has largely held true through the 20th century, allowing hundreds of professors teaching beginning statistics courses to deliver lectures on the difference between correlation and causation.
In the interest of giving them something else to add to their courses I propose the reality TV theory. It suggests that during depressions we see more reality shows. Since we didn’t have television before the 1950s, the counterpart of reality TV were shows on the radio and in local theaters featuring amateur performers.
Today network and cable television are dominated by reality shows, whether the latest weirdo to seek counseling from Dr. Phil, the newest villain on Survivor or the would-be star who feels the sting of Simon Cowell’s signature comments. You would think they would be running out of Americans willing to make fools of themselves in front of millions of people but that does not appear to be the case. Jerry Seinfeld must be short of cash because the man who once starred in one of America’s best sitcoms has signed on to be a marriage referee.
Amateur Shows in the Great Depression
During the Great Depression there were also a lot of reality shows most of which enticed people not with the promise of 30 seconds of fame but the hope earning a few extra bucks. There were the amateur hours that inspired American Idol that appeared on local radio stations and the national networks. Local ballrooms and theaters sponsored their own contests.
The most notorious of all were the dance marathons in which couples endeavored to stay on their feet for days at a time. The contests began in the late 1920s, but took off during the Depression. Dance marathon historian Carol Martin reports that nearly every American city of 50,000 people or more hosted at least one endurance dance marathon. According to Martin dance marathons were the number one public entertainment of the Great Depression’s early years. If you want to know what they were like rent a DVD of the film They Shoot Horses, Don’t They.
The trick was to perfect the art of switching off sleeping on your feet as your partner literally held you up while trying to make it appear both of you were awake. With some of the contestants half starved when the ordeal began, bodies would drop in heaps as the hours ground on until only one couple remained to take home the prize money. Some contestants went from contest the contest, especially the ones adept at the little tricks you needed to know to stay on your feet.
Historylink quotes June Havoc’s attitude towards the marathons, one that sounds strangely descriptive of today’s reality shows:
Our degradation was entertainment; sadism was sexy; masochism was talent.
Amateur Night in Two Eras
As Havoc suggests, there is in the reality contests of both eras a willingness of the contestants to publicly debase themselves for the chance at fame and fortune. More germane is the big picture which tells us that the harder the times, the more people are willing to do anything to grab the brass ring that holds out the possibility they might just be able to pull out of an impending crash.
There are also differences. The contests of the Great Depression were trials of endurance. Being able to stay your feet for days represented the situation too many Americans found themselves in during those turbulent times. Today’s contests have a different dimension. If the Depression’s contests demanded endurance, the reality shows of what some are calling the Great Recession require an all or nothing gamble. The odds of winning American Idol are infinitesimal; the reward immense.
Health Care Bill Realities
This brings us to health care. Like the contestants in contemporary reality shows the various sides in the health care debate seemed engaged in an all or nothing gamble. There is talk of reconciliation, the nuclear option and filibusters.
As someone who has read the entire telephone book-thick bill and as a person living on disability, to me the most important part of the health care initiative has always been the section on preexisting conditions. The insurance companies actually fear this more than they do a public option which is why they continue to fight the bill even with the public option removed.
Here is what they are fighting:
‘SEC. 2705. PROHIBITION OF PREEXISTING CONDITION EXCLUSIONS OR OTHER DISCRIMINATION BASED ON HEALTH STATUS.
‘‘(a) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage.’’With respect to the premium rate charged by a health insurance issuer for health insurance coverage offered in the individual or group market—
‘‘(1) such rate shall vary only by—
‘‘(A) family structure;
‘‘(B) community rating area;
‘‘(C) the actuarial value of the benefit;
‘‘(D) age, except that such rate shall not vary by more than 2 to 1; and‘‘(2) such rate shall not vary by health status- related factors, gender, class of business, claims experience, or any other factor not described in paragraph (1).
