In “Romeo and Juliet,” Juliet claimed, “A rose by any other name would smell as sweet,” the oft-quoted and obviously naïve line of a hopeful romantic. But of course, in today’s world of spin, labels are used to indicate meanings that often reflect little reality.
Today the label is everything. Unfortunately, this campaign season and its vitriolic aftermath all too clearly have rendered Juliet’s words as dead as their speaker. It’s the label that determines the traits for our modern observer rather than the traits determining the label.
Word parsing and redefining have never been more obvious, yet still effective. Take Chris Matthews’ show and his relentless framing of all things Republican as “white” (in implied when not expressed contrast to diverse). He knows that ultimately the public will perceive of Republicans as white guys with property, ignoring and marginalizing any other person who for any reason might consider a Republican viewpoint. It’s offensive, it’s inaccurate, but it works.
Ultimately today’s Republicans will be seen as white guys of property, regardless of the color of their skin or property holdings. Republican will be the new synonym for Racist. Similarly racism today only refers to any white person mentioning any race other than white in any way.
The same flawed and inaccurate process pervades healthcare reform. When the Supreme Court upheld the Patient Protection and Affordable Care Act, unhappy Republicans listened as the individual mandate was upheld based on the simple renaming of a penalty as a tax. What could not be done by one means was accomplished by another merely by changing its label.
The Act itself called the individual mandate a PENALTY and explained in section 1501 (a) (1) through a strained justification that the provision was lawful under the commerce clause because it is “commercial and economic in nature and substantially affects interstate commerce.”
Refer to the Act and its language for what happened. ACA, Subtitle F, Shared Responsibility for Health Care, Part I, Individual Responsibility, Section 1501, Requirement to Maintain Minimum Essential Coverage added Section 5000A, Requirement to Maintain Minimum Essential Coverage and in (a) provides that “for each month beginning after 2013,” (effective January 1, 2014), an “applicable individual and any dependent of the individual “ must be “covered under minimum essential coverage for the month” or under Section 5000A (b)(1) “there is hereby imposed a penalty.”
(The Supreme Court upheld the law but rejected its classification as a penalty and called it a lawful tax in National Federation of Independent Business et al v. Sebelius, Secretary of Health and Human Services et al.)
Oh, for Juliet, and the disproving of her quaint language about roses. A penalty by any other name was not a penalty which would have been unlawful, but a tax that was lawful. But it happens all the time. In our efforts to streamline communication we’ve designed labels as shorthand for description and many times we’ll read no further than the label.
Consider Mitt Romney and his language of self-deportation where he argued that by enforcing immigration law illegal aliens….uh hum, undocumented immigrants, would no longer be given preference over those legally pursuing citizenship in the U.S. and would return to their country of origin.
Self-deportation is a made-up label that Mitt Romney used to describe a process whereby through enforcement of immigration laws those of legal citizenship elsewhere would voluntarily return to their rightful countries or proceed legally to become US citizens. While the word deportation was the wrong word since deportation implies an outside force such as a government sending a person from a country, self-deportation was a made-up word because it described an individual’s choice to return to a country of legal residence.
Weeks after the election we see where Mitt Romney went wrong as even the most liberal commentators tell the story of “Reverse Migration,” where individuals are returning to their homes of citizenship because things are tough in the U.S. for a variety of reasons including enforcement of immigration law…sounds a lot like self-deportation, but is considered to have a different nature because of a more palatable label. Somehow the same actions and inactions that constituted Mr. Romney’s description of self-deportation are OK when called reverse migration.
Now, we face the “Fiscal Cliff,” and the infuriating discussion of “Entitlements.” This word needs to go, because while it may be OK under Juliet’s theory, Juliet is dead and the age of “spin” has numbed our brains to anything but the most repetitive use of emotionally charged language.
Technically, perhaps Medicare could have once been considered an entitlement according to an outmoded definition that includes the creation of a right by law or contract. But somewhere along the line “entitlement” became equivalent to “handout” which has an entirely different nature and attributes currently associated mistakenly with Medicare and Social Security.
Only in the world of government is a BREACH of CONTRACT given such a benign name as entitlement subject to removal by the sweeping pen of lawmakers. The consideration paid by every taxpaying American is years of payments going to support these programs.
