The Saved, the Damned, and Healthcare Policy

Catherine M Wallace

 The astounding cruelty of Trumpcare has elicited appropriate outrage: it's a tax cut for millionaires and devastating deregulation of the insurance industry thinly disguised as healthcare reform. Standard Republican talking points in support of the bill emphasize how marvelously it reflects core Republican values. That's a perfectly accurate claim: once again their legislative proposals seek to make the rich even richer at the expense of the most vulnerable: the very young, the very old, the disabled, the destitute, and the working poor. These proposals threaten all of the rest of us too. Employers and insurance companies will scramble to take advantage of all these new ways to game the system. The self-employed will be screwed.

The specific issues at stake in the American Healthcare Act have been adeptly summarized in editorials, organized in chart form by diligent journalists, and presented as interactive maps by healthcare-policy wonks. The Congressional Budget Office report has been summarized with tables and graphs. I want to do something different. I want to ask a deeper question: how is it possible that Republicans are even contemplating such an attack both on the national interest and on the physical health of fellow Americans? What is going on here?

As scholars like Kevin Kruse, William Martin, Nicole Hemmer and others have documented in painstaking academic detail, the hard-Right fringe of the Republican party has spent the last ninety years trading in hate, fear, lies, and shame to advance a radically libertarian agenda. They want to dismantle all federal regulations, programs, and agencies that serve the common good. They are ideologically opposed to requiring anyone to contribute a fair share to social goods that can be achieved only by working together. If healthcare were a communal barn-raising, their plan sets fire to the lumber. If healthcare were a church potluck, they are trying to overturn the buffet tables. Why? They are ideologically opposed to legal requirements that serve the common good, social justice, and the national interest generally. They want government to serve the short-term, short-sighted self-interest of the wealthy. Period.  Journalist Thomas Frank offers a superb fine-grain investigative report of how that has worked out in What's the Matter with Kansas? and Listen, Liberal.

At the electoral level, Republican are getting away with this. Why? That's what I want to explain. It we are going to resist effectively, we need to understand the cultural issues and psychosocial dynamics that have brought the nation to this dangerous pass. I want to unpack those issues step-by-step. I will do so as briefly as I can. Assuming college-level reading skills, that will take another four minutes of your time.

As we all know, Donald Trump divides America into winners and losers. Research indicates that his followers divide America into white and nonwhite. The GOP establishment divides America into "makers' and "takers." However you want to name the divide, the Republican Right has been demonizing other Americans since the 1930s. That's when radical libertarian millionaires first sought an alliance with evangelical fundamentalists in order to attack the progressive policies of Roosevelt's New Deal.

This hard-Right alliance grew in scope and political power during the 1950s and 60s through its concerted attack on desegregation. Given how well that campaign succeeded in attracting political support from Southern and rural voters, the hard Right went on to attack a whole series of scapegoats: feminists, gay people, Mexicans, Muslims, immigrants, non-Europeans, and even transgender teenagers. The goal of these hate-mongering campaigns was attracting voters to Republican candidates who would further dismantle progressive policies, programs, and federal agencies. As a result, income inequality skyrocketed; the middle class began its devastating collapse; another Gilded Age got underway.

Trump turned longstanding GOP dog-whistle attacks into unembarrassed catcalls—and the Republican base cheered. They cheered because for generations the Republican party has been blaming vulnerable subsets of the population for the social and economic dislocation caused by the GOP's radically libertarian socioeconomic agenda. As Jacqueline Jones trenchantly explains in A Dreadful Deceit: The Myth of Race From the Colonial Era to Obama’s America, it's a strategy with long roots in American culture: from the very beginning, the American economic elite have encouraged hostility between working whites and working nonwhites in order to keep these two groups from collaborating to resist socioeconomic exploitation.

Here's a crucial bit of backstory that's seldom discussed, but it's everywhere once you start noticing: the divisions variously labeled winner/ loser, maker/ taker, or white/ nonwhite are shaped by and derived from the mother-of-all-contrasts in American culture: the radical Puritan division of humanity into the Saved and the Damned. As I explain in Confronting Religious Violence, that culturally-dominant division provides crucial legitimacy for the power of one group and the pain of the other: "they" deserve whatever happens to them. "They" are morally legitimate objects of neglect, abuse, exploitation, exclusion, and attack; "we" prove our status as Saved by condemning them.

