Why We Need The Affordable Care Act (ACA)

I posted this story about my father (seen below) on Twitter a little over a week ago.

It’s gone around quite a lot since then, and I’m happy it has. I don’t suspect the right cosystemyes have seen it, nor do I guess that if they did see it, they’d care, but the truth of the story remains the same: my father would be alive today if the ACA were in place then. And without the protections of the ACA that let me get healthcare for me and my family without the roadblock of pre-existing conditions, I could end up in my father’s shoes, too. I’m 40, now. Certainly not an old man, but not a young one. My father was only 63 when he passed. Last year I had pneumonia twice — and pneumonia is a killer. What if I were without health care? Would I have gone to the doc? Maybe. Maybe not as fast. Maybe I would’ve gone and had a stack of bills to pay for years to come, or maybe I would’ve waited too long and suffered more — or worse, got dead.

The ACA isn’t just about insurance. It’s a panoply of protections: line items that seem small on the surface but are huge to those that need them, provisions to protect women’s health, provisions to help us get free tests to prevent big diseases, coverage for autism therapy, calorie/nutrition information at restaurants. The ACA is designed to protect individuals, and not a system. It’s just the first volley, an imperfect one, but one that makes health insurance — and by proxy, health care — affordable and within reach for millions of Americans, including us poor sods in the creative class who really would rather not do without it. The ACA helps the middle-class, the lower-class, it helps women, it helps the disabled, and all of those will be disproportionately affected by its repeal.

Its repeal is very much about protecting a system over protecting the individual.

It’s about protecting profits.

It’s about protecting the upper class only.

That’s what you need to understand about all of this — it’s about money.

It’s about taking it from you and giving it to someone else. It’s about tax cuts for the rich, it’s about lobbyists, it’s about bolstering a system and removing the protections for the individual. It’s the same way that the venomous and vigorous defense of the gun industry isn’t about your rights, it’s about protecting profits. It’s about protecting a system of gains that exploits you and your fear. (And in all of this you will find perhaps no greater irony than the fact it is a Constitutional Right to protect your guns, but you have no such right to health care.) For the record, I’m not even against guns or gun ownership. I am decidedly pro. But don’t mistake the fight as one that cares about you. It’s one that cares about lining the pockets of people who assuredly are not you. And the same goes with the fight for health care. It cares nothing for you. It pretends to. The GOP talk a very good game when it comes to you, the middle-class. (Or, even better, you, the white male middle class.) But they don’t give a shit about you, either. They stoke racism and sexism and other-ism to make you fear phantom enemies. They say, “It’s THEM. It’s THOSE PEOPLE who are hurting you. They’re welfare-grabbers, they’re terrorists, they’re needy women, they’re the weak disabled, they’re sexual deviants who deserve what they get,” and they wave their hands and gesticulate and point, and you look in that direction. And while you do, mad as hell, they give you a little hip-check and slip a hand into your pocket — and then they steal your wallet. And what they don’t tell you, what they never ever want you to figure out, is that you’re just as marginal to them as those other groups. They pretend you have solidarity with them, oh, ho ho ho, we’re all white, we’re all just working class people, we all love America.

Then they rob you blind and blame it on someone else.

If they cared about you, they’d protect you.

And they don’t care.

They care about their money. They care about the richie-riches.

Not having the ACA shackles you to a job — and it makes keeping that job more important, so it’s harder to leave, which gives that employer more leverage over you. Which again, favors the employer. It doesn’t favor you, the worker. It helps your boss, and your boss’ boss, and it helps the investors. Once again: it helps the wealthy. It helps ensure that the creative class can’t survive either, because we’re out here on the margins, on the frontier of wild space. It means we need jobs to survive, too. It means we suffer under an ecosystem that exploits us, rather than one that is meant to help us. We outnumber them by a massive, unconquerable margin, and yet we are conquered. Because we buy the lie. We take the story sold to us that we too can be rich someday, that the wealthy got there because of hard work, that they will extend their hand to us and help us up — despite the reality, the constantly proven reality, that they will slap your hand away from the golden ladder the moment you dare to fucking reach for it, you prole, you peon, you paltry serf. And we nod and we smile and we continue to vote to make them richer and us poorer, we vote to give them the best health care and to kiss our own health goodbye. We vote for ignorance over awareness, for a single path that someone else designed for us, for limitation over freedom. We always vote for them instead of us.

But the ACA is about us. Planned Parenthood is, too.

The ACA and PP is about giving us access to not just affordable health care, but knowledge about our own health. Without it, we’re gonna break. People are going to be hurt. The marginalized will suffer first, but the middle-class will suffer next — the working class is long in the tooth with horror stories of when family members fall ill. Just like the story of my father, a man who would still be around if he had access to health care when he got cancer.

Help keep the ACA. It isn’t perfect, but as I say below, just because your car needs new belts isn’t a reason to drive it off a fucking bridge. Call your representatives (need a script?). Go to a rally. Coverage matters. They don’t have a replacement. They’ve tried 60 times to repeal the ACA and over the course of several years they have continued to come up dry with any, any kind of replacement. They’re pushing us all out of a plane and promising to figure out how to build a parachute as we plummet. (And the truth is, they’re really only concerned for the golden parachutes they give themselves and CEOs.)

Don’t help them.

Help us. All of us. You, me, your neighbor.

We need the ACA. Demand they fix it, not destroy it.

Demand they help us, not destroy us.

And gods help us, in 2018: vote.

* * *


  • January 12, 2017 at 10:00 AM // Reply

    God, I love you, Chuck Wendig. This truth, so well laid out, is why writers are so very important, and especially NOW.

