Mom worked hard for social change the 90 years of her life. But she’d been frustrated by health care. She held on to the notion that if people just knew the facts, they’d support reform — or socialism, for that matter.

At the same time, Mom’s bottom-line political analysis of why bad things happen (Reagan’s reelection; support for the Iraq invasion) was “People are stupid.”

That’s the contradiction facing the supporters of health care reform going forward.

My mother’s daughter, I have to admit I’ve been hitching my hopes to the Democrats’ reality-based strategy: Tell people what’s in it for them, demonstrate how their fears won’t be realized, and sit back and watch as all but the wingnuttiest teabaggers retreat into apathy or even get on board the reform train.

It is hard to resist trying to overpower irrationality with reason. But, unfortunately, you can’t hold a rational colloquy with a person yelling “Fire” in a crowded theater.

In fact, speaking truth to unreason may fan the hysteria. Social-science research shows that people tend to believe only the “facts” that jibe with what they already believe. And worse: The more they hear corrections to what they believe, the more fiercely they hold to their misperceptions. A University of Michigan political scientist writing in the New York Times last week described an experiment finding that the proportion of conservatives who believed Bush’s tax cuts increased federal revenue almost doubled when they were given evidence against that claim. “People seem to argue so vehemently against the corrective information that they end up strengthening the misperception in their own minds,” he wrote. His grim point: That’s what’s going to happen with health care.

Still, I can’t help feeling that this political scientist’s prediction leaves something out: the importance of the specific subject on which people dig in their heels. Few of us ever get up close and personal with the federal budget. Illness and health care, on the other hand, hit as close as it comes: your own body and those of the people you love. Right now, both support for and opposition to reform have been mobilized by abstractions — security versus freedom, equity versus individual responsibility. So capacious are these concepts that it’s no wonder arguments get confounded: hatred of Big Pharma expressed in the same breath as defense of the insurance companies’ “right” to do business without regulation, or the now-immortal demand, “Keep your government hands off my Medicare!”

The political scientist seems to be saying that emotions will outmatch reason every time. But my mother’s contradictory analysis — people are rational; people are irrational — is not so contradictory after all. As I’ve pointed out before, emotion can either abet or undermine reason. Neurologists like Antonio Damasio have shown that people whose emotional brains are impaired can’t make rational decisions.

The job, then, is to counter bad ideas with better ones. But first, you have to supplant destructive emotions with constructive ones.

Understandable feelings may be treated gently. But then there’s hysteria, flaming not just from the websites of the insurrectionist fringe, but also from GOP members drawing salaries for their jobs on Capitol Hill. If only more Democrats had Barney Frank’s courage in calling madness by its name. Recall the town hall meeting this summer where he replied to a woman comparing Obama to Hitler: “On what planet do you spend most of your time?” Not to worry; there will be ample opportunity for Frankness in the future.

Some of the fear — itself a fount of some of the nastiest emotions — may dissipate as people realize health care reform won’t change their lives much, if at all. That’s what happened to the opposition to civil unions after the bill passed in Vermont. A few years later, gay marriage faced the merest of resistance.

But of course we hope health care reform will change people’s lives, for the better. For that to happen, supporters must protect the congressional majority: Vote. This includes the 20 percent of Americans who, according to a Gallup poll, dislike the new law because it doesn’t go far enough. It won’t go any further if Republicans control Washington. (For its part, Washington had better make the new system work, or we’re sunk.)

In the long run, health care reform has to win hearts, and only then will minds follow. Already, minds are following hearts, in the wrong direction (see above: “Keep your government hands off my Medicare!”)

How do hearts change? With experience. On that score, it’s a race for time: Enough good experience must accrue before the opponents can disable the law’s power to deliver it.

As it happens, in the same weeks when the Democrats were scrambling for votes, my family was getting a taste of what medical care might feel like in the new era. Mom suffered another stroke, which left her half-paralyzed, too tired to open her eyes and unable to swallow. She’d long ago nixed a feeding tube or other extraordinary life-extending measures. It was time to discontinue her meds and let her die.

We called in hospice. Along with her longtime caregivers, hospice doctors, nurses, social workers and aides helped us make my mother feel comfortable and safe. We felt safe, too: We could phone in 24 hours a day for advice about anything from constipation to crematory services. If we needed someone to come, they came. Without our asking, they showed up regularly at my mother’s apartment and hung around until we were ready for them to leave. They treated all of us, most of all Mom, with respect and kindness; to a person, they were competent and knowledgeable.

