Visions of the Apocalypse: Not in Fire, Nor in Ice, But in the Empyting Beds of a Nursing Home
A not-entirely-stray thought, pulled out of the swamps of pre-coffee semi-consciousness by Mistermix’s post on Medicaid and Medicare below.
The evisceration of Medicaid contemplated by the Ryan-Romney ticket and party is not simply a grotesque act of cruelty to people in their most urgent hours of need. It’s not just going to kill people. It’s not just crap economics, an enemy of prosperity on its face. (Short form argument here, for the sticklers among us: un- or under-treated illness sucks productive hours and capacity out of the economy. Think of it as a labor-supply sea-anchor, dragging us backward in any wind.)
No, or rather, more: gutting Medicaid, as Mistermix points out, radically constrains access to nursing home care for way too many Americans. And with that, you get the final step in the sequence of moves that the GOP hopes to make that will, taken together, finally transform the traditional American middle class (back) into an atomized and largely defenseless proletariat
Why so apocalyptic?
Connect the dots:
In his keynote at the convention on Tuesday Mayor Julián Castro pointed out that class mobility is a relay, not a sprint. The ability of lower income families to propel children into more secure futures than their parents lived was and is a key driver in creating what is both “middle” and a “class” out of the great mass of Americans.
That is — to reach the point where your family is not always one paycheck from real trouble (my loose definition of what it means to be in the middle) you need to be able to accumulate two kinds of assets that you can transfer to your children. One is intangible: the human capital that comes with education and the increasingly wide range of entry points to the economy that such education affords. And then there are the tangible assets, which for almost everyone short of Mitt Romney territory (or at least Paul Ryan turf), means a house. The single moment when most folks acquire significant chunks of capital in excess of daily needs comes when parents die and the next generation inherits. And most of what most people inherit is the value of their parents’ house.
I’ll try to keep this short (how….novel! — ed.) The GOP policy package would not just further immiserate the poor (see Bill Clinton’s “I don’t know what those families will do”). The GOP agenda as a whole makes it harder every step of the way for someone running the first leg of that relay Mayor Castro talked about. Cuts in education, the health care tax that the well and the halt alike would pay, all the rest — and the slog gets harder and the pace slows…until, if the GOP has its way, the baton drops — or rather, is stolen — at the point one generation hands off to the next, as the cost of being old sucks up whatever savings someone might have managed to accumulate over a life time’s work.
How? Go back to Medicaid and nursing home care. Long term care is already a huge drain on the resources of the poor and the middle class. Hammer Medicaid and Medicare, kick away such a major source of help– and the net effect is that for far too many, the cost of aging will suck up everything they’ve earned in a lifetime of work. Update: to be clear, as commenter Bloix points out over at Balloon Juice, Medicaid helps those who are already basically out of assets. The point I tried to compress in that last sentence is that you get hammered either way: if you can’t get nursing home care for your broke parents, then — again as Bloix notes — you have to take them in (or abandon them…) and care for them, which is a huge drain of cash and time. And even if you aren’t broke enough for Medicaid, constraints on Medicare will put the older-generation’s assets under increasing pressure…with the net effect that the inter-generational boost that a lifetime of work and saving could provide would get sliced or slaughtered in a Romney-Ryan war-of-all-against-all world. End update.
The spectre of old people dying in poverty is not the end of it, horrible as it is. Their kids will face an sharply increased likelihood that they’ll face the same fate — because whatever cushion they might have received from even a modest inheritance will have long since disappeared into the medical-industrial complex the GOP is so determined to defend. I’m not saying all social mobility will cease — that’s absurd. But if the GOP has its way, it will be a damn sight harder to enter–and remain in– a condition of genuine economic security.
Last thought, back to the significance of the word “class” for the middle class. Those on top of the GOP heap seem to perceive a (false) advantage in a permanently vulnerable labor supply. Henry Ford and his $5 day * long since demonstrated the folly of that idea by economic yardsticks as well as moral ones, but humans — especially, it appears, Republicans — are notoriously wretched one-trial learners. Reducing the ability of American working people to accumulate wealth and education over generations leaves each person and each generation so much the more isolated. Which is, of course, the point for everyone who breaks out in cold sweat at the thought of an actual middle class forging common cause among its members.
As the Big Dawg said, there’s a damn clear choice this time around.
*Yes — the history of Ford’s tension between paternalism and profit sharing on one hand, and intense loathing of unions on the other is much more complex than this post discusses. But the underlying point remains: the creation of an economically independent working class that becomes a middle class has been proven to be an explosive generator of wealth as well as a social good many times over.
Image: Thomas Anschutz, The Ironworker’s Noontime, 1880