  • The ACA didn’t help my family (my mom has rheumatoid arthritis and lupus and my dad has diabetes, among other things. They can’t afford the premiums and don’t qualify for subsidies. So they don’t go to the dr because they can’t afford bills.)

    But I know it helps millions of other people, and it’s outrageous that they are doing this.

    • Yep, the ACA had some definite holes — mostly because of GOP governors refusing to expand medicaid to cover people in the gap. Would be nice if Congress and the President-Elect worked to fill those holes. Instead, they’re ripping coverage away from the millions of people who depend on it.

  • January 12, 2017 at 10:24 AM // Reply

    Yup. Ironically, this whole thing has taken the pressure off my writing schedule. Since it’s unlikely that with a serious pre-existing condition, I’ll be able to quit the day-job now, I’m feeling a lot less urgency to publish fast.

    Very nicely said, Chuck, and giant sigh.

  • First of all, I am sorry for your loss.

    I’m for replacing the ACA with something better, like Ron Paul’s bills: HR 1495, 1498, 2630, 2329, 3994 and 3395. I’m not for repealing it without a replacement. It’s better than nothing, as people like you and your father need it.

    You’re right, the Constitution doesn’t guarantee healthcare. The Constitution only guarantees life, liberty and (the right to) keep the fruits of one’s labor. Health Care is not a right. To say that health care is a right means that you have a right to someone else’s labor. Do others have a right to your labor, or is your labor your own, to use it as you see fit?

    I understand the well-meaning intentions of those who say that health care is, and should be, a right. However, a right is an entitlement. How can you be entitled to the work of a doctor, a nurse, or any other health professional, as a matter of birth?

    If health care truly was a right, then that was quite the oversight by the Founding Fathers in not including it in the Bill of Rights in 1789. But it wasn’t an oversight. They recognized that it wasn’t a right.

    The consequence of recognizing that health care is not a right, I believe, is to put the focus back where it properly belongs, as to who is ultimately responsible for their own health — the individual. There are those who are unable to properly care for themselves, as there has been since the dawn of time. Those people should be appropriately cared for, as matter of public interest, not as a matter of right, as well as all others. But just because it’s in the public interest to take care of all individuals, doesn’t make it a right, nor necessitate the method of care.

    • All of that is barbaric and counter-intuitive to a healthy society.

      If I have a communicable disease, and I cannot properly get that cared for, and I go without care, and I continue to spread that disease — I hurt others beside myself. A pack of healthy individuals form a healthy nation.

      No, you’re right, it doesn’t make it a right. But it still doesn’t change the fact that we protect our people from threats beyond our borders, but — with a repeal — will once again fail to take any measure to protect our people from threats to health. A nation that refuses to care for its citizens is a nation that is in a fail state. We are the only first-world nation that acts like this. It is embarrassing and shameful and continues to prove that we are in service to forces that care very little about us as a whole — so, as a whole, it is time to demand better.

        • “If I have a communicable disease, and I cannot properly get that cared for, and I go without care, and I continue to spread that disease — I hurt others beside myself. A pack of healthy individuals form a healthy nation.”

          You are right, but you’re presuming that others don’t have insurance as well.

          I agree that healthcare needs to be made available to all. But it’s NOT the government’s place to do it, given the way the Constitution is set up (not like our lawmakers adhere to it, but that’s for another day). You make it more available by allowing insurance to be set up across state lines, for example. If the gov’t set things up to allow more competition, we’d all win. Because if Blue Cross could cover people with pre-existing conditions easily and without having to spend tons of $$ to do it, you best believe Aetna, UHC and other carriers would as well.

          • > But it’s NOT the government’s place to do it, given the way the Constitution is set up

            Then whose!? You can hide behind the constitution all you want, but at the end of the day it was written for it’s time (1776) and not modern times (20XX). What you’re doing is the same as quoting the bible to suit your needs until “oh well I really don’t think we should throw stones at people that cheated on their spouse or are gay, because that’s barbaric! *secretly: I totally do think that because let’s be honest, I’m not a turn-the-other-cheek-Christian-like-Jesus-wants-us-to-be^^TEE-HEE^^” when confronted about it.

            If the Fed does not mandate it, would you allow the states to mandate it? If not that, then there is NO WAY to guarantee every citizen can be healthy to the best of the nations ability.

    • Also worth noting… when our founding fathers drafted the Bill of Rights, there was no such thing as health insurance. There wasn’t even penicillin. So perhaps it is time for the Bill of Rights to be updated, so an outdated and oversimplified argument such as this cannot be used anymore.

        • Abortion is the removal of pre-sentient tissue, not a sentient being. To equate it with murder is to value a clump of undifferentiated tissue over the life and freedom of an adult woman. It is a logical fallacy that “living tissue” = “intelligent life.” Your assertion is empirically false, and your argument invalid.

    • January 12, 2017 at 12:36 PM // Reply

      Actually, health care is a right “under the Emergency Medical Treatment and Active Labor Act of 1986, virtually all hospitals are required to provide emergency care to anyone needing treatment, regardless of their citizenship status or their ability to pay.” This allows people to use the ER for medical care that puts undue stress on a trauma center not designed to handle other issues that probably would’ve been handled if that user had insurance and was able to see his/her doctor at an affordable price. Plus it is putting the burden of these people on hospitals, which then raise their prices to cover those costs.


    • Please show me where the guarantee to the keep the fruits of our labors is protected in the Constitution. I assume that you are referring to some specific text? Please include it in your argument.

    • Police are not a right. Fire services are not a right. They are however, eminently sensible things to provide as a public service. I can’t afford to personally fight bandits, so I like my taxpayer police force. I can’t afford to keep a fire truck in my garage just in case.