Medicare paid for everything from doctors and drugs to diapers. When Mom died, hospice called the funeral services and arranged for the death certificates to be signed. A bereavement counselor got in touch a few days later. We received a condolence card, signed by Mom’s whole team.

I’m not under the illusion that this is what health care will be like after reform. Part of what makes hospice great is its philosophy that medicine should enhance care, not the other way around. Americans’ attitudes toward high-tech, have-it-all medicine will have to change, too — the subject of another column.

But, aside from the kindness and competence and good sense, what made my mother’s dying extraordinarily easier was this: Not once did we talk about money. That is enough to make a person love American health care.

You’d think we’d be happy. Less uncomfortable breast squishing and a few bucks saved on health care (though the panel reviewed only clinical, not economic, data). Trustworthy players in the breast biz were delighted. The radical advocates’ group Breast Cancer Action, for one, had long warned women of the risks and oversold benefits of mammograms. The renowned breast doctor and feminist Susan Love also welcomed the new guidelines.

So did I. Having endured two painful, scary and probably unnecessary biopsies, I’d been putting off my next mammogram to avoid another biopsy — my own defensive medicine. I’m sure I wasn’t the only woman in this pickle.

But then women, and their presumptive friends, rose up. Republicans — those famous champions of women’s rights — spread rumors of a Democrat-insurance industry conspiracy to save pennies on the backs of women. The press fanned the uproar. TV reporters strode down hospital hallways beside oncologists, who worriedly condemned the new advice; an “expert panel” — all radiologists — also nixed it. Unlike Democratic bean counters and insurance lobbyists, these docs were exonerated of any self-interest. Soon a Gallup/USA Today poll reported widespread “anger” among women, many of whom planned to ignore the guidelines. (Respondents also overestimated the likelihood of getting breast cancer in one’s forties by as much as 50 times.)

Within days, Health and Human Services Secretary Kathleen Sebelius was dissociating the government from its own panel’s recommendations. And a week later, Delaware Democratic Senator Barbara Mikulski proposed an amendment to the health care bill guaranteeing free screenings for women — not just yearly mammograms starting in their forties but also tests for such killers as heart disease and diabetes. Most liberals supported the amendment, which passed 61 to 39.

Then another assault on a women’s health “need” surfaced: a proposed tax on elective cosmetic surgery to raise health care revenue. Middlebury College sociology professor (and my friend) Laurie Essig, whose forthcoming book American Plastic investigates the collaboration of the cosmetic surgery and consumer credit industries, blogged onTrue/Slant against the tax. You can’t say whether cosmetic surgery is “necessary” or not, she said, given the tough labor and romance markets and women’s place in them: “If someone is so depressed about the size of their boobs or their nose or their back fat that they stop going to work or school, is the surgery necessary?” Essig noted that such self-improvement is not the province of privilege anymore — a third of cosmetic surgery patients earn less than $30,000 — so the surcharge would be regressive, like cigarette taxes.

Similar outrage emanated from the National Organization for Women. Middle-age women “have to find work,” NOW President Terry O’Neill told the New York Times. “And they are going for Botox or going for eye work, because the fact is we live in a society that punishes women for getting older.” O’Neill decried women’s inferior pay (as of the last census, 70 percent of American working women earned less than $20,000 a year) and higher health care premiums. “And now they are going to put a tax on middle-aged women in a society that devalues them for being middle aged?” she wailed.

(I was starting to feel a sympathetic hot flash coming on for my Botox-deprived sisters, when it occurred to me there might be a silver lining to women being crowded into the crappy end of the job market: You don’t need an eyelid tuck to get hired as a chambermaid.)

Where does this entitlement end? Last week’s Times Style section reported on a cosmetic procedure in which fat is transferred from a hefty body part — say, the thighs — to a scrawnier site, usually the breasts. The few docs who do the operation admit there are risks — “oil cysts, masses, nodules and scarring,” for example (and sometimes the breasts just “go away”). But here’s another problem: The immigrant fat can cause little chips of calcium to form in the breasts, and these can confound radiological readings. A “baseline” mammogram must be done before the fat transfer. The calcifications are harmless, but they sometimes signal cancer, so a biopsy may be needed. An elective (or socially necessary?) procedure leads to a necessary (or overly cautious?) one. Will Mikulski’s amendment cover these tests, too?

