The New Problem with Motherhood

Another Veterans Day has come and gone, with Americans of all political persuasions saying “thank you for your service” – sheepishly or defiantly – to the few in the military, about one half of one percent of the population now. Most military folks shrug. It’s a nice enough gesture, and seems to make those who mouth the words feel better, which is fine, but no one asks them what they really do, day in and day out, and what they plan to do next, when they become civilians again. It must feel like being a character in someone else’s political psychodrama, even if the heroic character. That’s okay. Do the job, and do it well. Nod politely, and carry on. Their issues aren’t yours.

America has already shifted back to other concerns anyway. Veterans Day means Thanksgiving in three weeks, which means the Christmas ads are everywhere, because Thanksgiving means Christmas, and with the economy now crappy for anyone foolish enough not to be making at least the minimum half-million a year, those ads do have to start early. There’s money to be made, but it gets harder every year, so it’s vital to start drumming up business early. We’re in a recovery, but only for a very few, and they already have their new smartphones and HD gizmos. Extracting big money from the ninety-nine percent who got left behind is the challenge now, so this year, for the first time, almost all major retailers will be open Thanksgiving Day – something bound to upend all tradition – overeating and watching bad football, in a stupor, and arguing politics with relatives you only see a few times a year. Get used to it. Full-saturation Christmas has just started.

Americans this year will also settle down to full-saturation discussion of Obamacare. The website is still a mess, and Obama did say that if you liked your current healthcare policy you could keep it, but for those who bought bare-bones policies that covered next to nothing, that’s not true – there are minimum standards for all healthcare policies now. Cheap isn’t always good, and these cheap policies could also suddenly get real expensive, at the whim of the insurer, something the Affordable Care Act also forbids. Still, this is something to talk about. After all, Republicans didn’t have the votes to stop Obamacare from passing in 2010, and House Republicans have voted to repeal it, all of it, over forty times now, but they don’t have enough votes in the Senate to even suggest consideration of any such House bill, and they lost their suit in the Supreme Court to have the thing declared unconstitutional, and then Mitt Romney ran for president promising to repeal it, and lost convincingly – and then they shut down the government and threatened worldwide economic collapse with a default on our national debt, unless Obamacare was ended right now, and got nothing at all for that, other than the scorn of the American public – so full-saturation discussion of Obamacare will have to be about the website and just what a healthcare policy should cover, even if the new standards were voted into law three years ago.

That’s not much to work with, but it will have to do, and America had better get used to endless discussion of such things until Christmas, and beyond. The Christmas ads will eventually end, but this may not, and the Los Angeles Times’ Michael Hiltzik notes that things got underway on the first day of November:

Anti-Obamacare conservatives are chuckling over an exchange from the House’s grilling of Health and Human Services Secretary Kathleen Sebelius on Wednesday morning, in which Rep. Renee Ellmers (R-N.C.) challenged Sebelius to explain why men should have to pay for maternity coverage in their health insurance plans.

“To the best of your knowledge, has a man ever delivered a baby?” Ellmers asked. Ellmers and her cheering section seem to think this was hilarious, a conclusive, slam-dunk, let-me-hear-a-rimshot punchline. “Ellmers was on her ‘A’ game,” the deep thinkers over at Breitbart decided.

The reality is, of course, that Ellmers’ question revealed only her profound ignorance about how health insurance works, and her lack of desire to learn. And that goes for everyone else who thought this was a smart, telling blow.

Ellmers just asked a question. Why should men pay for a healthcare policy that includes maternity benefits? Why is the government telling them they have to buy something they’d never use? Hiltzik suggests it might have something to do with fairness:

It’s true, as Ellmers observed, no man has ever given birth to a baby. It’s also true that no baby has ever been born without a man being involved somewhere along the line. Limit maternity coverage only to women of childbearing age, and you’re giving many of these guys a free pass.

There’s also efficiency:

Unhealthy babies and mothers impose a cost on everybody – in the expense of caring for them as wards of the public, and in the waste of social resources that comes from children unable to reach their full potential as members of society because of injuries or illnesses caused by poor prenatal and postnatal health.