      I can’t afford a quarter of a million dollar medical bill that shows up at the wrong time. Some weights are better shared. That doesn’t make me a socialist, or even a bad capitalist. It’s just common sense

    • The 2A is also a right. Does that only apply to guns you make yourself? If we want to skip down that path, then you are using oxygen produced by trees growing in my yard, and I’d like to be paid for it, please.

      I need the extra money for my health care.

      Overall, your notion is flawed and barbaric. Humanity progresses when individuals work together. Ayn Rand only works until someone needs to flush.

  • I’ve seen quite a few people make the leap to creative work full time and tech work on their own full time in recent years because of the ACA. (They were no longer bound to a day job for insurance.) While I have a day job, the thought of having a possibility for insurance in the event of a layoff has been reassuring. (I have a pituitary tumor and, in the past, I’ve gone without medicine and suffered after layoffs.)

    I’ve heard people go on about how it “only insured 20 million people…at our expense!” and so many other arguments. I know it’s not technically a “right” and other other semantic bullshit, but it’s at least vaguely human…and would have been truly human if those claiming to care about life actually did.

    I wish those who are against it and feel like it’s thievery would at least admit that, in the end, they really don’t care about other people. I know one person who does, and at least he’s honest about how cold he is in pursuit of his cause.

    • Again, for the record, I am against an outright repeal. You HAVE to replace it. I am not a fan of it, but it’s better than nothing.

      I’d rather not pay for coverage because I never go to the doctor and I am single. But if I don’t, I have to pay a “tax” and that’s a bunch of BS. Government takes too much of my money as it is.

      • So, when you go without insurance, and have an accident and show up at the ER. Would you prefer they escorted you out and left you on the sidewalk or took you in? Because if they take you in, and don’t pay your bill… Who does? Well, I do. I pay for it. Because those costs are spread out amongst all the rest of us that have insurance. So, hey, that’s not fair!

        Health care is compassion to our fellow beings, to help them when they are sick or hurt. If we all want to just rather watch them all die, perhaps your argument makes sense. But as a complex society as we are, we all need to share the burden. By pushing the burden to those that can afford it, creates an unstable system that will eventually fail because as more people go without insurance, the more costly the insurance becomes.

        I pay for my insurance out of my own pocket. My wife is a cancer survivor. I paid over 20K last year alone, and this year will be about the same.

        • Once again, you’re presuming i don’t have a way to pay. Perhaps I put money aside, and have been since I got out of school?

          • A single car accident can leave you with a hospital bill exceeding $250,000. Even a simple broken bone can set you back $15,000 or more. Get diagnosed with a condition that requires a simple ongoing medication, but then try to fill that Rx without insurance, and you could find yourself getting dinged for hundreds of dollars a month.

            If you can afford to put money away in an HSA, you can afford to buy insurance or pay the tax penalty. If you can’t afford it, then you are a fool gambling with your life and fortune.

  • I don’t want to die. I mean, I’m already dying, so I guess it’s more like “I don’t want to die faster than I am already.” The ACA is what keeps me from paying thousands instead of hundreds of thousands of dollars to afford medication, procedures, and access to specialists so that I don’t spend the last year of my life in constant pain, unable to breathe, and wishing I hadn’t given up heroin and pills.

    So, to the politically minded, is this just a case of “too bad John, that sucks, but what can we do?” Do you want to explain that to my family in fourteen to seventeen months when I get worse (or sooner if the meds run out)? What’s the political advantage to a dead citizen who can’t vote? Or is it that I’m sick and therefore less valuable a citizen?

    To put the focus on me the individual, tells me what? Oh John, you shouldn’t have done those drugs (as if I didn’t already know that), and you should have saved/invested better so that you’d have more money to afford your bills (I didn’t spend my 20s thinking my heart was going to fail by 40, it didn’t occur to me, sorry). Insurance aids me in being responsible, because while yes, I’m an individual, I’m still part of a larger group who, I hope, considers me “worth it” enough to help contribute to its existence.

    • I really don’t have much to add, other than to say I hope you’re able to continue receiving care to make you as comfortable as you can be. That someone like you is made to feel like missteps in life [most of us have made] mean they deserve misery turns my stomach, but segments of society are so damn cruel. It’s like on one hand, you get that instance of a politician or someone propping up someone who’s overcome addiction and other things as the example everyone can be, “if only they tried harder.” Then you get someone who tries and succeeds, but it’s still like, “Not my fault you didn’t plan well — sorry, man!” (Only they aren’t truly sorry.)

      I at least wish people like that didn’t pretend they had any shred of decency and compassion…because they don’t. When they pretend they do, it’s one of the most sickening forms of hypocrisy there is.

      I wish you well, John — and wish you didn’t have to deal with any of this.

  • Hi! Just recently discovered your blog — enjoying it! Which has been nice since I’ve been in quite the funk since the election.

    Re: healthcare as a right — I’ve always found that construction a bit disturbing because it turns healthcare into something to be demanded rather than expected. I think we should have universal healthcare because we CAN have it (other countries have found ways to do it) and because it is the humane thing to do. It is the civilized thing to do.

    It is also the only response to reality: everyone gets sick sooner or later, but everyone isn’t rich.

    Individual American citizens have no control over the healthcare system yet they are expected to tolerate insane pricing and all the rest because some people think their notions of “personal responsibility” are more important than human dignity and human life. Those who preach “personal responsibility” NEVER talk about those things individuals have no control over. If your local big company(s) has been poisoning your air or water (Detroit?) and you get sick as a result of breathing or drinking water, who is responsible for that? If you’ve been buying salad greens at the local store and, due to failures in inspections because of budget cuts (by Republicans), those greens have ecoli bacteria which make you sick, who’s responsibility is that?