Essig is right that the line between necessary and elective is not clear. But if health reform is to be sustainable, effective and fair, we’re going to have to draw it. She suggests the taxes on cosmetic surgery should be levied on surgeons and credit companies, not patients. I agree that the rich should pay more to support the health care of those who have less. But taxes won’t cover it all. There will be rationing. Indeed, there should be rationing — also known as rational choosing between interventions that are needed and those that are only wanted; those that justify the risks and costs and those that don’t.

We do not have such a rational policy now, and the mammogram debate highlights the dysfunctional hybrid we do have — a “free-market” health care “system” driven by profit and consumer demand, with a soupçon of recognition of the right to care thrown in. So if the patient wants (or is persuaded to want) a procedure, and if she can afford (or finance) it, then she should have it, we apparently believe, whether it is a nose job at age 12 or a triple bypass at 92. Now we are making the transition to health care as a public good, not a private luxury — and, guess what, we can’t have it all. We’ll have to stop acting like spoiled customers at Saks.

Women should also heed the feminist health movement’s time-tested skepticism of medicine, rather than adopting the dubious notion that all troubles are biological and should be fixed medically. Maybe that gal immobilized by back fat should take a vigorous walk every day, tutor at a public school or, hey, join NOW. For its part, NOW should quit defending her right to liposuction and start changing her — and men’s — consciousness about age and beauty. Until that distant goal is won, feminists should hammer the government to fine the bejeezus out of employers who practice age or sex discrimination.

As for gender discrimination in health care, the reform bill would outlaw it, including higher insurance premiums for women.

In the health care debate, as in all politics, it is politically useful to slice the population into competing interest groups — old people, children, kidney dialysis patients, cancer sufferers — and win support bit by bit. But such Balkanization is antithetical to integrated policy; it undermines the goal of reform, which is to promote everyone’s well-being.

Plus, such tactics can backfire. The GOP has belatedly become the defender of Medicare. But, mark my words: It will use the cost of Medicare as a reason to vote against reform. The price tag of Mikulski’s amendment — about a billion dollars over 10 years — is another arrow in the opponents’ quiver. And if reform passes with the amendment intact, the costs of elective tests for worried-well female patients will come out of someone else’s care. Men also die of cancer, heart disease and diabetes. Must they get their own amendment?

There is, however, one medical procedure unique to women that cannot be jettisoned in the compromises reform will call for: abortion. Pregnancy happens only to women. Motherhood changes everything. These realities have been at the root of women’s oppression since the beginning of time. Without control over our own reproduction, women can never achieve equality.

This makes it all the more depressing that women are up in arms about their rights to unnecessary mammograms, and only the stalwart pro-choice organizations have mobilized against the House’s Stupak-Pitts amendment (a similar one from Nebraska Democratic Ben Nelson was defeated Tuesday in the Senate), which would effectively wipe out insurance coverage for the termination of an unwanted pregnancy. Such limited protest makes abortion look like the single-issue fetish of a few, rather than a bottom-line right for all women, whether they choose to exercise it or not. Compare Congress’ response to this tepid resistance — numerous putatively pro-choice Democrats voted for Stupak-Pitts — with the stampede to support Mikulski.

Health care reform will force us to sort needs from desires. Since we can’t have everything, we have to pick our battles. A nose job is an elective procedure; it is, frankly, not worth defending. A just-in-case mammogram is an elective procedure. We should cherish our mammo-free years.

And, unless the woman’s life or health is at stake, an abortion is also a medically elective procedure. But, socially, politically and existentially, the right to have an abortion — and the affordability and accessibility on which the right depends — is not elective. Abortion is necessary to women’s equality; it is necessary to women’s freedom. Abortion is necessary to more than women’s health.

This piece originally ran in Seven Days.

In Las Vegas and Washington, teenagers are beating up homeless people for the thrill of it.

On the greens, golfers are swinging their clubs at perpetrators of “slow play.”

G.I. Joe, featuring nonstop futuristic military mayhem, was last weekend’s biggest-grossing movie.