The Devil Is In the Details
It is a simple but revolutionary change. The problem with this relatively straight-forward language is that with the insurers whispering in their ears, politicians, pundits and bloggers are purposely trying to make the issue more complicated than it needs to be. They ask: how do we define a preexisting condition (did they read the bill)?
Then comes the “this provision will bankrupt us” argument. Insurers whine that if they have to accept sick people that it will saddle them with massive costs even as insurers raise rates and rake in record profits. This prompted the inclusion of the notorious “everyone has to have insurance” provision to the bill, the idea being that if you broaden the pool of the insured that spreads the risk. The insurers and their allies cry this is “socialized medicine” and “big government.”
The problem with this argument is that you don’t hear people whining about having to carry auto insurance. Why should health insurance be any different? Right now there is a cohort of the uninsured that is essentially young and healthy. They don’t carry insurance because they don’t think they need it. Then they show up in the ER after a car accident. The argument that people should not have to have health insurance because they are healthy is about as specious as my arguing I shouldn’t have to carry auto insurance because I am a safe driver.
The Importance of the Preexisting Condition Clause
A preexisting condition clause is revolutionary for two reasons. The first one is obvious, the second has been little noticed. Its power lies in the fact that this marks the first time the government has dictated fundamental terms to insurers. Once the precedent of eliminating the preexisting condition provision is established (and watch the insurers take this straight to the Scalito Supreme Court) it will open the door for the government to dictate other terms.
The problem is that like contestants in a dance marathon the Democrats seem to be running out of steam. With the heat being turned up to include a public option, the preexisting condition section has become an afterthought for some and a bargaining tool for others.
Are They Going to Scuttle the Preexisting Condition Clause?
There are reports there is some movement to drop the preexisting provisions section or restrict it only to those under 19. Gutting this portion of the bill would be a tragedy. Then the bill would be truly meaningless.
Blogger John Aravosis was the first to alert everyone to a change in the language being used by the Democrats. He put it plainly:
The only reason to specify that children under the age of 19 won’t be denied coverage is because you plan on letting everyone 19 and over BE denied coverage for pre-existing conditions. Even the lousy Senate and House bills outlawed that. But here’s the rub.
Joe Sudbay, his colleague on AMERICAblog, followed up with an essay that did as good a job as I have seen at defining what is at stake:
Hard to imagine how the Democrats can convince the American people that health care has been reformed if insurance companies aren’t reined in on the pre-existing conditions issue. Only people living in an out-of-touch bubble would think that’s a good political move.
The Consequences for Obama of Weakening the Preexisting Condition Clause
As Sudbay and others remind us, getting rid of the preexisting condition clause was right at the top of Barack Obama’s to-do list. Under the heading Make Health Insurance Work for People and Businesses — Not Just Insurance and Drug Companies the very first bullet point states:
Require insurance companies to cover pre-existing conditions so all Americans regardless of their health status or history can get comprehensive benefits at fair and stable premiums.
The implication is clear: if the final health care plan does not include this provision or slices it into meaninglessness, the Obama Administration will have lost all credibility and along with it what is left of its base.
Staying On Your Feet
If I were the Obama Administration I would position the thousand plus pages of the health care reform bill very simply — the bottom line is preexisting conditions. This will smoke out the insurance companies and put the Republicans in a tough spot for next fall. Any Republican who votes against eliminating the preexisting condition clause will find that vote hard to defend.
There is a lesson here we can learn from the dance marathons of the Great Depression: it’s not about winning a million to one shot or getting yourself on TV, it’s about staying on your feet.
If the Administration can successfully paint the Republicans into a corner over the preexisting condition provision, then it can perhaps increase its majority rather than lose it. Framing the debate around preexisting conditions is also a win/win for the Obama Administration. It can grab the high ground it has lost with its thousand-plus page nightmare by standing firm on eliminating the preexisting condition clause.
Obama’s Press Conference Bombshell
Unfortunately the proposal released this morning by the Obama Administration does not follow this path. Preexisting conditions are mentioned only briefly and cryptically. It states:
It will end discrimination against Americans with pre-existing conditions.