    If your area employers are allowed to pay people so poorly they have to work multiple jobs to survive, in consequence of which they are sleep-deprived, exercise-deprived, highly-stressed and therefore subject to a number of conditions, who’s responsible for that?

    In addition to the “personal responsibility” preachers we have the “profit trumps everything” preachers who find it perfectly acceptable that healthcare be treated as a commodity, to be doled out only to those who can afford it, and who refuse to acknowledge the system-wide conditions that result in a majority of it’s citizens being unable to afford that commodity. Healthcare as a commodity is an uncivilized concept.

    Civilization advances. As we make discoveries we move forward and we have to change as a result. We could, if the political will existed, provide cradle-to-grave healthcare to all our citizens now. But that would require moving healthcare from the profit-making column to the public-service column and that is the leap key people haven’t made/won’t make. Partly because they don’t know what to replace it with — 7% of our economy is bound up in the constellation of healthcare-related businesses/professionals.

    The ACA tries to have it both ways — provide healthcare at an affordable price (by subsidizing those who can’t afford premiums) while allowing the for-profit actors to continue to profit. The for-profiters were reined in to a degree by various measures, but there is still plenty of money to be made. Republicans decided to do everything they could to hamstring the law and now threaten to repeal it without replacing it. So there will be fun times ahead. But whatever damage is done, don’t let it be excused on the basis of “personal responsibility”. The damage will be the result of greed, narrow-mindedness, ignorance, and inhumanity.

    It will be no different than if a person, holding a bottle of water in the parking lot of a grocery store, refused to share it with someone who was dying, and then died, of thirst. The fact that the supplicant didn’t have $1 for a bottle of water does not excuse the withholder. We are not in a desert with only one bottle of water between us.

  • I’m from France, and indeed seen from here your system seems “barbaric”. And it sends shivers down my spine because I can see how my life would have been different had I been born in the USA.
    When my sister was six, she started having headaches. It seemed like nothing but my parents had her examined. The doctor also thought it was nothing, but he prescribed a radio and then the radiologist sent her to have an MRI. She had a brain tumor. She was operated for 10 hours straight the following day, and then 5 times in the following years and stayed in the hospital for months. But she got better. She had someone to help her in school at first, she had special training to get used to her peripheral vision being damaged. Now she is able to live on her own and she works as a social worker. I studied and became an engineer.
    From what i understand about USA is that, if we had been born there, my parents (school teachers) would probably not have had the money for the medical exams my sister passed “just to be on the safe side”. So she would either be dead or far more severely handicapped than she is. My parents would certainly be very much in debt, and I would probably not have been able to go to an engineering school at least not without more worries and more debt. Of course, all the things we had (medical treatment and help for my sister, good education for her and me) were not “free”, other people paid for it when they paid their taxes. But as a result, my sister is alive and well and we both have good jobs, and savings on the side. So now we can both pay taxes. And I’m REALLY happy to because I know what it brought to me and I know what it can do for others.
    I understand the argument of someone being “responsible” for his health but it looks to me like you should only be made responsible for something if you have the means to be. And from here, it looks like there are a lot of people who can’t, through no fault of their own.
    It horrifies me to think that the survival of my 6 year old sister could have depended on the amount on my parents bank account at the time, and that at this very moment, a lot of people are in this situation in the USA.

  • Great rant, as always, Chuck. Besides everything about repealing (and not replacing) the ACA being bad, the hardest to take will be how those with pre-existing conditions — like my wife, who is a breast cancer survivor — will either not be able to get insurance at all until she goes on Medicare or we’ll pay thousands more in premiums every year. We’re being betrayed by the government that supposedly swore to protect us and now we’re up shit creek.

    Those who have company-provided health insurance at the moment are going to be awfully pissed if they get laid off and once COBRA runs out, they have no health insurance and God forbid if they have a pre-existing condition. I guess only then will eyes open up. It’s sad that empathy is in such short supply these days.

    I fully believe with all of my heart that the only reason the US doesn’t have universal healthcare like all the other industrialized nations is because of the greed of the industry and the fact our Congress is bought and paid for by the lobbies.

    God help the Republic.

  • How about a sensible single payer system such as Canada’s? The US spends 17% of GDP on partial health care, Canada about 10% with everyone covered. In Canada, if you get sick, you go get treatment, you go home healthy again, the thought of money does not enter your head.

    Canada’s universal system, while it has issues, is excellent, a bargain to the nation and a huge pillar of economic and social stability. Workers move about freely. Hard earned family assets boost the next generation instead of inheritances draining into the pockets of medical corporations.

    The system remains private. The only difference is the single payer. A caring community bears costs together rather than abandoning individuals to debt and bankruptcy when illness strikes.

  • And one more thing … we spend billions fighting useless wars, propping up corrupt regimes, and all the rest of the real stupid reasons to piss away money, but we can’t help all citizens with healthcare protections? Tell me, how screw up our priorities anyway?

  • I’m a hospice nurse. I witness the end result of dis-ease, disease and plain ol’ life. I view health care as I would look at the state of a family. If only the strong family members were valued, the more vulnerable member would be compromised. The care of the most vulnerable in our society is what makes us a strong, loving, considerate human family. I just came from a family where the forty-four year old father of two is trying to stay alive. What is his family going to be left with after three years of fighting his ALS? Millions of dollars of debt. And no father. I just can’t comprehend it.

  • The metaphor is spot on, especially the golden parachutes part. It’s the Gilded Age all over again, except without Mark Twain to satirize it. Better start quizzing my 96 year old Grandma on how she got through the depression.

