“You either trust . . . your state . . . or you don’t”
May 8th, 2017 by Dr Karma

I’m a federalist.

I’m an American, so I should have the same rights in each state.

Thus, I had a knee-jerk negative reaction to Oklahoma Congressman Tom Cole’s discussion of the Republican health care plan on Morning Edition last Thursday. He did the typical Republican move–demonizing the federal government while making moves to allow the states to deny care to their citizens:

“But at the end of the day, you know, you either trust your governor and your state legislature or you don’t. In my case, I do. And it’s far easier, if they make an error, for people to frankly correct them and — or fire them if they need to, than it is to deal with a sort of faceless, federal bureaucracy that’s in many cases thousands of miles away.”

Having grown up in the South, I don’t trust state or local government more than I trust the federal government. Why was I taught that evolution was wrong in a public school? Because of local decisions. Why was my history teacher forced to pretend that the world was created 6000 years ago? Because of local decisions. Why was my doctor not allowed to talk to me about all my options for care when I was pregnant? Because of local decisions. Why was my aunt not able to get healthcare in the South even though she’s disabled? Because of local decisions.

Of course, I can point to a lot of federal decisions that have been awful too, but there are two important points to consider. First, and this is our fault, voters don’t usually pay attention to or vote in local elections. Second, the federal government–with its constitution–tends to move toward equality–and that’s where my values lie. The constitution says I shouldn’t have been taught Christian b.s. in a public school and recognizes my right to disagree. The federal government’s position is that my queer friends have the same rights that I do, that my Jewish neighbor has the same rights as her Christian ones, that my students of color deserve the same opportunity as their white counterparts, that my disabled staff have equal access to a job, etc. etc. etc.

But the Republican move is always to “let the states decide.” To decide whether your disabled child can go to public school. To decide if you can have access to healthcare. To decide if you can be married to your partner.

We’re American. The “state” I live in shouldn’t decide whether I’m equal to my neighbors. I am.

The end of Cole’s interview really brought the point home for me about trusting the states: “Look, I live in a state where we’re down to a single provider who’s losing money. We have a 69 percent rate increase coming for people that don’t have — aren’t subsidized in the pool. And finally, because we’re not a Medicaid expansion state, you know, we’ve got hospitals taking care of classes of patients that in other places they get compensated for — not here.”

We’re not having those problems in California–because California didn’t fight Obamacare. In other words, it shared the federal government’s move toward equality.

It’s that last line that gets me–he doesn’t live in a Medicaid expansion state, so he’s upset because uninsured patients are costing his state a lot of money.

In other words, his state chose to leave a significant portion of its population uninsured. Each state’s budget office can confirm it would make fiscal sense to expand Medicaid. But states like his didn’t. It left its people in danger. It left itself in a bad financial state. Why?

Because it was “Obamacare.”

No, Mr. Cole, I don’t trust the states to always do the right thing for their people, especially states like yours.

I’m Gonna Miss Obama
Jun 23rd, 2016 by Dr Karma

Republicans like to talk about how they’re going to kick Obama out of The White House next year–it always sounds weird to me–he couldn’t/wouldn’t stay no matter how the vote turns out. They know that, right?

Naturally, I have a preference for how the vote will turn out, but no matter what, I’ll miss Obama.

He has not been a perfect president, but no one ever has.

Am I disappointed by some things? Yes–many. For example, Obama has deported more undocumented people than W did.

Conservatives should love that.

He’s actually done a lot of things that conservatives should approve of–the deficit has shrunken (it initially went up under his rule because he added our foreign wars to the official budget–under W, they didn’t count) by quite a lot. We are in better economic shape than we were in 2008. Bin Laden is dead, along with lots of other terrorist leaders.

It’s also hard for me to solely blame Obama for the failings I see. Republicans began by saying they would work to block every single thing he wanted. And they’ve succeeded in blocking many things. They have also inflamed a part of their base that now embarrasses them–the moderate conservatives I grew up with have been replaced by amazingly unreasonable people–Tea Partiers, overt racists, Palins, and Trumps. Their reactions to him are hysterical (in the older sense of the word): he’s not American; he’s not Christian; he only pretends to cry when children have been gunned down. The latest: that he’s actually on the side of the terrorists.

(I would note, of course, that the terrorists and the Democrats are at odds. We like feminism and gay people and secularism and humor, etc.–they are in fact more conservative about these things. They want to make the world “great again”–but they want to go back to the 700s instead of the 1950s.)

I grew up Republican. I have a deep sense of sadness when I watch those 70s and 80s politicians trying to retain control as the base spirals. My soul hurts when I see my family spiraling down with them.

When Obama won, my mother and I had the following exchange:

Mom: Obama is going to take our rights away as white women.

