Health Care/Joan Retsinas

The Sad News of January: Scrooge Lives On and On

Every January, I search for the reformed Scrooge — the one beloved of Christmas tales. Instead, the misanthrope springs back. The old Scrooge was cheap: He threatened to dock Bob Cratchit a few pounds for a few hours off on Christmas Day, he refused to contribute alms to the poor, he ate a diet of gruel. Yet beyond cheapness, he was mean. Human suffering did not pierce his heart. If poor people died, it would decrease the surplus population (echoing Malthus’ fears about over population).

Here are contenders for the Old Scrooge award.

First runner-up: JD Vance. HIs memoir, “Hillbilly Eulogy,” reeked of “social darwinism,” the self-satisfaction of people who attribute their climb out of poverty to their own drive. The corollary is that those who don’t make it to Yale Law School, then to a hedge fund, lack the true grit character of this era’s Horatio Alger. And candidate Vance’s eagerness to deport all “undocumented” migrants, including those working full-time jobs, was cruel. His explanation, that native-born Americans were waiting in the wings, eager to take those jobs, was specious, refuted by a phalanx of economists; yet he persevered in lying that “the others” (mostly dark-skinned) were taking jobs from “Americans” (paler hues). JD Vance doesn’t capture the Scrooge award, though, because, however Scroogian the rhetoric, he as senator did not directly harm anybody. Indirectly, but not overtly. Maybe next year he will win the award.

Next runner-up: Elon Musk. In his zeal to pare government, he will sprinkle the federal workforce with pink slips, saving billions of dollars. Of course, some of those pink-slipped workers bolster our nation’s water, air, food supply. Some work in schools and hospitals. Some weigh the scales of justice in favor of the downtrodden. Just as crucially, Mr. Musk despises much of the American workforce. He wants immigration visas for the skilled high-tech workers, but considers much of America’s workforce sub-par. If he had been Scrooge, he would have fired Bob Cratchit and outsourced the clerical work. But, again, he hasn’t yet wreaked havoc. So he takes a pass.

This year the overwhelming winner of the Scrooge award: the U.S. District Court in North Dakota Judge Daniel Traynor, speaking for the majority, ruled that the Dreamers — the DACA generation — should not have access to the Obamacare Affordable Care Marketplace that has given so many Americans health insurance.

The Dreamers languish in immigration limbo. They came here illegally as children, some as infants. (Many have younger siblings, born in the United States, and consequently citizens). They have never truly lived in their “native” lands; they rarely can speak the language; and their parents may have gotten green cards to stay legally. Successive Congresses have tackled with the Dreamers: to send them back to a place they don’t know even though they have lived virtually their whole lives here, gone to school, graduated into professional-level jobs? Even President Trump, avid to deport/deport/deport, has hesitated to rush to deport them, but has tentatively promised, maybe, a path to stay. (Currently Dreamers have no legal pathway to citizenship. Marriage does not automatically guarantee a green card.)

As for health insurance, the Biden Administration allowed the Affordable Care Marketplace to cover them, as of November 2024. The rationale was both humane and commonsensical: we don’t want people too ill to work, carrying communicable diseases that don’t get treated, unable to get affordable vaccinations. For the Dreamer generation, the costs are not momentous: they are generally too young to incur the debilitating costly diseases of their grandparents. (Indeed, the conservative solons eager to pare Medicaid should look not so much to the young pregnant women and children, but to the grandparents in nursing homes.)

Back to the Biden ruling. Attorneys General in 19 states sued to stop the ruling, to end coverage for Dreamers. The rationale: access to the Affordable Care Marketplace would create a “powerful incentive” for Dreamers to remain in the United States, although this is the only home they have known. The justification for this meanness: access to insurance poses a substantial “monetary risk” to states.

The states bear mention: Kansas and North Dakota ,the lead plaintiffs, were joined by Alabama, Arkansas, Florida, Idaho, Indiana, Iowa, Kentucky, Missouri, Montana, Nebraska, New Hampshire, Ohio, South Carolina, South Dakota, Tennessee, Texas and Virginia.

Scrooge the misanthrope would have been impressed with this Court. While he didn’t help the people suffering around him; he didn’t kick them, piling additional misery upon them. This Court truly merits the award.

Joan Retsinas is a sociologist in Providence, R.I., who writes about health care. Email joan.retsinas@gmail.com.

From The Progressive Populist, February 1, 2025

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