And at town hall meetings across the nation, opponents of health care reform are shouting and shoving and burning their representatives in effigy.

The protesters say they represent a vast popular rage against a liberal plot to turn America into a totalitarian state. “This is truly a drive to put the population under complete government control,” comments one typical blog reader about “Obamacare.” “They will decide who lives and who dies. God help you if you didn’t vote for this marxist SOB. If his brown shirts have the opportunity they’ll eliminate you.”

The Dems counter that the anti-reformers are not a grassroots movement at all, but a media show funded by Big Pharma and orchestrated by national pro-business, antitax groups such as FreedomWorksand Americans for Prosperity, whose other worthy causes include, respectively, defeat of the beverage tax and defense of the tobacco industry against antismoking legislation.

Indeed, the disgruntlement is not as widespread as Fox News would have you believe. Among respondents to a recent Time poll, for instance, 63 percent “would support providing health care coverage for all Americans, even if the government had to subsidize those who could not afford it.” Fifty-five percent wanted a public option, and to pay for the plan, 57 percent were fine with raising taxes on people earning more than $280,000 a year.

But American public opinion is fickle, and the poll was conducted in the last week of July, before the media started covering the enragés 24/7. Facts about the reform are unlikely to quell the storm either, as Obama keeps insisting they will. In meeting after meeting, jeers meet representatives’ reassurances that Washington will not (alas) establish a single-payer system. These are the same folks who deplore motorcycle helmet laws and public schooling. They don’t like the gu’ment, and they wouldn’t trust a politician to mow their lawn.

In fact, the protests are both an Astroturf campaign financed by the insurance and medical industry lobbies and the pained cry of a native movement flung from the center of power to its margins, like Sarah Palin packed onto a helicopter to Alaska. As in all modern American politics, the passions are organic and media-pumped, authentic and manufactured — and there’s no bright line between the two.

I’ve been watching these people on YouTube and reading their fulminations in the blogosphere and, as anyone can see, there’s anger here, all right. But angry may be the wrong word for how the protesters are behaving. Rather, they are apoplectic. Piqued. Irritated. Agitated. Theirs is agitation as the progressive organizer Saul Alinskyconceived it: both a public emotion and a political tactic that involves ratcheting up the ressentiment of the protesters, empowering them to confront the powerful — the politician or CEO. The idea, wrote Alinsky, is to “rub raw the sores of discontent,” then deploy it.

FreedomWorks has adopted Alinsky’s Rules for Radicals as its training manual. But there’s a pesky difference: He was siding with disenfranchised poor people and workers, whereas the organization stands up for rich taxpayers and corporations. How to turn the victor into a victim? You can simply keep asserting your victimhood, like Rush Limbaugh at the height of the Bush years griping about left-wing domination of the media and politics. Or you can find another oppressor. Many of the anti-reformers are happy with their health insurance; they just don’t want to pay taxes to extend the privilege. Since helping the less fortunate might broadly be viewed as a public good, taxes themselves, in any amount, must be figured as a “burden,” indeed, a tyranny.

Still, for others in the tea party movement, its ideology appears to fight personal need and desire — to pit “freedom” against the ability to take a sick kid to the doctor without going bankrupt. How do you get an unemployed guy, like the one recently interviewed on National Public Radio, to oppose government-funded job creation? How do you persuade an uninsured person such as Ken Gladney — the St. Louis resident who took up a collection to pay his medical bill after an alleged beating by union “thugs” — to despise affordable health care?

For these people, too, the solution must look worse than their problem. Confusing claims and conspiracy theories are circulated: Medicaid might be taken over by the government! A congressional panel will euthanize medically expensive senior citizens! To perpetuate the paranoia, protesters disrupt public events rather than engage in public conversation. In town hall meetings, they are asking questions larded with misinformation, then cutting the speaker off before he or she has a chance to respond. Such an exchange guarantees that the interrogator — and, not incidentally, the audience — learns nothing, certainly nothing to assuage the alarm the question has engendered. Learning nothing, everyone also gets nothing: no possibility of hope, no idea to realize creatively, no goal to work toward.

And the activists husband their useful frustration.