The largest single group of "Them" in American culture was enslaved African captives in the South. Legitimating slavery—or at least tolerating its presence on American soil—played a huge role in the American cultural psyche because it so flatly contradicted our proud claim that "all men are created equal and . . . endowed by their Creator with certain inalienable rights." That contradiction opened out a moral abyss in the American soul: as a culture, as a nation, we came of age accustomed to the idea that there exists a group of people who dwell outside the circle of "all men" to whom we owe the rudimentary moral respect demanded by God. The Civil War may have ended legal slavery, but its unprecedented carnage exacerbated the tendency for Americans to hate and despise one another. The abyss opened out by slavery could later be populated by a whole variety of subsequent scapegoats.

The Religious Right played a crucial role in this process. Just as Southern Christians had vigorously defended slavery as a "biblical" institution, so their fundamentalist heirs—also prominently Southern—draped a veneer of fake piety on the twentieth-century politics of hate and ridicule. Recall, if you will, Jonathan Edwards's 1741 sermon describing how God feels about sinners:

"The God that holds you over the Pit of Hell, much as one holds a Spider, or some loathsome Insect, over the Fire, abhors you, and is dreadfully provoked; his Wrath towards you burns like Fire; he looks upon you as worthy of nothing else, but to be cast into the Fire . . ."

This crazy-violent and vindictive God is not the God proclaimed by Jesus of Nazareth. Jesus insisted that God's compassionate love extends without qualification to all of humanity. But thanks to the Religious Right, Edwards's angry God profoundly informs America's hate-mongering politics. The Religious Right has hijacked and weaponized the heritage of Jesus; they have boldly used hate—above, all, racial hatred—as a political tool.

Here the story gets complicated, because Mr. Trump is a complex—indeed, fascinating—character in American cultural history. The radical divide between Saved and Damned had a thoroughly secular parallel as early as Benjamin Franklin: it shapes the American Myth of the Self-Made Man, the promise and the pretense that in America anyone can be anything, rising high on the paired wings of talent and hard work. Fame-and-fortune are the secular equivalent of Salvation—and it's our own fault if we're Damned. In America, the unequivocal Land of Opportunity, we have no excuse if we are not as wealthy as the wealthiest, as buff as the most athletic, as glamorous as the glitziest—and, of course, young, in flawlessly perfect health, married to someone with flawlessly perfect health, and having flawlessly healthy children. If we're not, then heaven help us—because the Winners won't. As the CBO reports, middle-income sick or older Americans will be priced out of the market. By 2026, for instance, a 64-year-old earning $56,800 would pay $20,500 a year for healthcare insurance. For small-business owners, for start-ups, and for those of us in the gig economy, that's a catastrophe.

Let me repeat: What is going on here? Once again, cultural history offers real insight. The radical Puritan divide between Saved and Damned, along with its secular twin Self-Made Winner versus pathetic Loser, intersects in powerful ways with social class structure in America.

Or, to be more precise, with the lack of social-class structure. Because almost all Americans came here from elsewhere (willingly or not), America lacks the inherited social-class structure found in traditional mono-ethnic cultures. In traditional British or French society, for instance, a penniless aristocrat is still an aristocrat. A real-estate developer, no matter how wealthy, is not an aristocrat. But that's not how it is in America. As I explain in Confronting Religious Judgmentalism (chapter 3), social status in America—"aristocracy"—is something that people achieve. Social status must be demonstrated. It must be performed. And the central performance is radical individualism.

The great American Hero never needs anyone else. The Winner never relies upon anyone else. The Self-Made Man would never turn to the government—or even to a functioning insurance marketplace—for help with anything. Like the classic figure of the hyper-Protestant "Saved" with his one-on-one relationship with God, unmediated by symbol, sacrament, or liturgy, the Self-Made Man becomes astoundingly rich all on his own. Even to admit that you might some day depend upon others is to reveal that you are a Loser, shamed, one of the Damned.

Like other Republicans, Vice-President Pence calls this radical individualism "personal responsibility" in a pair of tweets dated June 24, 2017. In the context of Trumpcare, "personal responsibility" means "so rich you don't need insurance anyhow." In American mythic terms, if you are not that rich then clearly you are "irresponsible." If you need affordable insurance to pay for the ridiculously expensive inhalers or epi-pens you or your children need to avoid an excruciating death, or if you can't quit work to care full time for an elderly aunt evicted from her nursing home, then clearly you are irresponsible. According to the Republicans, you now stand outside the circle of those to whom other people owe simple human decency—because the libertarian Right believes that no one owes human decency to anyone. We are to command respect with our wealth, power, and glamour; respect is due only to those who can pay their own way in everything for all of their lives, from private preschool to nursing-home care.

