I have watched my favorite teams lose championship games. I remember the sinking feeling that I experienced when Richard Nixon was elected for the second time, even after it was really pretty clear that he was a crook. I suffered when Jimmy Carter, one of the most honest and earnest men ever to enter politics, lost to Ronald Reagan who was the champion of making America feel good about its defects. I read Bush One’s lips and was distressed. I lost my mind over hanging chads and shook my head when the country made the same mistake again after we knew that there really were no weapons of mass destruction in Iraq. I have been pinching myself in disbelief since the second Tuesday in November, hoping that it is really just a bad dream. None of those many losses has left me feeling as bad as I felt when I saw the president, Paul Ryan and some of some of their favorite sycophants congratulating themselves in the Rose Garden after the House narrowly passed Ryan’s package of lies and misconceptions. Intellectually I know that there are still many potential barriers to their ultimate objective, but there was something pernicious about the moment.
My first response was to turn to that reliable source of “fake news”, The New York TImes, to check out what its pundits had to say. I felt somewhat better when I learned that the margin of the victory that our president was crowing about was really only three votes. I felt profoundly grateful for the twenty Republican members of Congress who for whatever reason refused to knuckle under to the pressure and distorted reasoning presented by Speaker Ryan and Reince Priebus over the last few weeks. I was delighted by the request of the Times for readers to respond with stories about how the loss of the ACA would hurt them. I think their questions form the basis of the future defense of the ACA. Here is their request:
The House of Representatives voted Thursday to repeal and replace large portions of the Affordable Care Act. Times reporters who write about health care would like to hear from people who would be affected the most by the new bill, including:
- People who receive tax credits under the A.C.A. to help cover their premiums, or who have qualified for Medicaid under the law
- People who get insurance through the individual market but earn too much to qualify for tax credits under the A.C.A.
- Employers who are required to provide insurance to their employees under the A.C.A.
- People who have had to pay tax penalties for going without insurance under the A.C.A.
I hope these questions produce a wide range of perspectives from pro repeal to pro ACA. I think that this is a useful exercise because it is clear that the complexity of the issues precludes most people from doing a systematic analysis. Stories are better to share than projections and statistics. The president and Paul Ryan have built their case for appeal upon the expense experienced by some people in the self insured market of the exchanges. Many of these people were unable to get insurance at any price pre ACA because of their pre existing conditions. Some who qualify because of their lower relative income get financial support. Some need to pay the whole price from their own resources. The exact size of this group is hard to know, but less than eight or nine million people are enrolled through the exchanges.
Insurance companies have withdrawn from the exchanges in some states, but the reason in part has been that Congressional Republicans have blocked some of the support that was originally guaranteed to insurers, and Congressional Republicans are currently pressing a battle in the courts to try to deny other payments. What is difficult to understand from the lumped accusations by the president and speaker against the ACA is the real benefit going to those in the 31 states that accepted the Medicaid expansion and the benefits we have all enjoyed because of the assurance of insurability, the certainty of the quality of the coverage that we are buying, and the benefit to the institutions that provide our care from the fact that more people are actually covered.
Folks who earnestly want a deeper understanding of healthcare become confused and their eyes glaze over when we talk numbers and policy. Their minds begin to wander when we start using terms like the “self insured market” or “community rating.” “Mandate” sounds like something that any rational individual would resist rather than an necessary component of the assurance that insurance markets will be stable and affordable. People gain understanding and respond to stories. One of the most effective stories told this year was the personal story told in Hillbilly Elegy by J. D. Vance about growing up in an impoverished and dysfunctional family in rust belt Ohio.
My greatest relief during the few days prior to the regrettable House vote was not the tension relieving belly laughs that I got from the likes of Stephen Colbert, Samantha Bee or John Oliver, but rather from the story Jimmy Kimmel told about his son who was born on April 21 with Tetralogy of Fallot. Perhaps you have seen Jimmy Kimmel’s tearful and thankful testimony. I cried, but then old men who are grandfathers and have another one on the way are easy marks for stories about families with sick kids. If you don’t have time for the thirteen minute clip, move the cursor to about 11 minutes and listen from there. A less effective alternative option is to read the transcription below. These are Kimmel’s words delivered after he knows that his son will be ok. The experience has given him a sharpened perspective and an enormous sense of community and gratitude for something that he realizes is not, but should be, enjoyed by every person if America is really to be great.
