January 20, 2011
About Arizona

Given that the shooter seems not to have been motivated by the extreme rhetoric of Republican politicians and conservative commentators, is it logical that the shooting should focus attention on that rhetoric? Perhaps not strictly. But two points. (1) Irresponsible right-wing rhetoric didn’t become an issue with the Arizona shooting. It’s been one almost since the start of Obama’s presidency. The salience of political issues rises and falls based on many factors. If the Arizona shooting raises the salience of an issue that is after all quite real, I don’t see the problem. (Proponents of the idea that 9-11 somehow awakened us to the threat of Saddam Hussein have nothing to complain about.) (2) The shooting gives us our fullest taste yet of what could actually result from this rhetoric.

Sarah Palin’s cross-hairs map and admonition not to retreat but “reload” are almost certainly just metaphors (meant to capitalize on solidarity with the gun community), just incredibly irresponsible metaphors. (Not sure about Sharon Angle’s “Second Amendment remedies.” If it’s not a call to violence, what is it?) But even outside the “eliminationist” vein, Republican and conservative rhetoric has been, well, crazy. Let’s take some statements about the health care bill:

• Former Arizona representative John Shedogg: “What we’re really getting here is we’re not just getting single-payer care. We’re getting full on Russian gulag, Soviet-style gulag health care.”
• Rush Limbaugh: “Who are we targeting in health care? Old people. Rationing the care of old people... And then it hit me....What’s the first thing Mao se Tung did? What was the cultural revolution? He took out the educated people. He took out people who had a cultural, historical memory of China's past.”
• Tom Coburn [to seniors]: “You're going to die sooner [if health care reform passes].”
• John Cornyn: “It will limit people's choices to, in many cases, to a government-run program like Medicaid which is essentially a health care gulag, because people will not have any choices but to take that poorly performing government plan.”
• Sarah Palin: “The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil.”
• John Boehner: “We’re about 24 hours from Armageddon…. This health care bill will ruin our country.”

If I honestly believed that politicians like Barack Obama and Gabrielle Giffords were trying to establish a “gulag” (chain of brutal labor camps for political prisoners) or “ruin our country” or create a Maoist Hell or hasten the deaths of seniors, I might think assassination an appropriate response. What the above statements actually reference is a moderate insurance market reform quite similar to the 1993 Republican counter-proposal (co-sponsored by Bob Dole) to Bill Clinton’s health care reform proposal and nearly identical to the reform plan championed and signed into law in Massachusetts by a plausible 2012 Republican presidential nominee. It’s not my ideal of health care reform. But it’s a vast improvement over what we have now. It keeps the present system almost entirely intact, including the for-profit private health insurance industry. But it eliminates the system’s most barbaric aspects. It ends denial of coverage because of preexisting conditions, ends rescission, requires automatic renewability of policies, limits annual and lifetime out-of-pocket fees, ends lifetime payment caps (so tens of thousands of Americans with insurance will no longer go bankrupt each year paying expensive medical bills), doesn’t cut benefits to traditional Medicare recipients (though it cuts those to Medicare Advantage recipients), extends the solvency of Medicare, establishes free preventive care (like cancer screening) for seniors, closes the Medicare “doughnut hole,” enables children to remain on parents’ health care plans until age 27, creates an individual and small group insurance market where insurers compete on price and quality rather than by denying claims, reduces the federal deficit by (according to the CBO) $138 billion in the first decade and $1.2 trillion in the second decade, extends insurance to over 30 million Americans (thus saving the lives of tens of thousands who would otherwise die each year for lack of consistent access to health care), establishes a number of programs (like the Medicare advisory board, bundled payments as an alternative to fee-for-service in the Medicare program, and comparative effectiveness research) to find ways of stemming rapidly rising health care costs (the root cause of our problem), and much else.

Few Americans would object to many of these things. What people object to is the individual mandate, the requirement that nearly everyone buy health insurance. But two points:

(1) The individual mandate isn’t separable from the benefits listed above. If insurers are to take all comers (i.e., not deny coverage based on preexisting conditions, not rescind coverage, automatically renew policies, etc.), there must be a mandate, since otherwise people will buy insurance just when they get sick, which isn’t viable. Insurance is a fund people pay into over time. That entitles them to make claims on that fund under certain conditions. If people haven’t paid into the fund in the first place, it doesn’t work.

(2) The moral high-ground is entirely on the side of the mandate. When someone without insurance requires emergency care, the rest of us pay for it in higher premiums. If it were possible to stipulate that those without insurance will be denied necessary care, fine. There’d be no case for requiring them to buy health insurance. But that’s not possible. In the special case of health care, a decision not to buy a product is not a decision not to consume it. And that consumption must be paid for. The health care bill thus mandates that those who can afford insurance buy it and those who cannot afford it get subsidies to buy it or receive care through Medicaid.*

If one has philosophical or technocratic or economic objections to the health care bill, fine. I respectfully disagree. But anyone claiming there were “death panels” in the bill (for a description of the “death panels,” see this), or that it would create a “health care gulag,” or that it follows a “Maoist” strategy of eliminating the elderly, deserves no civility whatsoever. The use of fear in politics is common. (And it’s not always unwarranted; there are things we should fear.) But the above-cited rhetoric about the health care bill is beyond the bounds of acceptable discourse. It bears no relation whatever to what would actually happen if the health care bill were implemented. Its sole purpose is to implant fear. And by using that other age-old political tactic of repeating something so often that people start to believe it, they’ve gotten this nonsense into the mainstream discourse.