The American Myth has a dark side: shame, one of our most powerful social emotions. Trump's success attests to the extraordinary political power of shame. Mr. Trump won the Republican nomination in part because he was so remarkably adept at playing on this classic American status-anxiety. During the debates, his GOP opponents visibly flinched at his fearlessly demeaning attacks. The same dynamic shaped his campaign rallies: his supporters roared their approval when he attacked blacks, Mexicans, and Muslims, when he called for violence against protestors, and when he denounced common courtesy as "political correctness." Their cheers—their identity as Trump supporters—proved that they too were Winners, standing securely among the Saved. Mr. Trump created what I've called "negative communities," a group held together by shared hatred of scapegoats, not shared commitments to values, virtues, or ideals. 

Mr. Trump's campaign rallies were, in effect, secular remixes of Jonathan Edwards's fire-and-brimstone sermons about the deliberate malice of a violent God. Come to Trump, like come to Jesus, and you too will win until you are tired of winning. Once and for all you will find solace for your shame and your social anxiety. As a slogan, "Make American Great Again" conceptually unified Mr. Trump's politics of ridicule into a global promise of relief from shame through hatred for others and above all the freedom to abuse them just as Mr. Trump does.

Mr. Trump is remarkably talented at manipulating the relationship between shame and rage. Anger can help solace the uniquely American shame that follows from failing to meet radically individualist Heroic standards. Hate can help comfort our sense of not measuring up to the impossible American Dream of growing up to be richer than Bill Gates, more heroic than Harry Potter, and more glamorous than any star at the Academy Awards. Rage can feel all the more consoling and compensatory the less conscious we are of the cultural dynamic that traps us into feeling that no matter what, we will never measure up. We will never enjoy the unquestioned respect and psychosocial security that our social-animal biology so deeply craves. More seriously yet, shame becomes acutely threatening if you happen to live in a culture with such a powerful history of allowing Winners to dehumanize, abuse, and exploit Losers.

But please note: that heroic Self-Made Man ideal is wildly at odds with our inherent and inescapable character as social animals. The purely autonomous Self of hard-Right libertarian socioeconomics is an illusion—or a deliberate lie, a deceptive front providing cover for commonplace predatory behavior by an immoral subset of the billionaire class and the politicians they have purchased for themselves. As scholars have documented in stunning detail, our well-being is inevitably interwoven with and dependent upon the well-being of our entire society.

Cut Medicare and we all bleed. Let insurance companies prey upon anybody and we all suffer. Throw anybody's grandmother out of her nursing home, invoke a lifetime insurance limit on anybody's sick child, and all of our hearts break. All of our lives go up in flames like that horrible London highrise housing project. It was clad in material known to be highly flammable, an unconscionable failure by regulators—but a boon for developers. That's a great metaphor for what's going on in Washington.

Keep the image of that burning highrise in your mind's eye as you follow the healthcare debates, the climate-policy debates, and who knows what other issues in the years ahead. It looked a lot like the Twin Towers, didn't it? The Republican attack on federal programs, policies, and agencies is like the flammable sheathing on that building or the hijacked airliners: if they get their way, catastrophe will befall us sooner or later. These attacks on the common good—these radical ideological attacks on the concept of government for the common good—are intrinsically evil because they deliberately seek to destroy the wellbeing of many for the increased wealth of the wealthy.

Mr. Trump is not an aberration in American politics. Mr. Trump is the quintessential contemporary hard-Right Republican, building on well-established Republican electoral strategies. Despite the disarray in his administration, he enjoys the approval of 81% of Republican voters. He differs from other Republican officials only in his flamboyant and impulsive character. He is open where they are secretive. He is plainspoken in his lies, not glibly polished in doubletalk and dog-whistling. He has an uncanny salesman's skill at presenting himself as deeply "authentic" to the Republican base among white rural non-college-educated voters.

The rest of us face the moral challenge of our lifetimes in figuring out what to do next. I hope we can do so before the American democracy goes up in flames.