We were brought up to believe that we live in the greatest country in the world but until a few years ago millions and millions of us had no access to health insurance at all. You know, before 2014, if you were born with congenital heart disease like my son was, there was a good chance you’d never be able to get health insurance because you had a pre-existing condition. You were born with a pre-existing condition. And if your parents didn’t have medical insurance, you might not live long enough to even get denied because of a pre-existing condition.
If your baby is going to die and it doesn’t have to, it shouldn’t matter how much money you make, I think that’s something that, whether you’re a Republican, or a Democrat or something else, we all agree on that, right? I mean, we do.
Whatever your party, whatever you believe, whoever you support, we need to make sure that the people who are supposed to represent us, the people who are meeting about this right now in Washington, understand that very clearly.
Let’s stop with the nonsense, This isn’t football. There are no teams. We are the team. It is the United States. Don’t let their partisan squabbles divide us on something every decent person wants. We need to take care of each other. I saw a lot of families there [Children’s Hospital of Los Angeles]. No parent should ever have to decide if they can afford to save their child’s life. It just shouldn’t happen. Not here…
Most people who listened to Kimmel probably felt the way I did and in the moment we’re ready to say let’s do it! It’s gotta happen! Just like we wanted assault rifles out of our communities the minute after we heard about Newtown, Aurora, or Orlando. Others feel differently, and our constitution guarantees them the right to their perspective. Chicago Tribune columnist Eric Zorn wrote about such a person:
Former Congressman Joe Walsh was acting very presidential Tuesday afternoon. By which I mean he was impulsively tweeting venomous, half-baked thoughts — in this case his reaction to late-night comedian Jimmy Kimmel‘s monologue Monday about his newborn son’s dramatic battle for life at Children’s Hospital Los Angeles.
“Sorry Jimmy Kimmel,” wrote the feisty Republican who represented the northwest suburban 8th U.S. Congressional District [Chicago] from 2011 to 2013. “Your sad story doesn’t obligate me or anybody else to pay for somebody else’s health care.”
Zorn moved from reporting the event to offering commentary.
Many found this outrageous. I merely found it illustrative. I understand Kimmel’s desire not to sully his powerful tale with partisanship, but the central difference of opinion in this major battle over insurance coverage is partisan. Democrats generally believe that access to consistent, affordable, quality health care is a right. Republicans generally believe that it is a privilege properly enjoyed by those with the means to afford it, like access to quality restaurants.
Zorn continues describing who Walsh is and adding yet another quote from him:
Walsh, 55, who has a nationally syndicated daily program that originates from Chicago conservative talk station WIND AM-560, helpfully jumped online to clarify.
To paraphrase: Life is about choices. And if you choose not to have enough money or a job that provides your children with urgently needed care, it’s not my problem. It’s your sick baby’s problem. Good luck with that.
Walsh is reported to be delinquent by over a hundred thousands dollars in child support payments, but that did not prevent him from tweeting advice:
“…hey, if people with pre-existing medical conditions happen to live in a state that waives their protections under the GOP health care bill if it is enacted, they can always move to another state. The proposal “brings choice back to the American people,…”
Zorn closed with his own analysis.
Look. We’re all born with a terminal condition. Few of us face the fact as early as Billy Kimmel, but something’s going to get us in the end. Luck will play a huge role in what ailments and injuries we have to fight along the way and how expensive those fights are going to be. Luck will also play a role in how able we’ll be to cover those bills.
True compassion demands that we minimize the role of luck in access to necessary health care, not layer on hope for charity and pity.
Expand Kimmel’s idea that “no parent should ever have to decide if they can afford to save their child’s life” to include spouses, parents, siblings and selves.
That’s what Democrats are fighting for and they owe Joe Walsh thanks for so clearly illustrating what they’re fighting against.
Stories will be the difference as the battle moves to the Senate. The people who will show up at town hall meetings will not be there hoping to see Powerpoint presentations and Excel spreadsheets. They will be there with concerns and worries for themselves, their families and their neighbors. All of us, rich and poor, no matter what our coverage status is, have much to lose by the ultimate passage of the AHCA and much to gain if we can begin a process of repair of what needs fixing and expansion and improvement of the work started by the ACA. We must continue to strive for
…Care better than we’ve seen, health better than we’ve ever known, cost we can afford,…for every person, every time…in settings that support caregiver wellness.
Congress will be away for the next week. Now is the time to stop, reflect on the importance of what we have achieved and then continue to conceptualize the strategies that might finally kill the AHCA or whatever the name will be for the obsession that Republicans have with the repeal of the ACA and its replacement with an illusion of care and reason. As my old coach always said, “It’s crunch time. Do not forget how bad it feels to lose!”