The Health Care Crisis and the Addiction Crisis Are the Same

Donald Trump was elected by a white underclass that is resentful, suicidal, and addictive, and whose existence is declining rapidly. The most noted element in the current health-care debate is how the Republicans’ White House champion, along with the Republican Congress headed by Paul Ryan, is driven to deprive poorer Americans, white and black, of life-sustaining health care. (Current estimates are that 15,000,000 people will lose their health insurance.)

Why do these constituents (or at least a significant proportion of them) support this self-destructive endeavor? Why do Republicans who depend on the white underclass vote push this policy? Because they all subscribe to a 19th-century free-market philosophy, developed in another historic era, that no longer applies to America.

In fact, it is destroying America.

A growing number of conservative commentators are beginning to sound like socialists. According to David Brooks, The New York Times conservative columnist, in a column entitled “The Republican Health Care Crackup,” the major problem confronting America is as follows:

People with fewer skills were seeing their wages stagnate, the labor markets evaporate. Second…the social fabric, especially for those without a college degree, was disintegrating—marriage rates plummeting, opiate abuse rates rising.

The Republicans’ reaction?

Trump came along and exploited these crises. But if his administration’s health care approach teaches us anything, it is that he has no positive agenda for addressing them. He can tap into working-class anxiety negatively, by harnessing hostility toward immigrants, foreigners, and the poor. But he can’t come up with a positive agenda to make working-class life more secure.

So we have a group of Freedom Caucus Republicans who still think the major problems in the country today can be cured with tax and spending cuts. We have a Trump administration that has populist impulses but no actual populist safety net policies. And we’ve got a Republican leadership in Congress mired in Reagan-era thinking. . . .

The result:

The Republican health plan would make America’s economic chasm worse. It would cut health subsidies that go to the poor while eliminating the net investment income tax, which benefits only the top 1 percent.

The Republican plan would further destabilize the social fabric for those at the bottom. Throwing perhaps 10 million people off the insurance rolls will increase fear, isolation, social tension, chronic illness, suicide and bankruptcy.

In the words of another Times conservative columnist, Ross Douthat (“Why Republicans Can’t Do Health Care“):

The health-care debate makes this danger particularly clear. In the long Reagan era, the Republican Party was, in effect, the party of the health care status quo—bending to accept certain expansions of the welfare state (S-CHIP, a prescription drug benefit in Medicare) in order to forestall a larger government takeover of health insurance.

By the late 2000s, however, the decline in employer-provided coverage and the steady rise of health care costs made status-quo politics untenable: Too many workers who made too much to qualify for Medicaid were unable to afford insurance. Meanwhile, over the same period, Republicans were winning more working-class votes, which meant that their own constituents increasingly stood to benefit from a coverage-expanding health-care reform.

But a large part of America, and certainly of the U.S. Congress, clings desperately to the 19th-century idea that personal initiative will solve all of our social problems—economic, social, health, cultural. It won’t, and we’re headed to a shipwreck disaster—what Douthat describes as an age of inflection, where we will have to make a sudden, decisive political shift.

Or we can continue to sink as a nation.

This is exactly the same situation that confronts us as a nation in relation to addiction and mental illness. As I have often written, we are governed by a 19th-century disease conception of addiction for which abstinence is the cure—the essence of the Temperance philosophy reflected in both AA’s and the 12-step’s abstinence fixation and the supposedly modern brain chemistry model of addiction.

As a result, Nora Volkow dominates the American addiction landscape (and, to a growing extent, the world’s), even as the worst addiction outcomes—simultaneous record levels of heroin, tranquilizer, opiate painkiller, synthetic narcotics (i.e., Fentanyl) deaths and a giant jump in alcohol use disorders with accompanying life dysfunction—grow exponentially.

The opposing point of view—that addiction is the result of people’s deprived existences that only life solutions can remedy and for which abstinence is neither necessary or sufficient—points to an entirely different philosophy for approaching addiction, one that sees drug use as a normal part of human behavior and addiction as one end of the spectrum of drug use.* Unfortunately, this new way of thinking is nowhere in evidence in our government’s thinking.