Republicans regularly emit streams of bellicosity on a wide range of subjects, some of them backed by destructive or deplorable political or governmental action (or non-action), some of them just wind to soothe the savage rightist breast. But when it comes to the subject of American health care and American health insurance their negligence or belligerence as the case may be is ruinous in the most despicable way.

It is well known how viciously the right has fought on behalf of the American health insurance industry for decades in order to stigmatize, demonize and vastly lie about universal health care systems utilized elsewhere in the modern industrial world, America the single outlier among modern democracies in its lack of universally accessible care. Whether surprising or expected at this point, the Republican reaction to the accumulated and myriad assessments of American health care as remarkably inferior in outcomes and remarkably costly at the same time is that it rolls off their ideologically insouciant backs.

Political expedience (health insurers and health providers bathe them in contributions) may account for some of the denial, obdurateness and disregard for the acute economic and human consequences for the nation and its people as a result of this deprivation and inadequacy, but otherwise it reeks of a combination of rank stupidity, genuine mendacity and blithe ideological habit.

It likewise is well known how vociferously and dishonestly Republicans recently pursued the obstruction of American health reform, and how petulant and incessant are their threats against the modest, but extremely helpful reforms that have been enacted. As has frequently been noted, these enacted reforms are all but identical both to the health reform implemented in Massachusetts under Mitt Romney, and the go-to health proposals of Republican politicians for well beyond a decade now, Rick Santorum, Newt Gingrich… practically any elected Republican in office during the Nineties, or say, prior to the election of Barack Obama, on the record endorsing the health care mandate that is key to the Affordable Care Act as well as the structure and principles of enacted health reform.  As useful and valuable as cynicism may be in the realm of raw politics, cynicism of this depth and with such literally critical ramifications on a matter of literal life, death, and quality of life for a nation’s citizens is monumental immorality, well-beyond any example of the politically unconscionable one previously could imagine.

The subject has come to the fore of late as Republican candidates for president have opined in debates and on the stump in response to questions concerning health care and health reform, and aside from rote condemnations of the Affordable Care Act and falsehood-laden demagoguery, the basic theme running through their obfuscatory pastiches of verbiage is: “Who gives a shit?”

Apropos of this habitual hostility and calculated obliviousness is the study published yesterday in Health Affairs analyzing health care for 2010. According to the study, U.S health care spending grew at the second-lowest rate on record, attributable the report said to American consumes avoiding doctor visits, expensive prescription drugs and costly procedures:  “Persistently high unemployment, continued loss of private health insurance coverage and increased cost sharing led some people to forgo care or seek less costly alternatives than they would have otherwise used.” It also noted that growth in health insurance premiums exceeded the growth in insurers’ spending on benefits. If this isn’t an American tragedy, nothing is. If this isn’t a manifest and damnable American failure, there is no such thing as one.

In a debate during which audience members famously cheered death as a suitable result for a hypothetical thirty year old lacking health insurance Ron Paul said, “In a society that you accept welfarism and socialism, he expects the government to take care of him.” Wolf Blitzer pressed the question of what should happen to the man, and Paul answered, “What he should do is whatever he wants to do, and assume responsibility for himself. My advice to him would have a major medical policy, but not before —”

“But he doesn’t have that,” Blitzer tells him. “He doesn’t have it and he’s — and he needs — he needs intensive care for six months. Who pays?”

Paul says, “That’s what freedom is all about: taking your own risks.”

If one requires assistance determining the moral and practical location of libertarianism among the economic and governing philosophies of the modern, civilized world this is remarkably helpful, the full-frontal delusion and crippling abstraction and mythology of absolutist ideology revealed. Unfortunately, this absolutism is the operational creed of the Republican Party now, and the Republican answer to Americans’ health care needs is blunt and stark indifference.

Questioned by the mother of a boy with cancer about the unavailability of health coverage for those who already are sick, Rick Santorum answered, “Insurance works when people who are higher risk end up having to pay more, as they should. People with higher risk should pay more. Why should we charge more to people who have done everything right?”

First, note the Republican mania for putative moral dismissal of segments of the population (the poor, generally, here the sick) in the course of demonizing them for political purposes goes to extreme lengths even for them in assessing the contraction of disease as a moral failure. Surely I am not alone in wondering if most Americans privy to such statements and the attitude they reflect are not struck by the irrationality, cruelty and sheer lunacy of what they hear. If I am not joined by millions upon millions in wondering this, god help us.

More importantly, note that Santorum, reflecting the broad Republican view cites insurance as working when health care is made less accessible for America’s sick. This is equally stunning for its irrationality, cruelty and yes, sheer lunacy.  So the Republican ideal is that those who become ill are precisely those who cannot access a health provider. The status quo prior to health reform and the system defended and advocated by Republicans is one designed to guarantee the sick remain priced out of care or treatment. Such is a system enemies of America would design, those who wish us harm would foist upon us with the goal of decline or destruction of the country.  A prescription for a healthy, well and productive nation this is not. Is fidelity to a manifestly perverted ideal of a market system or retention of a view of health care as a consumer item largely out of reach of great swaths of American citizenry, and correctly so in this view, a higher priority than a nation of the greatest number of healthy people possible?

And then there’s Romney.  Yesterday he said, “If you don’t like what [insurance companies] do, you can fire them. I like being able to fire people who provide services to me.”  While it is expected that the punditocracy would make hay of this statement for its rhetorical ineptness and the ramifications for the horserace, it should be pointed out how the inadequacy of the media response illustrates the enfeebled character of our present media. Has anyone as yet illuminated for Americans the fact that beyond being a clueless elocution Romney’s answer is substantive nonsense? Has anyone thought to ask him how one fires a company that will not let one hire it even to begin with? Has he been asked, on behalf of those with preexisting conditions (in other words, those previously susceptible to the human incidence of physiological fallibility) how they are to dismiss the services of those who will not provide those services in the first place? What good is this supposed competition if none of those competing will offer accessible services to the entire population of Americans who are suffering or ever have suffered illness?

Is this really the best the discussion gets when it comes to American health care? Is this a dream? An existential prank? A Luis Bunuel film?

In any case, this is not what civilized modern capitalist societies do; it is not how they behave. It is not what capitalism is intended to do, and in fact is a mockery of rational behavior: economic irrationalism at its most destructive.  And above all it is inhumane and indecent, and beneath the dignity of a great nation…and almost entirely attributable to the machinations of the American right.

Some political scientists aver there is a segment of America that will suffer all manner of abuse from above, the withholding of material things and dignity, yet retain support for the social structure that allows for such abuse and withholding as long as such a structure guarantees there will be those with still less than themselves, those from whom even more material things and dignity are withheld. If this dynamic holds true in health care for anything like a broad swath of the American middle class, it would be a remarkable case of self-inflicted harm. I hope that is not the case and I am yet to be convinced it is.