  • I’m an OB/GYN in a small rural NC town. I should also add the disclaimer that I have an MPH in maternal and child health, so I’ve spent some time studying the medical system and have a vested interest in it working well. This past year I cannot count the number of folks who came in saying “I finally got my health insurance.” Now, admittedly, they followed those words with quite an extensive list of problems they’d been dealing with for years untold. However, hooray! They were here in my office, rather than in the ER, hopefully lessening the burden of cost of care on the system. On the down side, many of those visits did not end in an outcome they desired. There was one week in particular I recall, where I diagnosed, on sight, 3 patients with advance stage cancer. The first, a lovely 28 year-old in with her husband for bleeding with intercourse. Her cervical cancer was too advanced for surgery, so I sent her in for radiation treatment. I should add, intercourse sucks after that, fyi. She hadn’t been able to afford to come in for her pap smears for 7 years. The second was a 34 year-old with advanced vulvar cancer. Her presenting complaint was please, please take this mass off my bottom that is draining pus and hurts like the dickens. No care in 10 years. The last was a 65 year-old with cancer of her uterus, growing out of her belly button. I received a note on her obituary the week after I met her.

    These are preventable cancers. I have the capacity and an overwhelming desire to catch this sort of thing BEFORE it turns invasive. I could have prevented each of these with proper, routine medical care. I could have saved them. I want to save them. I didn’t go into medicine to be a business woman, or for money. I did it because I believe women (and men, but by law I don’t see them) deserve to reach their full potential and remain healthy and happy. Bless our hearts, we can do better for ourselves!

    On a selfish note, I just signed a 7-year lease on our office building. As a small business owner, if patients stop coming to see me because of cost, I will likely lose my practice. Sadness.

    • Erin, you say “by law” you don’t see men – are OB/GYNs only permitted to see women patients in NC? I mean you’re a full MD as well as an MPH – I would think you are qualified to see any patient. :/

      • ABOG, our national governing board until very recently prohibited me from treating men or I’d lose my board certification. Technically, now I can, but am not qualified to do much more than treat STDs, and often I do in order to expedite partner treatment. I certainly have no interest in providing testosterone shots or cosmetic treatment in men, and it’s been about 15 years since I’ve done a vasectomy, so, probably safest to see someone who does that more often! Technically it isn’t law, just extreme tradition. Sorry to misspeak! I always end up getting “lawful good” as my alignment, so I tend to lump everything together. 🙂

  • I am one of those lucky people who has always had jobs that came with health insurance. Or rather, I am one of those people who has consistently chosen such jobs instead of doing what I really wanted to do. Have always been too risk-averse to go without coverage. Over the past twenty years I estimate I have paid out at least $120,000 on health-insurance premiums (my share; my employers have paid at least that much again).

    And I have been lucky to have been born with good physiology and to have remained healthy and uninjured for half a century. I would have paid out much more if I had had a condition requiring regular medical care, and I would have been a complete hostage to my employer. Being healthy, I had the option of leaving a shitty job. With a pre-existing condition I would have been stuck.

    At 51, I am now staring down a future with a lot less income security because of what the McConnell Congress is doing. If my job remains stable (not at all a guaranteed thing) and I am able to save “enough” to live on in retirement, I am still now wondering if I will be able to afford health insurance. If Medicare and the ACA are both repealed, I will have the option – because I live in California – of insuring through the state’s plans.

    But I have to assume that the cost of the state plans will go up, because I have to assume that we are going to get some health-care refugees from red states, and the state will no longer receive any federal funds to help fund the coverage. Maybe it will just be too expensive. In that case, I will have to choose between a higher-quality but almost certainly shorter life, or pinching pennies in order to live a longer sicker life.

    I don’t understand citizens who think “if I can’t have it no one should have it,” but that appears to be the underlying motivation of the Trump voter, or the McConnell voter, or the Ryan voter. They don’t understand that they themselves benefit from progressive policies. I wonder if they will ever understand what they have created, or if they will look for someone else – a Democrat, or a woman, or a black man, or an “out-of-touch academic elite” – to blame, again.

  • If you want to know what a constitution that protects liberty *should* provide and fund you do as John Rawls suggests and imagine a ‘veil of ignorance’ from which all decisions about what freedoms matter most are decided. Behind the veil you don’t know if you are disabled, able-bodied, rich, poor, female, male, smart, not so smart, healthy or sick, etc. Take individual prejudices and advantages out of our calculations about what a right to liberty means and all of us would decide that the first thing it means is affordable health care for all. This is the only fair way to decide what freedom actually means. Chuck, very sorry to hear your dad died for want of this basic right.

  • House and Senate at state and federal levels as well as Congress have wonderful healthcare paid for by all American tax payers. Why are we less deserving than the people we employ?

  • You inspired me to speak up today. I spoke up at the doctors office, I spoke up at work, I spoke up at the grocery store, I called my Senator and followed up with a letter. I copied my letter and sent it to everyone I knew asking them to write to their representative. This is how change happens. Thank you. I am grateful.

  • Watching from Canada, it’s pretty annoying that even though most Republicans now agree with public health care, they hate the ACA because the Obama gov’t came up with it.
    So they derisively label it Obamacare and all their supporters hate Obamacare simply because it has the word Obama in it.

  • It’s insurance companies that drive the price of medicine in this country. There needs to be more competition between them, just like shopping for anything else in life. I wonder what our healthcare would look like if we hadn’t jumped on the health insurance bandwagon.
    Think about it. What is “insurance?” It’s a safety net for the “just in case.” So, we dump all this money into a company that gets richer and richer off of the “just in case” people. What if we only paid for health care when we needed it. Doctors could charge less. Hospitals could charge less.