And there’s the nature of insurance:

Up to now – before Obamacare’s rules kick in Jan. 1 – only 12% of policies in the individual insurance market offered maternity coverage. Those that offered the coverage often did so as separate riders imposing huge deductibles for maternity care alone – $5,000 for maternity services, according to a 2010 survey by the House Committee on Energy and Commerce, and limits on benefits of only a few thousand dollars. The cost of maternity and newborn care is the principal reason that, pre-Obamacare, women were systematically charged more for health insurance than men.

Because insurers pitched maternity coverage in the individual market only to buyers of childbearing age, the premiums were high and they still made almost no money on them. One company internal memo reviewed by the committee stated that its loss on maternity riders came to 90% of income, a money-losing ratio, the memo said.

But that’s what happens when you sell an insurance benefit to a narrowly defined market. Without the cross-subsidies inherent in a large pool of insured people, no single coverage is affordable to those who specifically need it.

That’s the principle of universal coverage inherent in Obamacare, after all. Once you start segmenting the market so that only those vulnerable to a specific condition can buy coverage for that condition, the cost of that coverage soars into outer space.

There’s much more, but those are the main points, and a few days later, Salon’s Joan Walsh added this:

Amazingly, Ellmers chairs the House GOP’s “women’s policy committee” – so how could she be so tone-deaf in attacking the way the ACA helps that increasingly elusive GOP constituency, female voters?

Because the right-wing base of the modern Republican Party is dedicated to restoring men as the head of the household, and the nuclear, husband-headed family as the principle social unit. From Rick Santorum railing against contraception and preaching the nuclear family as the answer to poverty in last year’s GOP presidential primary, to Rafael Cruz Sr. telling an audience that “God commands us men to teach your wife, to teach your children – to be the spiritual leader of your family,” today’s right-wing Republicans are increasingly comfortable with open displays of old-time crackpot patriarchy.

Walsh trots out example after example, but things are pretty clear:

Let’s face it: The only way charging women more for health insurance and healthcare makes sense is if they have a partner who either shares that burden or shoulders it entirely. As in… a husband. Then it’s clear that the male of the species is doing his part to keep the species healthy and reproducing itself. A woman who doesn’t have a husband to play that role? Well, there shouldn’t be women like that – and certainly if there are, they shouldn’t be having children anyway, or even having sex, so they don’t need maternity care or contraception.

That’s the only way I can explain the GOP’s willingness to openly endorse an enormous transfer of wealth from women back to men by not only advocating the repeal of the ACA but specifically railing against its equal-premium provisions. But don’t worry, gals, you’ll get that wealth back once you get yourself a man!

So the battle lines have been drawn:

Right now those extremists matter more to key GOP leaders than ordinary women do. But if Ken Cuccinelli loses the Virginia governor’s race to Democrat Terry McAuliffe, as polls indicate is likely, he’ll do so because of the women’s vote. Republicans can’t win women because they’re still fighting a culture war to restore men to their “rightful” place as the head of the family and society. They’re profoundly uncomfortable with women’s autonomy – and that makes women voters increasingly uncomfortable voting Republican. Making Renee Ellmers the face of the backlash won’t help.

It didn’t help. Ken Cuccinelli lost, not that it mattered, as the Harvard economist, Greg Mankiw, who was chair of George W. Bush’s Council of Economic Advisors and a key advisor to Romney last time out, is now arguing the same thing as Renee Ellmers, only he uses a different analogy:

But having children is more a choice than a random act of nature. People who drive a new Porsche pay more for car insurance than those who drive an old Chevy. We consider that fair because which car you drive is a choice. Why isn’t having children viewed in the same way?

Michael Hiltzik already covered that, but this analogy really sets off Joan Walsh, who suggests that Mankiw needs to read E. J. Dionne’s latest column on this odd new sort of war on motherhood, which Walsh summarizes:

Dionne is a Catholic liberal with a long history of advocating that pro-choice liberals should try to find common ground with antiabortion folks on issues like maternal and child care, women, infants and children nutrition programs and other supports to make sure women are never forced to have an abortion for economic reasons. But in the last decade liberals can’t find conservatives in Congress to collaborate with on those issues.

