Towards a Medicaid Policy With Teeth

A Washington Post story about a Maryland boy who died of a toothache has lit the latest fire under the liberal blogosphere. As it should--the idea that in the richest country in the world, anyone should die because they did not receive an $80 tooth extraction is abhorrent.

While dental issues may not always be life-and-death (though tell that to Twelve-year-old Deamonte Driver's family), it is a really important concern. The Plank quotes from an old New Yorker article showing how bad teeth is both one of the more common ailments of the poor in society, and one of the largest barriers towards any upward social mobility. Think of the entry-level jobs one would never get hired for if you had rotted teeth--basically, anything where you interact with customers or serve as a company's public face. It's an expression of class privilege where we view dental care as a vaguely burdensome luxury rather than a necessity for navigating American society.

But lest we focus on the meta too much, let us recall that this is not some tragic but unpreventable problem. It isn't even something that we vaguely say shouldn't happen in the "richest country in the world." This is a direct result of Medicaid cutbacks and bureaucratic mazes which--as we love to forget--have real effects on real people's lives that cause real people to get sick and die.

One thing that's been noted is that dental care for the poor has been a longtime crusade for "socialist Senator" Bernie Sanders (I-VT). The hope is that a story like this can generate enough momentum for him to get some allies on the subject, perhaps an otherwise rock-ribbed conservative who nonetheless feels that 12-year olds need not die from toothaches. I'm always optimistic that stories like this will move the hearts of normally apathetic rightwingers, and I'm always disappointed. The National Review is offended that the death of the rabble even got ink in a paper as august as the Washington Post, and also is more concerned about "unanswered questions" about the mother, than the fact that a 12-year old died due to a completely preventable illness. The first conservative post I saw on the article was even more of a doozy. Not only does it tragically yet predictably blame the mother for not shelling out the $80 for the procedure, it goes so far as to call for her prosecution as a child abuser. This is one of the more spectacularly arrogant and malicious things I've ever read. We're talking about a family that was in homeless shelters. Is $80 worth it even for poor families if it would prevent the death of your child? Of course (though that doesn't mean even that small amount is able to be scrounged up). But that's not how any rational person in their position would have perceived the issue. Now let's all raise our hands--how many of us, upon having a toothache, think that putting off going to the dentist is gambling with our lives? How many of us, if that $80 was money we needed to eat, wouldn't try to just deal with the pain? For that matter--the mother was bit distracted here--she was busy trying to get dental coverage for her other son, who had six bad teeth. Of course, eventually doctors became aware that this toothache had turned into a much bigger and more threatening problem. But by that point, the price tag had risen slightly from $80--to $250,000. Yes, obviously, this mother acted in a completely irrational and malignant manner, and we should call her a child abuser. Philosophical rationalization strikes again.

It's amazing to me how perfectly this verifies Melvin Lerner's "Just World" hypothesis and how it leads people to both tolerate and rationalize even naked injustice.

Jon and Kathleen Hanson's "The Blame Frame: Justifying (Racial) Injustice in America" [41 Harv. C.R.-C.L. L. Rev. 413 (2006)]....hit[s on]...what's known as the "just world" mindset. People want to believe that the world is just. As a result, "people crave justice and, consistent with that craving, actively work to eliminate injustice" (419). That's the good news. The bad news is that instead of actually eliminating the injustice itself, we simply redefine the questionable event so that it seems "just." Hanson and Hanson continue "[W]e often satisfy the craving [for justice] through troubling means: when alleviating innocent suffering is at all difficult or complex, people reconceive the victim as deserving the suffering by assigning negative characteristics to her" (id.).

A study by Melvin J. Lerner & Carolyn H. Simmons elucidates how this happens. Test subjects were asked to observe a "learner" who appeared to be subjected to painful shocks when he got an answer wrong. One group of subjects was given the option to move the learner to a different study where she'd receive positive reinforcement for right answer instead of being shocked for wrong ones. Most took the offer. The second group of subjects was given no such option, and could only watch as the learner was shocked again and again [Melvin J. Lerner & Carolyn H. Simmons, The Observer's Reaction to the "Innocent Victim": Compassion or Rejection?, 4 J. Personality & Soc. Psychol. 203 (1966)].

The subjects were then queried as to their views of the learner. The first group, which was presented with an easy option to rectify the injustice, tended to describe the learners as "likeable, innocent victims of shocks who deserved to be reassigned to a positive reinforcement environment" (Hanson & Hanson, at 19). Those who had no easy option to end the suffering, by contrast, tended to describe the victim in negative terms, as blameworthy and deserving of what happened to them.

Further studies showed just how "easy" the option has to be before we'll concede injustice--even such a difficult and onerous burden like pushing a button could be too much to demand of people in the pursuit of justice.

Whatever. I suspect by next week, everyone will have forgotten, and universal healthcare will go back to be the crazy, radical, communist idea that we've convinced ourselves it is when we don't want to accept our share of the blame for the unnecessary deaths of children.