    I say we need to rethink the entire deal. There’s got to be a better way that doesn’t keep making insurance companies more and more wealthy while we peons scrabble for what little bit of care we can get. Even with the health insurance I pay for out the nose, I still have to make copays, pay for labs, medicines, other things my insurance won’t cover. Why won’t they cover it? I pay them to. But they get to decide. WHY??
    Who gave them that power?
    It’s all wrong.
    Insurance companies need to be made to cover everything, or they need to be go away.
    In the minds of most Republicans, the ACA is just a way to force people to do something they don’t want to do – pay for insurance. I have friends who, before ACA, set up a savings account that they used when they needed to go to the doctor. Rather than pay an insurance company every month, they paid the account, then used it when they needed to. I know, this wouldn’t do if something catastrophic were to occur, like a terrible accident or a serious illness. But for the normal everyday, this worked so much better. Their money stayed “their money,” and they used it how and when thy chose. Now they don’t get to choose.
    So, if you want to understand the mind and thinking of some Republicans, this is part of it.

    You’re everyday Republicans off the street aren’t evil people who want all those living in poverty to die due to lack of medical care. If you think that, then you’re just out for a fight. (Although, politicians aren’t normal, everyday Republicans. They’re aliens, here to take over the world. And so are the Democratic ones.)
    What normal everyday Republicans want is the same as Democrats – a fair and equitable way of receiving healthcare.
    To them, the ACA is not it.
    But, they aren’t against finding something better. Something that is truly affordable for everyone – even those with money.

    • Friends who are able to set up a savings account to pay the doctor are people who have enough money to do that. It’s amazing what you can do when you have enough money! One of the problems now is that a very large proportion of Americans DON’T have enough money to do that, and these are people who work full-time. Not only do they not have enough money, they have zero control over what will be charged by whom. So I agree there has to be a change, the question is “what change?”

      The ACA was a series of compromises because various stakeholders wanted to give as little as possible in exchange for as much as possible, and this was seen as unchangeable by Obama and the Dems. They didn’t believe they could pass anything that drastically overhauled the system because too many people make money from it — big money — and too many Americans were completely ignorant about every aspect of the problem. (This is by design — the stakeholders do not want Americans to believe Single Payer etc. works, hence the constant repetition of nonsense about Canadian, UK, French healthcare by Republicans.)

      While I can believe your average Republican doesn’t want people to die due to lack of healthcare, unless and until they actually know what’s IN the ACA, and what the results of repealing it would actually be, and can offer a substitute that accomplishes the same objectives, they’re useless and counter-productive.

      When the ACA was being built and debated I said at the time the problem they were trying to solve was NOT: what is the best possible way to provide healthcare to all, all things considered?

      Instead, they were working on: how can we extend healthcare to everyone and stop or reduce price increases with the least disruption to our existing system. That’s what the ACA did.

      If you want something different you have to let go of the “least disruption to existing system” part. Otherwise the best you can do is going to be complicated and not entirely satisfactory.

  • This substantiates what I’ve often said: the Republican Party isn’t exhibiting the true definition of insanity (trying the same thing over and over, expecting different results) when they keep shoving the “trickle-down” economics theory down the throats of the voting masses. They know it doesn’t work; they just don’t care. But some people keep falling for that bullshit anyway.

  • It is my belief that if you think the ACA is a good thing, fair and equitable for all, then you do not fully understand the ACA. Because it isn’t. I now pay double what I used to for insurance, and I don’t get as good of coverage. How’s that fair and equitable?

    My friends who set up a savings account to pay for medical if and when the need arose are a typical, lower middle class working family. They have 5 kids and house. They don’t have any more means than the next typical lower middle class family. That’s just the choice they decided on, and they made it happen. They sacrificed a lot of things so they could have that safety net.
    Now it is no longer a choice for them. They HAVE to have medical insurance, in other words, forced.
    How is that fair and equitable?

    • I think the words “fair and equitable” are misplaced in this argument. I certainly didn’t make the claim that the ACA is either of those and I don’t think anyone else did here (perhaps I missed a comment). My argument is that the ACA set out to resolve a set of problems within a set of constraints, and it has largely succeeded to those ends. I believe it can be improved, however. And the Exchanges and the Medicaid expansion components should have been available nationwide from the start — but Republican Gov’s said “no”. How fair was that to citizens in those states who wanted them?

      Personally I would prefer a Single Payer system administered by the Feds, and how fair is it that I can’t have that? Quite possibly we’ll end up there, which is fine by me. But I by no means want to unload a lot of hardship on people during some sort of messy transition that takes us to Single Payer as a result of terrible upheaval/political malpractice abetted by citizen ignorance — which is what a repeal without a genuinely usable replacement would cause. And a usable replacement is NOT selling insurance over state lines or health savings accounts. Those simply don’t address the systemic roadblocks to genuine affordability/quality.

      As for your personal situation, I really can’t evaluate the statement that your insurance costs more and covers less, unless I know all the surrounding details: where do you live, is your insurance through an employer or the exchanges, what level of policy did you get and who’s covered by it, what is your income, etc. I know that there were people at the mid-upper income level who don’t qualify for subsidies who’s costs went up. That’s a problem with pricing and subsidy levels which should be addressed. But for me, costs went way down and quality went way up. How fair is it to me to lose that to please you?

      And around we go.

      I wanted a Public Option because I hate medical insurance companies and don’t want to give them money, but I didn’t get the PO. So I can sympathize with people not wanting to buy insurance. But there’s a difference between not wanting to buy it and not being able to buy it. And there are questions of responsibility. If you have a family is it fair to risk your children’s health/safety because you don’t like the idea of having to buy a policy? Even if you’re single, young and healthy, if you’re uninsured and something terrible happens it’s not just you that would pay a price — everyone who loves you then suffers and they either have to pay up or feel like hell because they didn’t/can’t and there you are unable to get treatment/medicine/therapy, etc. And, as someone else mentioned, if you get something contagious and can’t get treatment you become a health hazard to others. So I don’t think it’s a question of “fairness and euitableness” — I think it’s a question of humanity, morality and the common good.

