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Wednesday, September 22, 2004

Health care is a class issue

Not that anyone isn't aware of this, especially after all the discussion of a universal health care plan and the patient's bill of rights we got instead of any kind of comprehensive health care plan.

That doesn't mean that everyone agrees on whether or not health care is a privilege or a right. Most people fall somewhere on a spectrum of beliefs on whether it's a privilege or a right, believing for instance that plastic surgery is definitely not a right, but getting emergency care if you're having a stroke is. The struggle is in the gray area between those two extremes. Is prenatal care a right? Cancer screening? Antibiotics for a cold?

Conservatives are getting better all the time at redefining certain procedures as privileges all the time by changing the subject from patient rights to provider rights. By getting people to discuss whether or not someone should be forced to provide a service, they erase the issue of whether or not a patient has a right to that service or not. That discussion just disappears.

And the class of people whose rights are under direct attack right now in this backhanded way are women. Anyone who is paying attention is bound to have noticed that seemingly overnight an onslaught of pharmacists have taken it upon themselves to decide whether or not women deserve to have their birth control pills or not. Now a bill has been snuck through the House that has limited a woman's right to reproductive health care to the whims of the provider's "morality". Of course, it isn't defined that way. It's defined as a provider's right to distribute services according to his beliefs.

What kind of abuse can happen when we stop seeing health care services through the eyes of the patient receiving it and his/her rights and start seeing it as a service like any other that can be withheld according to the whims of the provider? Or even worse, what happens when we focus exclusively on preserving the "morals" of the provider as a priority over care of the patient? Well, we have a great example on hand from the Taliban. In their eagerness to preserve proper relations between men and women, they made it illegal for male doctors to ruin their "morality" by touching female patients. And eager to preserve the "morality" of women, which we all know is ruined by vulgar work, they banned women from practicing medicine themselves. Oops, they forgot to figure out how women are therefore going to get any kind of medical care. And women died.

Don't think it can't happen here. Christian "morality" has already become hyper-focused on sexual "morality" for most people. My daily missives from Focus on Family and other right wing Christian organizations are downright tedious in their focus on criticizing gays, single women who have sex, teenagers who have sex and women who have abortions. As people become more enamored of strict sexual morality, we can only expect more and more health care providers who consider themselves Christian to take it upon themselves to refrain from caring for women whose sexual behavior they disapprove of.

How is this a class issue? Well, a woman with a good health plan who finds that her gynecologist has found Jesus and now wishes to punish her for having sex with as many blessings of children as possible is free to go elsewhere. But women who rely on public clinics are at the whims of the providers at those clinics now. This is no small thing. When I was in college, our free clinic for the students was under Vatican control and therefore didn't give out any contraception. Luckily, this is a big city, so I just went to Planned Parenthood. But if we didn't have a Planned Parenthood, we were shit out of luck.

But this is way beyond just women and reproductive services. By getting people to agree that providers have a right to decide whether or not to provide services on a case-by-case basis, conservatives have a great chance to expand the class war in health care. Now that the genie is out of the bottle, the survelliance of the behavior of poor people can expand dramatically. There are all sorts of health issues beyond contraception and abortion that create judgement possibilities between the provider and the patient--everyone from AIDS patients to people with lung cancer can be viewed as sinners who are being punished for misbehavior.

In the long term, the focus on provider rights to withhold care over patient rights to certain services could expand into punishing people for just being poor outright. There is already a lot of this going on--if nothing else, the enormous medical bills presented to those who already cannot pay for emergency care are straight up punishment for the sin of being poor. If providers can withhold care simply because they disapprove of a person, why not expand that to the right to withhold care because a person can't pay? Or because a person is an illegal immigrant?

The long-term consequence of these morality clauses is that the poor will be singled out and punished for being poor even more than they already are. It's a real shame the way that so-called Christians are allowing themselves to be used by the Republican party to justify policies that escalate the class war. Any Christian who supports this sort of thing really needs to stop and consider how Jesus really would feel about cooperating with politicians who have declared open season on the poor.

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