Thursday, September 26, 2013

‘Obamacare’ and the Kübler-Ross effect



AT NOON on Wednesday, Texas Republican Sen. Ted Cruz withdrew the catheters and pulled out the line to his French roast IV drip, signaling the end of his marathon soliloquy, 21 hours and 19 minutes after he rose to speak “in opposition to Obamacare” on the United States Senate floor.

Cruz held forth in a literally one-man crusade against the Affordable Care Act, an effort that, if called quixotic, would be an insult to Don Quixote. He rhetorically meandered from one topic to another, his non-filibuster filibuster weaving from Nazi Germany to the World Wrestling Federation, from White Castle hamburgers to “Green Eggs and Ham.”

This wasn’t Ted Cruz channeling Jimmy Stewart in “Mr. Smith Goes to Washington” (an act of political theater [or theatrics] that Cruz’s fellow senator, Rand Paul of Kentucky, more or less successfully pulled off not so long ago). This was a last-ditch attempt to link defunding of the Act, shorthanded in the culture as Obamacare, with the continued operation of the federal government, with a meaningless expression of his opposition to the Senate voting on the bill.

The Senate voted Wednesday, 100-0, to move to debate the continuing resolution that was passed by the House, a measure that would keep the federal government open beyond the end of the fiscal year, Oct. 1. Cruz’s vote was, obviously, one of the 100.

The House bill would keep the government lights on through Dec. 15 while defunding the Affordable Care Act. Senate Democrats and Republicans have agreed to end debate over the bill on Friday. Senate Majority Leader Harry Reid is expected to strip that defunding language out with a majority vote.

On Tuesday, when Cruz’s non-filibuster started, he vowed to speak “until I am no longer able to stand.”

“Washington depends on the American people not paying attention,” Cruz said. He can bet people are paying attention now, but not like he thinks.

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The freshman senator from Texas can take some solace in knowing that his little stunt — and that’s the only word for it — has a long precedent. Cruz was attempting to exploit the almost reflexive opposition to wide-scale change Americans have shown throughout our history.

Cruz, Sen. Mike Lee of Utah and others in the Republican Party have enlisted opinion polls on their behalf; many of those surveys show the American people at least statistically skeptical about Obamacare. But if Cruz and other GOP naysayers, and the poll respondents, weren’t quite so short-sighted, they’d see how the ferocity of the current debate dovetails with other debates earlier in the national experience. In their opposition to Obamacare, the Republicans, like many others in previous American eras, stand athwart the history of our literal transformation.

As with other seismic American events, the advent of the Affordable Care Act has engendered the first part of a process a lot like some of Elisabeth Kübler-Ross’ renowned five stages of grief — only with a more favorable expected prognosis for the patient of a nation.

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FIRST, WE'VE had the denial: the health-care program that goes into effect on Oct. 1 has been roundly rejected by lawmakers and met with skepticism by the public (doubt cultivated by those same lawmakers). What’s followed in recent weeks has been anger and bargaining —much of that being played out right now on Rush Limbaugh’s radio wind machine, the Sunday-gasbag talk shows and in the coatrooms of Capitol Hill.

If the debate over the Affordable Care Act develops consistent with American history, what’s coming next will ultimately be the acceptance phase — a critical stage when affordable, aspirationally universal health care will become one of the real, functional and hopefully successful constants of life in a nation in transition.

The long road of American progress is littered with navigable hazards — the condemnations and contrarian actions of those who don’t want us on that road in the first place. We’ve been here before, more than once.

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In 1862, President Lincoln secured congressional passage of an act “to aid in the construction of a railroad and telegraph line from the Missouri river to the Pacific ocean, and to secure to the government the use of the same for postal, military and other purposes.”

He authorized two railroad companies — the Union Pacific and the Central Pacific — to build the lines. And in March 1864, he issued an executive order “respecting the points of commencement of the Union Pacific railroad on the one hundredth degree of west longitude, and of the branch road from the western boundary of Iowa to the said one hundredth degree of longitude.” This set the easternmost point of what would become the first transcontinental railroad.

He did it when the responsibilities already facing him as president — working to bind a nation torn apart by civil war amid the searing issue of slavery — would have been more than enough. Lincoln did it anyway, despite the opposition of northern lawmakers, who feared the south would use it to their military advantage. The result: Nothing less than the creation of the first infrastructure of modern America. With its completion in May 1869, by one estimate, coast-to-coast travel time dramatically dropped from five or six months to six days.

“There's no greater expression of [a] vision for the future than the transcontinental railroad,” said David Von Drehle, editor at large at Time magazine and author of the forthcoming “1862: Abraham Lincoln and the Making of America,” in a July 2012 interview with the Omaha World Herald. “The war was about dividing the country; the railroad was about bringing it together.”

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IN 1956, the Federal Aid Highway Act was enacted, authorizing the start of construction of what’s now called the Interstate Highway System. At a cost of $482 billion (adjusted for inflation in 2012 dollars), the project linked the country in much the same way the transcontinental railroad had done.

President Eisenhower passionately pursued the plan, partly inspired by his wartime travels on the German autobahn system. But Eisenhower was bitterly opposed by state governments, who objected to increase in gas taxes.