As any barroom denizen or battered spouse will tell you, the combination of cultivated grievance and foiled conversation is a volatile one. It’s a mood that can move a golfer to raise his nine-iron or a bunch of boys to search out a park dweller to stab. And it can set fists flying at the school gym. But when violence erupts, the movement’s spokespeople can claim perfectly plausible deniability. Hitting your neighbor or sending a death threat to your representative is deplorable, of course! But you can’t blame these people. They’re frustrated!

It’s all classic right-wing organizing: hysteria as discourse; temper tantrum as social movement. And, contrary to the Democrats’ naïve hopes, it works. It works because opponents of almost anything are more passionate than proponents, even — especially — when the proponents outnumber their foes. Securely in the majority, observing the dicey tactics of the other side, the proponents step back, unwilling to risk reputation or safety to defend a cause they think will win without them. In their absence, the loud, aggressive minority has its way (often with the help of corporations hiding quietly behind their foundations). And that’s how you end up with the Defense of Marriage Act — or a chaotic, costly and crappy health care system.

But a strategy of fomented frustration also has its weakness: You get frustration and risk burnout. Bitterness is a brittle motivator; an army that marches on its spleen may not have the wherewithal to stick out the battle to the end.

What is the end? That’s another glitch in the strategy. Unlike other conservative oppositional politics, the anti of health care reform has no clear pro. Antiabortion activists are pro-life; they really want to save fetuses. Anti-gay-marriage forces really believe in the superiority of heterosexuality. What right-wing libertarians want, in a sense, is nothing: no government. But nothing is a hard desire to sustain.

In health care, moreover, getting nothing means keeping what you already have: the “free” insurance market. A demonstrator in a photo posted to the Huffington Postheld up a placard reading, “No Health Care!” No health care would be an insurer’s dream come true. What profits would pile up if only they could eliminate those costly doctors’ visits!

But might the placard wavers wake up some morning with no health care and realize they want it?

Supporters of reform cannot sit around waiting for the tea partiers to go soft steeping in their own frustration. We have our own frustrated millions to mobilize: Americans so fed up with commercial medicine that they’re willing to pay taxes to care for everyone.

But frustration is only a catalyst. In the end, patience — what my partner, a former legislator, calls “staying in the room” — may be the virtue that wins the day. Congress has had about four months to sort out one of the most vexing policy problems confronting the U.S. The Obama administration’s exhortation to hurry up and “get it done” — and Congress’ own mantra that if the legislators don’t succeed this fall, they will fail — is self-defeating and self-fulfilling. What if they don’t finish by Thanksgiving? Should they move on to something more pressing, like a federal Driving While Distracted felony statute?

The opponents are counting on Americans’ low tolerance for frustration — and representatives’ terror of the two-year election cycle — to defeat health care reform. But in government as in life, things worth doing usually take longer than expected. Citizens need to speak their impatience with a government that has done not too much but too little, then patiently hold elected officials to getting the right thing done.

This piece originally ran in Seven Days.

I have recently been walloped by human need, its depth and constancy. For the better part of the past three months I have been caring for my mother. At nearly 90, Mom was taking care of her own business. Retired after 45 years’ work in nonprofit organizations, she managed her finances, walked two miles a day, read two books a week, volunteered at a public garden, handed out leaflets for peace, practiced the piano and pursued a social life that would exhaust Paris Hilton.

Then, at about 4 a.m. one Sunday in March, three blood clots traveled from her heart to her brain. The stroke knocked out her short-term memory, most of her sight and her ability to reason reliably. Since then, my mother has been unable to read or play the piano. She cannot remember her grandson’s name, make a piece of toast or leave the house alone. She needs full-time care.

The hour my mother went into the ER, my life was virtually supplanted by hers: first her hospitalization and rehab, then the oversight of her care, her money and her household, which has meant piecing together the details of a now only vaguely remembered existence, from medication schedules to email password. And all the while, I have carried my mother’s immense grief and distress at the radical transformation of her self.

In spite of the fact that she has had home health aides with her from the day she returned home, I have been almost unable to work; I can barely think. My partner, Paul, has assumed a huge part of the burden. But it is still not enough. If I am not to go broke or crazy, we will have to pay someone else to assume my mother’s care.

If she lives a few years, such professional assistance will devour every penny of her savings. After that, she will go on Medicaid, at which point the quality of her care may precipitously decline. Health insurance does not pay for chronic care.