And how dangerous is right-wing violence in America today? More dangerous than left-wing violence. Serious threats to Congress-members tripled after passage of the health care bill, according to federal law enforcement officers. (Threats to Obama reportedly have been four times higher, averaging 30 per day, than they were to George W. Bush.) Looking over a list of violent acts compiled by the Coalition to Stop Gun Violence, I count 12 acts of politically-motivated violence since July 2008. (Undoubtedly there were more. These are ones that made the news.) Eight resulted in fatalities for a total of 13 killings (not including the perpetrators, many of whom were killed in these incidents). Just one, which did not involve a killing, is plausibly “left-wing” in inspiration (a radical environmentalist taking hostages). The other 11 are plausibly “right-wing.” The motives are in some cases overlapping. Four appear to reflect generalized anti-government sentiment, three gun rights, three a sort of generalized anti-Democrat, anti-liberal sentiment, two the health care bill, and one abortion (the murder of Dr. George Tiller).

In one of the most underreported stories in years, in Spokane, Washington, on January 17^th, a backpack containing an “improvised explosive device” that could have “inflicted multiple casualties,” according to the FBI, was found on the route of an MLK Day parade shortly before the parade was scheduled to start. The bomb reportedly included a remote control detonator, was packed with shrapnel, and was placed facing away from a brick wall evidently to direct the bomb’s destructive force toward the street (i.e., onto the parade route). In contrast to other recent terrorist attempts, this wasn’t an amateur affair. It’s unknown who planted the bomb. If the prime suspects had been middle-Eastern in origin or descent, is it imaginable that the story would have gotten so little attention?

Threats naturally outnumber deeds by orders of magnitude. Words don’t kill, but they almost certainly provide insight into the mentality behind some of the violence. There are many, many examples. To take one, after passage of the health care bill, concealed handgun permit owner Charles Alan Wilson left voicemail messages on Senator Patty Murray’s office phone. He said Murray had “a target on her back” and that “since you are going to put my life at risk, and a bureaucrat is going determine my health care, your life is at risk, dear... I hope somebody puts a...bullet between your...eyes.” 

The man is obviously deranged. But on the narrow question of whether one should defend oneself if one’s life is threatened, he was rational. Now why would anyone think that a moderate (indeed Republican) insurance market reform would threaten one’s life? Oh right. Prominent national figures have been saying that it will. When people are repeatedly told that a moderate insurance market reform will threaten their, or their relatives’, lives, and the media regularly channel that message as if it were a legitimate point of view, some will believe it, and some will act on it. Yes, the man was deranged. But the lion’s share of the derangement—the idea that the health care bill threatens his life—was planted in his brain by unscrupulous and/or deranged politicians and commentators, many of whom hold prominent positions in the Republican Party.

Though the Arizona shooter seems not to have been politically motivated, the event gives us our fullest taste yet of what to expect as prominent Republicans continue to paint a picture of their moderately reformist opponents as evil. Most disheartening perhaps is that the debates fanning the rancor are almost entirely without substance. The Republicans favored the current version of health care reform until the Democrats favored it, at which point they had to switch positions for obvious reasons.

The Republicans’ objective is clearly to sow enough fear to give them an electoral advantage, a strategy that seems to be working. They can also calculate, if it were a priority, that some portion of the public will take their rhetoric at face value, and literally believe that Obama’s and the Democrats’ policies will “destroy the country,” or take away their gun rights or liberties or even lives. It strikes me as mathematics that events like those described above will continue to occur, and that some may well have the scale and character of the Arizona massacre.

*This, incidentally, is why the individual mandate is constitutional. The question is whether a decision not to buy health insurance enters the stream of commerce. Your bank account (and mine) diminishes as a result of others’ decisions not to buy health insurance. This doesn’t happen by magic, but because sales of goods and services (i.e., commerce) arise from those decisions. Ergo, in this one case (and I don’t know of any others that apply broadly to everyone regardless of circumstance), a decision not to buy a product impacts commerce anf thus is within the power of Congress to regulate. For a clear account of the legal issues and of why, unless the Supreme Court "is willing to rewrite hundreds of years of jurisprudence," it will not overturn the law, see David Cole.

On a more philosophical note, one may believe that health care shouldn’t be a right. But the reality is that it is a right. If someone without insurance is dying by the side of the road, they get health care, whether they pay for it or not. Unless you’re willing to practice what you preach (and that means (a) refusing emergency medical care if you haven’t bought health insurance and (b) denying emergency care to others if they can’t pay for it), just acknowledge that health care is different from other products. It is a right.