And then says nothing further about how it will do that, only adding fuel to the fire of rumors about modifying the provision.
I waited to post this until the briefing by White House Press Secretary Robert Gibbs. It was ominous enough that the briefing was delayed a half hour. Either you have your act together or you don’t. Thirty minutes will help even less than last-minute cramming for a college exam.
A key moment came early in the briefing when Gibbs was asked what the President would not compromise on. Tellingly he left preexisting conditions and the public option off this list. His answers to other questions resembled the staggering motions of an over-fatigued marathon dancer.
Then came the bombshell. After an hour of wobbling on his feet, Gibs was asked about the reports that the preexisting condition clause would only apply to children. He answered that the provision would go into effect immediately for children but would be phased in for adults. He did not go into detail about the phasing or what would be phased.
If this is the Administration’s new position it means the game is over. Barack Obama has backed off from what he said was his number one priority. Without a meaningful preexisting condition clause this bill deserves to go down as a failure.
Gibbs’ Press Briefing as Dance Marathon
There were moments in a dance marathon where the combination of lack of sleep, inadequate food and being on their feet for days would cause contestants to lose touch with reality. They would babble incoherently or see things that weren’t there or break out in frenzied movements.
Press Secretary Gibbs seemed on the verge of that today. The change he seemed to indicate in the preexisting condition provision suggests either he or others at the White House have lost touch with reality and with their own principles.
The Public Option
Gibbs also all but ruled out the public option, meaning that the two provisions that made the original plan a genuine reform have vanished. The public option was always a bit of a stretch, but the President and Congress had the courage to put it on the table.
Last fall five Democrats on the Senate Finance Committee voted against the public option defeating the provision before it even reached the floor. Meanwhile in the House the Blue Dogs have also been noticeably cool to the public option.
Do we give up the fight for the public option? Of course not. Why? The 2008 report of the World Health Organization states:
The health sector can take significant actions to advance health equity internally. The basis for this is the set of reforms that aim at moving towards universal coverage, i.e. towards universal access to health services with social health protection.
The 2009 WHO statistical report shows the mediocre performance of the American health care system. Our under five mortality rate ranks with that of Slovakia and below almost every European country, Thailand, Singapore, Korea, Japan, Canada and, yes, Cuba. This is inexcusable and falls squarely in the laps of America’s HMOs and other insurers.
If this situation is allowed to continue this country will be in deep trouble.
Abortion
BTW it is interesting how many so-called liberal bloggers seem willing to leave abortion restrictions in the bill as long as they get a public option. Sorry, but a public option with the Stupak Amendment is not a public option for American women. Eliminating the abortion restriction is right up there with eliminating the preexisting conditions clause as a no compromise issue.
I was appalled that no one asked Gibbs about the Stupak Amendment during the press briefing. It was a question that demanded to be asked.
The Need for Action
With the White House and Congress looking like fatigued contestants in a dance marathon, it now comes down to whether each of us are willing to do the hard work it will take to save health care. That means writing op ed pieces, letters to our Congressional delegations (and the White House), jamming the phone lines and email boxes, and, above all, talking to our neighbors. If each of us would talk to five people that might help to turn the tide.
There is little question that most Americans are fatigued by this marathon health care dance. This is causing many to consider dropping out. That would be wrong.
We need to make this President get some backbone and stand up for his own principles. It is the future for our children that is at stake. Do we want them to grow up under a health care system that is worse than Cuba’s?
To the Readers:
If you are a regular reader of this blog you probably wonder what has happened over the past few weeks. You also know that this blog believes in people taking action. All talk with no action will get us nowhere. So in the past few weeks I have been trying to walk my own talk by testifying before a legislative committee about school funding, working on an environmental grant project with a state agency, helping to try to save my local school district, serving on a community commission and seeking grant funds to reinvigorate my community. The draft of the follow-up to Strange Death has also reached a critical point.
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