Me: Which ones?

[LOOOOOOOONG silence.]

Me: ‘Cause as a straight educated white American woman, I have more rights than the majority of the people who’ve ever lived on this planet. I have more rights than some of my friends. And I can’t think of any that Obama could actually take away.

[She changes the conversation.]

Obama has not, in his time in office, taken away my rights as a white woman.

I hope, in fact, that whoever takes the office will continue his work.

Here are a few things I’m happy about:

  • I’m in a better position than I was eight years ago, financially. (Many elections ago, that’s what voters were asked to consider as the basis for their vote.)
  • My disabled aunt has access to healthcare. For those who know me, you’ll know I had to take her in a couple of years ago for a while–in the South, which rejected Obamacare despite their own budget offices reporting that Obamacare would save them money, she wasn’t able to get it. She was going in and out of emergency rooms (those bills will forever be unpaid), but not getting fixed, not getting to really see a doctor, not getting prescriptions she could fill.
  • I have access to more services under Obamacare. For example, my chiropractor, who is not in my insurance network, was able to recommend therapies to my insurance company–a new communication feature under the legislation. I now have a new TENS unit, a traction device, and a back brace for prolonged sitting–none of which I had to pay for–because of my chiropractor’s argument.

Do I wish we had a single payer system? Yes, but Obamacare is better than what we had before.

  • Workers are being paid better and slightly more equally. Minimum wage is going up (although it still hasn’t caught up with inflation); overtime pay has been extended so more workers are eligible for it; Obama supports equal pay.
  • He has proposed cutting funding for abstinence-only education, after it had been expanded by W. Every study show that it doesn’t work–rates of teenage pregnancy, rates of divorce, and rates of venereal disease are at their highest in the states that support it. Studies also show that those kids still have sex–abstinence only delays virginity loss by a bit, but raises–dramatically–the likelihood that they won’t use condoms.
  • No child left behind is gone. I don’t love every part of the new education plan (to be fair, I don’t love every part of any plan that I can think of), but it’s SO much better than NCLB.
  • Changes have been made to help Native Americans–our invisible and most oppressed and most victimized minority. Native women, for example, are raped at alarming rates (and that’s within a country that already has high rape rates). This legislation attempts to address this and other issues.
  • We have opened relations with Cuba, which is long overdue.
  • This administration has done more to support LGBTQ rights than any other. The backlash is, predictably, absurd.

Here are five things I’ll miss:

Have any other presidents talked about Finland’s music (and how it relates to good governance)?

Has any other president called himself a feminist? Obama seems to care about and respect women–and by acknowledging that he is a feminist, he also signals that “women’s issues” are human issues. Oh, and he’s against sex shaming, which is awesome, cause I’m one horny feminist, and it’s good to know my President supports me.


Has any other president included we “nonbelievers” in the list of Americans? No–most ignore us or conflate us with those who either aren’t American or who aren’t patriotic. But we nonbelievers can believe in America.

Depending on who’s elected, I’ll miss my break from having to explain the electorate to foreigners. When W was in office, I was constantly having to explain how he was our President, especially in the second term. I would usually start with “let me tell you about the South.”

Not every foreign person I know loves Obama–many are critical of the drones–but they don’t question how he exists as a leader–the basic fact of him is comprehensible.

As an American, I am deeply ashamed that Trump is the nominee of the other party–it manages to reflect badly on all of us. If he’s elected, I’ll be torn between a desire to be out of the country as much as possible and worrying about how I’ll be able to show my American face to the rest of the world.

But most of all, I’ll miss his sense of humor.

I hope his post-presidency work is just as awesome as Carter’s and Clinton’s have been.


A lack of empathy
Oct 7th, 2013 by Dr Karma

Usually, I can understand why the other side is doing what it’s doing, even if I don’t agree.

I understand that pro-lifers put the life of a fetus above everything else, even above the fact that the outlawing of abortion has historically been correlated with higher rates of abortion. I don’t think most pro-lifers are evil (the ones who would murder for it are)–I just wish they would put their energy into assuring that women have access to good birth control and sex education and that the babies who are born are born with good health care etc., since I find it SO problematic when lifers are fine with letting babies, but not fetuses, die.

I get the fiscal libertarian view, which is: “this is my money, don’t touch it. You and your child can go die in that ditch, there, no–that’s my ditch–THAT ditch over there–the one off my property.” I do think it’s evil, but I get it.

I get why the Republican leadership are against Obamacare. It’s because they’re on the side of business. They want the insurance company to have the freedom to spend as much of their profit on their shareholders and paperwork as they want (Obama wants them to use it on patients). They want the insurance company to have the freedom to not insure me, to turn me down for procedures, to drop me when I get too expensive. They tell me they don’t want the government to get between me and my doctor–that’s the insurance company’s job!!! I get it.