    • Consider this. If they experience a catastrophe such as a car accident or unexpected surgery, the money they set aside will not cover the expense, leading to them either defaulting on the debt and having it paid by the remainder of taxpayers in the area who indirectly support public hospitals or they will incur significant debt which will haunt them for years. I use the example of my sister whose pregnancy was complicated. Her deductible was $5000, which she easily met, and the insurance covered the remaining $50,000. Think about that number. Whether it is fair or not for healthcare to cost a given amount, that amount would bankrupt most families. That is why we gamble on paying for health insurance. It is the same reason we are required to have it to drive a car: To protect those harmed by us or harm done to ourselves. Also, the same reason we pay taxes to ensure infrastructure, education and public safety. While I am aware the cost of public education could be an entirely new discussion, I have no children. Why should I pay for others’ education? Aside from the fact that I myself benefited from affordable public school or plain common good sense in supporting our future generations that will one day support me. The health of those around us does cost money. Whether we see it directly or not, a sicker population costs more. Er visits as primary care are insanely expensive. We do pay for that. We will continue to pay for that. Fair or not. I know this system could be better. Believe me. But any system we choose falls victim to the dreaded triangle of doom: Cost-Access-Quality. We cannot have all of the above in the ratios we want unless someone miraculously develops those awesome Star Trek replicators and some nice cheap clean fusion… and world peace while I’m wishing for things. We always sacrifice something. We have chosen as a country to sacrifice low cost and universal access in exchange for high quality. Not everyone in the country agrees on what is fair to sacrifice. I get that. I wish us all the best of luck in coming up with something that makes the most people happy. Mama always told me I couldn’t make everyone happy, after all.

    • Insurance is for the times that you can’t pay out of pocket. Plain and simple. Or it’s to enable a life-changing surgery you otherwise couldn’t afford. My hysterectomy was completely complication-free, but it cost $52,000. Does that come close to the $120,000+ I’ve paid out in premiums? No, but what if there HAD been complications? What if I had cancer? What if …? Insurance is about the what ifs.

      The market determines whether there are good or bad options available to the purchaser of health insurance. The ACA was intended to help even that market out. The GOP threw every obstacle they could into the implementation, with the result that some markets do not have good options. California has decent plans because our state government worked with the ACA instead of trying to wreck it. Apparently your state didn’t.

      But again, that’s implementation not intent. The people who have been trying since 2010 to destroy the ACA *could* have been trying to fix it instead.

  • January 12, 2017 at 7:04 PM // Reply

    Here’s an off the cuff and not particularly well-reasoned argument to the “healthcare isn’t a right” thing.

    There is also no Constitutional provision for the existence of corporations. It was invented by court order.

    So, if you’re going to apply a strict interpretation of the Constitution as your basis for opposition to government provided health care, you also have to get rid of corporations, leases for drilling rights on public lands, None of those are specifically provided for.

    You want also want to check the Constitution about gun rights while you are at it, since a very reasonable reading of the Second Ammendment would interpret that membership in an organized militia would be a prerequisite for owning a firearm.

    Many things in our society exist through legislation and court rulings without a Constitutional Ammendment. You want to say health care isn’t a right? Okay, fine, let’s get rid corporations.

    But history has shown that there is a clear history of our government establishing systems of services for the benefit of the citizens because that benefits society as a whole — that’s why we have public highways and schools, student and mortgage loan programs, government authorized utilities, clean air and water laws, etc. Government has determined that it is in the public interest to provide these things even though none of them were specifically authorized by the Constitution.

    I find it ironic that the people who most want to make sure that anyone, and I mean anyone, can buy and carry a gun at all times are the ones who are most concerned that people have to show ID to vote despite no evidence of anything more than trivial voter fraud. Because, after all, lots of people die when people are allowed to vote …

    (I’m not anti gun by the way, just noting the irony … the people who scream most about individual freedoms and liberties are the ones who spend an enormous amount of effort trying to pass legislation that regulates what people can do in their own bedrooms or watch or read in the privacy of their own homes or engage in religion differently or have a different political opinion. They wrap themselves in the word liberty without ever understanding what the word actually means.)

    • For the record, that isn’t me. As long as you don’t infringe upon my rights (or my familiy’s), go ahead and do what you want to do in your bedroom, watch or read what you want, engage in your preferred religion and have a different political opinion.

  • I spent most of my 20s living overseas. I could write a TOME on how nice it was to get healthcare without even thinking about it. The most you cared about was the actual time it took to go to the doctor. And prenatal care? O.M.G. Outstanding. Every, single tiny town had a doctor and a pharmacy. My village had a population of 500. Many of us went to the doctor in the next big town, but we had a doctor and a pharmacy in our village. More than once, I left the pharmacy with my meds without paying. The pharmacist just placed a yellow stickie on the register that said, “Last name; 14 francs.” They’d say, “Just pay by the end of the month, once your tally/tab is bigger.” I could go on and on and on and on with stories like this, and better ones. Just on and ON.

  • I am not an american. But I have lived in 3 different countries with very different health care. And what I know is this: everyone should be able to get free basic healthcare. Everyone. If they want you to pay, fine, do a sliding scale for income/and/or insurance. I can pay and I don’t mind if I do. But it should not be a case of only catering to the rich. The ACA should be kept. If anything, it shows there is humanity left in the world when it has clearly gone crazy recently.

  • Well, I totally oppose Obamacare, for personal reasons spelled out on my Blogspot, but @ChuckWendig, I wanted you to know that I respect your feelings and admire the way you’ve written them out. This is a good post; it’s just written in the lack of some information that I happen to have, and will now try to share even half as well as you’ve shared your insights.