It is not argued here that government cannot breach its contract with Americans, it is argued here that Americans should be made whole, in the language of the President, because” it’s the right thing to do.” An 18-year-old should recover his or her contributions to the programs and the 54-year-olds, those subject to the new arbitrary cutoffs of getting what they paid for should receive refunds of what they’ve paid in.
As it was when I posted in August based on the government’s budget it’s a myth that ONLY reducing entitlements will solve our problems, (See: “The Mean-ing of America: Elderly, Children and Women First? Think Again.”). But we’re comfortable with reducing “entitlements” because they’re seen as “handouts” whereas other equally or more wasteful or inequitable policies are deemed untouchable. So, we’ll have to suck it up as the President explains that he wants to rescue us from the fiscal cliff off the backs of the middle class by cutting into “entitlements,” instead of hearing him apologize for the government’s breach of contract and devising a means of making it up to the injured parties.
In the context of healthcare, there’s a lot to be learned from the renaming of the proverbial individual mandate “rose” as a tax rather than a penalty without changing one word of the Act. The Act didn’t accidentally use the word “penalty”. It’s easier to SELL a penalty than a tax.
Penalty is associated with a consequence for something an individual did that was wrong, tax is something imposed on an individual by a government regardless of the individual’s action, or at least it seems so to us. In fact, by using the word penalty to describe different treatment, we can in fact change HOW WE SEE an individual acting in a way that is subject to a penalty. Those who don’t purchase health insurance will be deemed to be “wrongdoers”, worthy of having a penalty imposed on them even if they don’t use any medical services or are able to pay for their healthcare in cash.
We attach moral culpability to individuals subject to penalties and similarly by removing penalties we remove notions of a “wrongdoer.” For instance, by describing grown illegal immigrants brought to this country by their parents who use false ID to drive or obtain employment as “NOT RESPONSIBLE” for being here, these grown illegals were provided with amnesty, they are no longer wrongdoers and therefore not subject to “penalties” for being wrongdoers.
Even in those cases where individuals are grown and aware of their status as is the case with most who have used false ID to get around additional laws in the US, suddenly all is forgiven. In fact, these illegals have superior rights to citizens who use false IDs who are subject to prosecution for using fake ID. These individuals are also given superior rights to citizens who have paid over years of residence in a state money qualifying them for in-state tuition, which is granted to this new group of “legals” without a provision for paying past taxes before they become eligible for in-state tuition.
We do not excuse the illegal conduct of other grown “children” in our society who by no choice of their own were born to parents who break a variety of laws when those children break the same law. For instance, drug users whose parents were drug users and through no choice of their own became drug users, we hold them responsible.
In the healthcare world of Affordable Care, the language is ultimately all geared at a single goal, getting consumers to pay for health insurance costs at increasing rates to maintain current and rising level of salaries paid to healthcare providers for providing healthcare services while maintaining and improving insurance company profitability. No more, no less.
Being perpetually hoodwinked by believing that it’s one person’s “fault” or one group’s “fault” that physician salaries, healthcare salaries, and diagnostic testing costs have skyrocketed along with insurance costs justifies the “penalty” of different treatment for those “blameworthy” individuals in the form of increased costs or limited treatment options has not only NOT WORKED in containing costs and expanding coverage options for individuals but will NEVER work. That’s right, NEVER.
Without cost controls we are forever chasing the carrot and will never catch up as insurers charge more to individuals so that they can pay more to providers and service providers who continue to charge more.
As the implementation of Affordable Care moves forward, consumers must look beyond labels and false assumptions revolving around those labels used to render something objectionable as something desirable. A label does not change the nature of what you’re dealing with, Juliet was correct.
We’ve already seen it in Affordable Care, the use of the phrase cost-sharing instead of the real message which is increased individual contribution. We’ve seen the redefinition of discrimination in ACA section 2701 (a) Prohibiting Discriminatory Premium Rates EXCEPT higher premiums are OK for older people violating all traditional notions of a protected class under antidiscrimination laws.
We see the term individual “empowerment” used to describe weakened consumer leverage when individuals try to negotiate their best healthcare options versus the superior plans that unions and governments get because they have the leverage of numbers. And don’t leave out the “SHARED RESPONSIBILITY FOR HEALTH CARE” provision which contains the provision for the individual mandate tax.
We examine all sorts of labels as consumers. In healthcare it is critical to examine labels as well. When you hear entitlements, consider your own payments into Medicare and social security. Cannibalizing entitlements is not only NOT necessary but should be a political death sentence for any party or politician who tries to sell it as such.