But I don’t get the shut down.

The law passed.

We elected the guy. Twice.

When W got elected the second time (the first time, really), he said he had a mandate and that he was going to use it.

Republicans ignored the law and the mandate and sued, and the Supreme Court said sorry, and so here we are.

I’m trying to imagine applying this logic to my life. There’s A bill I don’t want to pay. So I don’t pay any of them. And I tell the people I owe money to that it’s what they want and that it’s for their own good. It’s for their freedom!

I think I’d get locked up. I would at least get sued and kicked out of my house and a bunch of my shit would stop working. Republicans are half complaining that national parks are closed and half crowing that only the national parks are closed (not true–lots of things are affected–but they haven’t decided on just one message here).

And I can’t get my head around it. When I hear people say we need to find a compromise with these people, I scream, “No, we don’t!” or “What compromise?”

And this is how America becomes divided.

What We Talk About When We Talk About Healthcare
Jul 4th, 2013 by Dr Karma

My job during my frequent trips to London is to try to explain Americans and American policy to our former cousins.

When I was first there in 2006, I had to explain how it was that W had gotten a second term.

Now they want to know about healthcare. About how people can believe that it’s okay to let your fellow citizens die for lack of it. About how we would resist a single payer system when it would cost less and deliver more. About why we think everyone having health insurance (the way all car owners have car insurance) would somehow make us all commies.

I can’t always give answers. I don’t know why members of my own family believe that if you don’t have insurance, due to its expense or due to pre-existing conditions, you should just be allowed to die. But they do. One told me that it was a shame, but it wasn’t his responsibility to keep anyone else alive–staying alive is a personal responsibility, you see.

It was Christmas, and we were told to stop arguing, so I didn’t say that other people’s tax dollars pay for his children’s school, blah, blah, blah.

I can’t explain these positions because I can’t even begin to follow the logic. My mother is furious right now because her sister is ill. Due to pre-existing conditions, my aunt has not had health insurance in decades. No primary care physician in their area will take her. No specialist will see her. Rather than looking forward to January, when the pre-existing condition problem won’t be a problem, or when Florida finally allows its healthcare program for the poor to be expanded, my mother’s response to this situation is to say:

“This is how it’s going to be for everyone when Obamacare kicks in.”

When asked to explain, she says she doesn’t “believe” that my aunt would be able to get health insurance under the new regulations. Instead, she believes that the new rules will mean that because my aunt doesn’t have insurance, the IRS will take away her house.

No, I can’t explain that to people, who, even though they don’t live here, understand Obamacare better than that.

(By the way, I’m not entirely happy with Obamacare. I would rather have a single-payer option. But I think the changes under Obamacare are better than what my family’s political party wanted to do–to blame my aunt and people like her for not having insurance and to watch while she suffers.)

What I can do is explain that many Americans have myths about the British healthcare system. That people believe Brits have to wait forever for care, that they can’t choose their doctors, that the quality of their care is low, that the government makes their health care decisions, and that they don’t like their own system.

These myths surprise my British friends.

The other thing I can do is challenge the myths they have about our system. Most of these myths are about what life is like for those of us with insurance.

Surely, they think, if my company and I are going to pay WAY more for my healthcare than it costs in tax dollars in the British system, I must have it good.

Then I explain some things:

1. My insurance company makes a lot of my health care decisions. These decision come in the form of them telling me that I’m not allowed to have something the doctor wants me to have. Yes, while the other side is terrified of the government deciding which asthma medicine I can be on, they are fine with a company making that choice–a company who bases that choice on their own profit.

2. I have to wait for care. Every time I need to see a specialist, it takes months. Once, when my son really needed to see an ENT doctor, my GP had to mark “urgent” on the referral to guarantee that he would be seen within two months. Insurance doesn’t guarantee prompt care.

3. Although I have insurance, I could still easily go broke due to medical costs. In 2001, I had insurance. I also had a significant health issue that ended in surgery (although the surgery didn’t completely resolve the issue). I spent over 1/3 of my gross income that year on healthcare. As I was a single mother making less than 20,000, it should come as no surprise that I am still dealing with medical debt from way back then.

In May, I was in an emergency room. A doctor came in and said I needed surgery and that he was going to call an ambulance to transfer me to a hospital that could do it. I am now supposed to pay over $800 for an ambulance that a doctor called for me.

This blows my mind. It blows the minds of the Brits.

After I explain how our system works, our cousins don’t envy us. And they don’t just feel sorry for Americans without insurance. They feel sorry for Americans with it too.

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