Our family’s situation is ordinary. In 2004 there were an estimated 44 million family caregivers in the U.S. Some families supplement this work with paid home aides. The dedication, competence and kindness of many of these workers belie the paltriness of their pay: rarely more than $10 an hour, often for 24-hour shifts. But others are untrained and uninterested, and their wages are beyond the means of most families anyway. Those who can afford paid care are not off the hook. The fragile systems regularly break down, and with each crisis everyone’s health, sanity and money take a hit.

Disability rights activists call us sighted, hearing, mobile bipeds the “currently able.” What they know is that autonomy, the cornerstone of Western ethics and personhood, is a myth. Sooner or later we will all be in some way halt, in some way blind, and neither science nor the grace of God will prevent us from going where the currently disabled already are. In the meantime, we already are what they are: dependent, from our first breaths to our last.

Paradoxically, our dependence may be more acute in this age of Web-shopping, tax-resisting, single-person-householding consumer-citizenship than it was when we hunted in packs and dragged home a bison for the communal feast. Back then you didn’t survive long without the help of others. Today, you need the help of others because you survive so long. Modern medicine has all but defeated premature death from acute illness; we stay healthy for more years. The irony of this accomplishment is that we will be sicker later, and for longer. We can count on surviving seven, eight, even nine decades, but an American who reached the age of 65 in 1996 can also expect an average of more than five years of “dysfunction,” probably from a chronic illness, before she dies. “Much of the peculiar pathos of aging in American culture,” notes historian Thomas R. Cole in The Journey of Life: A Cultural History of Aging in America, “derives from the denial of this new fate.”

The new fate is the same as the old one. As University of Missouri sociologist Jaber Gubrium once told me, “Failure is a natural part of life.” So if we fail — when we fail — who is responsible for picking us up? Karen Buhler-Wilkerson, professor emeritus at the University of Pennsylvania School of Nursing and a historian of home care, says there’s a loose consensus in America that the family should do it, with a little help from the state. But that’s as far as we’ve gotten after a century of irresolution. Charity and the profit motive, individualism and personal desperation, left and right continue to duke it out. What never happens is the establishment of an adequately funded, integrated system of care similar to those in almost every other developed country.

“In the absence of the requisite public will,” writes Buhler-Wilkerson, “our stance appears to be one of waiting for a complete breakdown of long-term care before definitive action will be taken in response to the needs of the present and growing aging and chronically ill population.”

Policymakers and advocates have recently taken a step. They’ve realized that home care is cheaper than institutionalization. That’s why many states, including Vermont, now allow Medicare payments to family members who care for the ill or aged at home. But those payments are few and small, and anyway the savings are based on a false economy. Yearly, family caregivers provide an estimated $257 billion in unpaid care.

Who are those family caregivers? Need you ask?

They’re the same people who provide free childcare and housework: wives, daughters, grandmothers, sisters, nieces and female domestic partners. Paul is an exception among men. Indeed, everywhere in the world, almost to a person, caregivers are female.

Americans imagine we will never become old, sick or dependent. But just in case we do, Mommy will kiss the boo-boo. These two fantasies strike me as related. Even as we figure ourselves self-made and self-reliant, we are, as social beings, infantile. Nowhere are we more attached to the delusion of our perpetual youth than where our bodies are concerned. Cosmetic surgery, Viagra, stem cells: These will keep us vital forever.

Small children do not understand death; they believe Grandma or the pet hamster is only sleeping. Adolescents think they’re unbreakable; they’ll take any drug or any dare. But growing old means recognizing your frailties. Growing up means facing your death.

There are many political, economic and bureaucratic obstacles to universal health care in the U.S. — powerful insurance lobbies, fee-for-service medicine, budget-cutting mania. But these are trifles compared to the real obstacle: our dumb faith in ourselves.

Americans are showing signs of readiness for health-care reform. A New York Times/CBS poll last week found overwhelming support for a public insurance option, as well as trust in the government to do it right. Two-thirds of respondents said covering everyone is more important than controlling costs. Will we actually do it? And will we as a nation ever assume responsibility for people like my mother, whose troubles are neither curable nor fatal? Desperation may finally get us there.

But as long as we cannot give up the fiction that we are invulnerable and autonomous, we will fail to provide ourselves collective security. As long as we deny our mortality, we will condemn ourselves to die alone. 

This column originally appeared in Seven Days.