There were other costs as well. As part of a digital history project on the impact of the interstate system in Omaha, Nicholas D. Stewart, a scholar at the University of Nebraska-Lincoln, writes of how the Eisenhower plan

“surprised residents of numerous inner-city neighborhoods with rapid and unprecedented changes it brought to the metropolitan landscape. Eminent domain empowered State Highway officials across the country to take control of and demolish residential properties for highway right-of-ways without requirements to provide replacement housing. Residents of inner-city neighborhoods with lower property valuations learned firsthand that state and local officials maximized federal funds by placing depressed multilane freeways, loops, and spurs through their neighborhoods to connect central business districts to the broader metropolitan community.

“Affected individuals and families, homeowners and renters, coped with uprooting their lives and finding replacement housing. Facing economic burdens unexpected in prior years, many families took on new debt or witnessed their savings disappear in order finance a move. ...

“The freeways' disruption proposed a threat to homeownership and thus jeopardized access to or retention of middle-class financial stability for many American families.”

Eisenhower went ahead anyway, despite the principled objections of state governments and the real pain caused to tens of thousands of families. The result: the most expansive public works project in American history ultimately created millions of jobs, and completed the work of connecting the country that Lincoln had championed and enabled. What had been a reasonably reliable patchwork of roads and regional highways was transformed into a central nervous system that shuttled American business, and the American people, into the future, and defined American efficiency to the world.

Just try moving from one state to another without using one.

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It’s getting harder to remember when wearing seat belts behind the wheel wasn’t required by state governments across the country, back before New York State became the first in the nation, in December 1984, to make seat-belt use mandatory. Back when people complained bitterly about their personal rights being taken away ... back before the statistics came in proving that seat belt use saves lives.

It’s almost impossible to remember how President Kennedy’s daring conceit — “of landing a man on the moon and returning him safely to the Earth” — surprised and confused scientists and enraged other Americans after he issued that momentous gauntlet throwdown in a joint session of Congress in May 1961.

He knew what he was in for. “No single space project in this period will be more impressive to mankind, or more important for the long-range exploration of space; and none will be so difficult or expensive to accomplish,” he said that evening.

Underline that part about “expensive to accomplish.” In 1966, NASA funding represented 4.4 percent of the federal budget, according to Space.com. This was one of the economic reasons that, quiet as it’s been kept through 50-plus years of rose-colored technological reverie, there was more than sporadic opposition to the Kennedy space program.

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IN A BRILLIANT, well-researched September 2012 essay in The Atlantic, Alexis C. Madrigal writes about “the forgotten opposition to the Apollo program.” Madrigal cites the observations of space historian Roger Launius of the National Air and Space Museum, who wrote: “[M]any people believe that Project Apollo was popular, probably because it garnered significant media attention, but the polls do not support a contention that Americans embraced the lunar landing mission. Consistently throughout the 1960s a majority of Americans did not believe Apollo was worth the cost...”


Madrigal writes: “Many black papers questioned the use of American funds for space research at a time when many African Americans were struggling at the margins of the working class.” And Madrigal looks at the downbeat assessments of sociologist Amitai Etzioni, then of Columbia University, whose 1964 book, “Moon-Doggle: The Domestic and International Implications of the Space Race,” laid out a case against a manned space program.

And Kennedy pressed ahead with the program anyway, as did his successor Lyndon Johnson, despite the other foreign and domestic entanglements that awaited each of them. The result: A wider view of the human frontier; a more expansive scientific and technological body of knowledge; a growth in companies and industries related to these still-emerging technologies; and finally, for those of us shackled to life on this third stone from the sun, a bigger, bolder, wider sense of ourselves and our potential as human beings.

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Since the United States became a nation, somebody’s always said No. It’s too expensive. It’s too outrageous. It’ll never work. It isn’t popular. There’s no market for it. Nobody else has ever done it before. It’ll change everything and what we have now works fine.

It’s been true since before the United States was a nation. People were prepared to say No to the United States itself: “[I]n the years leading up to the Revolutionary War, as many as a fifth of those living in America wanted to remain British subjects,” Cynthia Crossen reported in The Wall Street Journal in July 2006. “Probably at least that many again were apathetic or opportunistically waiting to see which side won.” We have a habit of not seeing the bigger picture, until we do.

The Affordable Care Act stands poised to join the other national transformations we couldn’t imagine — from the transcontinental railroad, which marked the grid of our national ambition, to the interstate highways that defined that grid in modern times; from the ATM machine, which changed our sense of the plasticity of money, to the personal computer, which literally transformed the process of communication; from Social Security to Medicare — until they seeped into the bedrock of everyday life. Until people traveled the path from denial to acceptance.

President Lincoln understood how this works. So did Presidents Roosevelt and Eisenhower and Kennedy and Johnson. So does President Obama.

And so did someone who was never president. So did Steve Jobs, whose personal computers changed everything. “A lot of times,” he said, “people don't know what they want until you show it to them.”

Also published at Medium.com. Image credits: Cruz top: Jim Lo Scalzo/EPA. Cruz lower: via Senate TV. Lincoln: Portrait by Alexander Gardner, 1865. Union Pacific Railroad logo: © Union Pacific. Eisenhower: public domain. U.S. interstate highway system: wrongplanet.net. Kennedy: NASA.

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