That leads Walsh to assume the Republicans are now saying this:

I will defend to the death your right to be gouged by your insurance company, so you can either go bankrupt when it doesn’t pay your medical bills, or go the ER and stick taxpayers with the bill. All the angst about changes in the private insurance market reveal why overhauling the insurance system has been so problematic, forever: It’s heavily premised on gambling and wishful thinking. Some people gamble that they won’t get sick, so they go without insurance entirely. Or they hope they won’t need hospitalization, so they go with cheap plans that cover almost nothing. Of course, when those people bet wrong, society covers their costs via emergency room visits, or they pay themselves and many go bankrupt.

On the issue of maternity care, specifically: Women who buy policies that don’t cover it are gambling that they won’t become pregnant, or that they can pay full freight themselves if they do – and plenty of them bet wrong. Of course, Mankiw’s response would presumably be something like the 1970s TV detective Tony Baretta’s: Don’t do the crime if you can’t do the time.

This Harvard man doesn’t like sex or something, but what Walsh finds even odder is that this man does seem to know that a snazzy Porsche is also a double symbol, the car that every rich man buys when he goes through that mid-life crisis, which is pathetic in and of itself, and the car is a symbol of vast idle wealth. A Porsche is for fun only, not for hauling groceries or the daily commute to the office to that job that depresses you, but the guy is who he is:

Mankiw doesn’t come from the social-issue wing of the party; he was Mitt Romney’s economic adviser. So he’s arguing in terms that make sense to his top One-Percent cohort: comparing the decision to have a baby to the decision to buy a Porsche. Are people still wondering why Romney lost last year?

This is Walsh’s conclusion:

This battle is exposing the rightward drift of even “reasonable” conservatives. They are increasingly uncomfortable with the government helping to level the playing field for corporations and their customers. At its base, “insurance” represents a private-sector approach to social risk-sharing and cost-sharing. Private companies have figured out how to make money helping people avoid certain kinds of catastrophes like illness, along with floods, earthquakes, burglaries or car accidents. Along the way they’ve also figured out how to game that system to pay out as little as possible to the insured while maximizing their premiums.

The Affordable Care Act has tried to work with that existing private system, but make it a little bit less like high-stakes gambling and more like, well, insurance: in which you’re insured that you’ll get what you need, and what you’re paying for, when you need it.

They want none of that. Rig the game to make good money – it’s the American way. And now, as Walsh says, “social conservatives and plutocrats have found common ground in the modern GOP” – not that anyone should be surprised.

Matthew Yglesias, a Harvard man himself, does, however, have a more nuanced view:

Obviously Mankiw has perfectly sound grounds on which to oppose the ACA. Like most conservative economists, Mankiw believes that higher tax rates on wealthy individuals are economically ruinous and perhaps immoral. And the ACA really does include higher tax rates on wealthy individuals. But even though conservative opposition to higher tax rates on wealthy individuals is a well-known and prominent feature of American politics and intellectual life, conservatives seem unable to simply state that this is what’s driving their opposition to the ACA. Instead you get this kind of kitchen sink argumentation. But note: Subsidization of child rearing is hardly a unique feature of the Affordable Care Act. Most notably, we spend all this money on public schools! Conservative proposals to replace public schools with vouchers would revolutionize almost everything about the education system in America while specifically retaining the aspect of the system that transfers resources from nonparents to parents.

It is probably possible to justify subsidization of child rearing through some kind of economist-friendly rhetoric about externalities and long-term fiscal sustainability.

Yglesias would just like some consistency, but he doesn’t expect it here:

One of the main goals of any kind of political community is the enduring of the political community. That requires the rule of law… but it also obviously requires there to continue to be living, breathing human beings who belong to the political community – which is to say that children, though expensive, differ from luxury cars in that they are human beings. By the same token, you could note that while it is illegal to take your Porsche (“theft”) and also illegal to take your baby (“kidnapping”), we have different words for these crimes and one is punished more severely than the other.

Indeed, babies aside, if I were to destroy Mankiw’s Porsche, that would be punished much less severely than if I were to destroy Mankiw himself (“murder”) because, again, Mankiw is a person. It’s not just that people are considered very valuable. Even if I destroyed 10 or 20 Porsches, the punishment would be light compared with if I murdered someone in cold blood.