  • I still don’t understand how so many Americans don’t seem to understand that a healthy country means healthy soldiers, healthy people in charge, healthy citizens…Is not a country stronger when people have their health? A healthy nation is everyone’s concern and I truly believe that one of the richest nations in the free world should take care of its own citizens, landed immigrants, and refugees.

    Of course, in Canada, our health care doesn’t cover dental, eye care, drug prescriptions, or birth control. We’re not perfect, but we don’t have to die from very curable diseases either.

    It makes me so sad when I see Americans who don’t think their fellow citizens “deserve” health care. Everyone deserves a shot at life and when there is the means to do, why not do it?

    Everyone was crying about all the celebrity deaths last year. Just wait until this year and the next when all your friends are dropping dead because they can’t afford to see a doctor.

    Makes me sad and mad. Good luck fighting it out, everyone.

    (And don’t get me started on anti-abortion people who won’t help the people who are already here!)

  • I can certainly agree your point the we should “demand they fix it” — in this case, the “they” is both Democrats and Republicans.

    The ACA in its current form is unsustainable. Improved health care for all is a great ideal, but a law that reduces the quality for all is not the solution.

  • Last night I watched Paul Ryan speak on CNN about the repeal of the ACA and the defunding of Planned Parenthood. One of the things that struck me was his statement about not wanting tax payers to have to pay for other peoples’ abortions. What about the people who would rather have their tax dollars go to the one-time cost of an abortion as opposed to the continued cost of raising a welfare baby? It’s far cheaper to terminate a potential life than support the continued well-being of one. I know that sounds harsh, but if our lawmakers insist on defining humanity in dollars and cents they might as well face the ugly truth and stop demonizing pro-choice organizations.

    • Paul Ryan is a liar in a party of liars and he will never face any ugly truths — its entirely counter to the mendacious hypocrite he is. And using abortion as the excuse to deprive millions of people of affordable healthcare is just his way of trying to rationalize the wickedness of his intentions. He, who is quite comfortably covered for healthcare, can tell himself the folks who will suffer and die as a result of his political actions will, of course, be pleased to sacrifice themselves to serve his anti-choice agenda. He will bask in the warm feeling of his morality as depriving others will have no impact on his life or health. Sacrifice is so easy, so noble, as long as someone else has to do it.

  • I work in a hospital lab. We, and many others, offer reduced cost blood screenings which you can walk in and pay for anytime. You can get a PSA (prostate cancer screening) for $30. I’m sorry about your father, but insurance being too expensive is no excuse to ignore basic preventative health checks.

    • What a privileged, jerky thing to say.

      “Sorry your Dad died, but it’s no excuse.”

      Listen, here’s the deal — PSAs right now are actually free, thanks to the ACA. Before that, sure, maybe it would cost thirty bucks, or sometimes upwards of a hundred. Still not a bank breaker, no. But the treatment that would result absolutely would be a bank breaker. Other tests and biopsies can rank up in the thousands of dollars, and if cancer is found? Well, it’s what ended up happening to my father who, again, racked up hundreds of thousands of dollars in medical debt before dying anyway. Should he have gotten the test? Of course. That’s not the point, you ding dong.

      — c.

  • Here’s an idea. Why not give every American the opportunity to join the excellent taxpayer supported health plans of the federal Senate and Congress or of the military? Those who object to having their health care paid for by taxpayers can continue to pay the medical insurance premiums of their choice. Everybody happy.

  • First off I am terribly sorry for the loss of your father, Chuck. No one should have to go through that. Secondly I am a libertarian. Have been since Ron Paul first ran for office. I am a big believer in the constitution, but even I think that there should be some type of amendment made to give EVERYONE health care coverage. It may not be a right but it’s the decent, humane thing to do. No one should have to die before their time a quarter of a million dollars in debt because of greedy bullshit insurance companies.

    Almost seven years ago I moved to the UK. I’m originally from Cincinnati but my wife is British. We looked at starting our life together in the US but simply couldn’t do so because of the lack of affordable health care. My wife suffers from rheumatoid arthritis and is on a steady diet of medication, which she’ll need to take for the rest of her life. The company I worked for at the time had an insurance package that would simply not cover her. The old pre-existing condition bullshit. So we did the only thing that we could do; started our life together in the UK where her company provided her with private insurance and she had the NHS to fall back on.

    Now the NHS is not perfect, and it is currently wobbling under the strain, but it’s much better than anything that the US is currently doing. I’m quite happy paying a bit more tax to prop it up and the people that work in the NHS – doctors, nurses, caregivers, etc – are top notch. Because of the NHS my wife was able to move away from corporate employement and pursue her dream of becoming a full time costume designer. She wouldn’t have been able to do that if we had stayed in the US. I get that the ACA isn’t without it’s flaws, but it’s certainly better than nothing. If countries like Canada and the UK can provide affordable health care for all than there’s simply no reason the US can’t as well.

    That’s my two cents, for what it’s worth.

  • If they repeal the ACA, the first thing to do is for everyone stop all work and get out in the streets. You can bet after a week of nobody (and I mean nobody) working, the government would fund universal health care faster than you can find your missing pants.

  • I can only speak for me here. I am against the ACA, but that doesn’t mean I don’t want my fellow Americans to go without it. We should all have access to it. I am against the government requring us to buy it. Goes against the principles of freedom. Also, what the government gives, the government can also take away.

    • The mandate is a necessary component to keep prices and markets stable and exploit-free. If that and the ACA go away, the only freedom exercised is the freedom to go without health care because it’s too goddamn expensive.

    • By removing the barriers that make it that way – like allowing us to buy across state lines, for example, it becomes less expensive and more people can afford it.

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