This is pretty simple:

Cars aren’t people. Babies aren’t luxury consumer goods. That’s just how it is.

It’s odd that anyone has to take the time to point that out, but then we live in odd times. Santa’s on the television in the other room, selling snazzy VW sedans, in early November, and on Thanksgiving Day it will be turkey and then four hours of fighting through the crowds at Target, looking for a deal on some toy the kid wants that they don’t carry, and on the news every night the Republicans will be hammering Obamacare, because it covers women, and particularly mothers, when everyone knows they should pay for their own damn problems, or their husbands should – not the rest of us. The most wonderful time of the year isn’t that wonderful this year – but do buy something nice for your mother this year. Insurance would be nice.

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About Alan

The editor is a former systems manager for a large California-based HMO, and a former senior systems manager for Northrop, Hughes-Raytheon, Computer Sciences Corporation, Perot Systems and other such organizations. One position was managing the financial and payroll systems for a large hospital chain. And somewhere in there was a two-year stint in Canada running the systems shop at a General Motors locomotive factory - in London, Ontario. That explains Canadian matters scattered through these pages. Otherwise, think large-scale HR, payroll, financial and manufacturing systems. A résumé is available if you wish. The editor has a graduate degree in Eighteenth-Century British Literature from Duke University where he was a National Woodrow Wilson Fellow, and taught English and music in upstate New York in the seventies, and then in the early eighties moved to California and left teaching. The editor currently resides in Hollywood California, a block north of the Sunset Strip.
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One Response to The New Problem with Motherhood

  1. Rick says:

    Conservative economist Greg Mankiw:

    “But having children is more a choice than a random act of nature. People who drive a new Porsche pay more for car insurance than those who drive an old Chevy. We consider that fair because which car you drive is a choice. Why isn’t having children viewed in the same way?”

    My son’s high school economics course last year used a textbook written by Greg Mankiw, which at the time made me question the value of the course, since I don’t think Mankiw understands the basics of how the economy works, and obviously doesn’t even grasp these simple points:

    (1) Given that so many of his fellow conservatives are against the idea that having children is even a choice in the first place — they’re not only against abortion, many of them are even against contraception — maybe someday, if they get their way, it won’t be a choice.

    (2) If indeed you do pay more insurance for a new Porsche than an old Chevy, and you don’t like that, you should lobby for universal car insurance, but most of the nation hasn’t seen the problem of the high cost of car care in this country as one that demands our attention, while the problem of health care has been a thorn in our collective side for years.

    (3) It’s not that the state should be subsidizing having children, it’s that pregnancy is a medical issue, and medical issues are covered by health insurance. I suppose having a heart attack or lung cancer could also be considered a choice, depending on what you eat or how much you exercise or how much you smoke, but health insurance covers those things, too. But does this mean we are all subsidizing heart attacks and lung cancer when we have them covered by Obamacare?

    But if his basic question is “Why should men have to pay for maternity coverage?”, that was answered already by Michael Hiltzik — that is, to make universal insurance work, it has to spread the risk by increasing the pool to those who don’t need it.

    Joan Walsh:

    “Women who buy policies that don’t cover it are gambling that they won’t become pregnant, or that they can pay full freight themselves if they do – and plenty of them bet wrong.” … and … “The Affordable Care Act has tried to work with that existing private system, but make it a little bit less like high-stakes gambling and more like, well, insurance”.

    Yes, it is true that not having insurance is a gamble, although oddly, so is it true that having insurance is gambling. In the case of health insurance, I am betting my insurance company that I will get sick, while they are taking that bet, willing to gamble that I will not get sick, and promise to pay me money if I do. That’s just the nature of the business, and telling them they have to take bets they wouldn’t ordinarily take — such as covering pre-existing conditions — isn’t really doing it the “free market” way.

    But to Greg Mankiw:

    You don’t think we should be telling private insurance companies how to do their business?

    Fine. Neither do I. Join with me and let’s replace Obamacare with Single Payer — which, by the way, would pretty much eliminate private insurance companies altogether.

    Rick

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