Sarah Gailey: Get Rich Or Die Trying — On Repealing The ACA

Fellow awesome writer person Sarah Gailey had some stuff to say about the class eugenics that lurk unspoken in the repeal of the Affordable Care Act, and if you know Sarah, you know that what she writes is worth reading. Just check out her work at, or her upcoming novella (omg hippos), River of Teeth

Healthcare is essential to human life.

Without it, people die. Babies die. Mothers die. Kids with allergies die. Grandfathers with pancreatic cancer die. People with disabilities die. A steelworker who gets his hand crushed, a farmer who gets bitten by a snake, a teacher who has a heart attack. Without doctors and medicine and treatment, people who get sick or injured die.

This is the endgame of the ACA repeal: death for those who can’t afford insurance and who can’t privately pay for healthcare. Death for the poor, death for the unemployed, death for the newly self-employed entrepreneur, death for the laborer with three part-time jobs and no benefits. Death for the widow who relied on her late husband’s insurance; death for the orphan who was a dependent. Death for the infant whose mother couldn’t afford birth control or prenatal care. Wealth or death: those are the choices.

While this may sound harsh, it shouldn’t be surprising. The social Darwinism that drives so much of America’s rhetoric — the pull-yourself-up-by-the-bootstraps narrative that undergirds the American Dream — makes a snug fit with the consequences of the ACA repeal. This is the comfort of the wealthy: those who can’t afford healthcare can’t afford it because they’re lazy. They didn’t try hard enough, so when they die, they have only themselves to blame.

“If you can’t afford treatment, you don’t get treatment.” This is the basic concept that drives opposition to universal healthcare — and yet, even that blunt statement flinches away from the true conclusion of its execution. The true conclusion is this: “if you can’t afford treatment, you deserve to die.” Those who can’t afford antibiotics will die of fevers. Those who can’t afford dental care will die of rotten teeth. Those who can’t afford chemotherapy will die of cancer.

In this scenario, the poverty that American morality has always scorned becomes a capital offense; the pursuit of wealth, a necessary route to survival. Never mind that wealth is overwhelmingly concentrated in populations of privileged white people with family legacies that are rooted in the exploitation of those who benefit from the programs like the ACA — never mind that. [8 people hold as much wealth as 3.6 billion — cdw] The bottom line is this: those who are not wealthy enough to afford the cost of healthcare will be eliminated.

How could this be allowed to happen? How, in our nation, which we call the wealthiest, the greatest, the strongest nation on earth? How could we propose to allow millions of citizens to go without the medical care they need? How?

Well. Let’s talk about eugenics.

For those who are unfamiliar with the concept, eugenics is a horrific application of selective breeding. To understand selective breeding, imagine a gardener who wants all of his pea plants to have purple flowers on them. He would have to weed out the pea plants with white flowers on them, and plant only seeds from the plants with purple flowers.

In 1937, a guy named Frederick Osborn proposed that the principles of selective breeding should be applied to the social order: encourage people with desirable traits to reproduce, and sterilize “undesirables” to remove their genes from the pool. Osborn’s ideas were heavily tied into the rhetoric of social Darwinism, which suggests that the law of natural selection applies to modern society: only the strong deserve to survive.

Many will rightly associate this concept with fascism and particularly with Nazi Germany — but it cannot be forgotten that eugenics was popular throughout the Western world, and particularly in the United States, during the early 20th century. Our country participated in the “removal” of traits which the government deemed undesirable — traits which included mental illness, physical disability, nonwhite heritage, and any sexual identity other than heterosexual. In 1927, the United States Supreme Court passed Buck v. Bell, which effectively legalized compulsory sterilization. Individuals were sterilized against their will, incapacitated, or killed under the euphemism of ‘euthanasia’.

Today, this practice is widely considered to be unethical, dehumanizing, and morally repugnant. The repeal of the ACA brings it to the forefront of American society, hidden behind a thin veil of capitalist ideology.

Does this embody the national character Americans claim to have? We call ourselves “the greatest nation in the world,” and “the land of opportunity.” We pride ourselves on our immense national wealth. We claim to have a social, political, and economic system upon which all others should be modeled — and yet we are debating a proposition that would leave millions of Americans at risk of death due to a lack of coverage. And so it is that we must ask ourselves: does an American morality that leaves the uninsured to die embody the universal right to life that is promised in the second sentence of our Declaration of Independence?

No. Instead, it embodies the darkest facet of the American perspective on capitalism: that citizens are justified only by their earnings, and that without justification through labor and wealth, the life of a citizen is not the concern of the American government. This is the America that we so consistently look away from: the America whose constitution was written solely for the benefit of landed white men. The America that pioneered early eugenics; the America that, years before Hitler’s rise to power, began attempting to rid itself of “undesirables.”

Today, those citizens who are not wealthy are being declared undesirable by the ACA repeal.

And we know what happens to undesirables.

* * *

ADDENDUM, 1.17.17, by Sarah Gailey

When I wrote the above piece, I failed to recognize a long-running conversation in the disabled community about the eugenicist roots of healthcare reform, and about the destructive legacy of American eugenics. I am so thankful to the people who took the time and energy to help me recognize the frustration that’s caused by my participation in this conversation. Several disability activists and disabled people brought this to my attention after the piece went live: disabled voices have been talking about this issue, but their voices are too often ignored. The ACA repeal and American eugenics have a massive effect on the disabled community, and in a conversation about either, that harm should not be elided. I’m not qualified to write about the specific ways in which the disabled community is impacted, nor would it be appropriate for me to do so. With that in mind, I had a conversation with disability activists Heather Ratcliff and Elsa Sjunneson-Henry. They suggested we add that conversation to this piece, adding their perspectives on the way these issues intersect with disability.

Elsa Sjunneson-Henry is a .5 deaf, .5 blind, .5 Scandinavian SFF writer. She is the founder of feminist sonar ( and has written about disability for Writing the Other, Terrible Minds, Dragon+ and many other websites. She’s a disability rights activist and general loudmouth. She tweets @snarkbat and is the assistant editor of Fireside Fiction.

Heather Ace Ratcliff is a former mortician and current disability rights activist. She has been featured talking about her invisible disability, Ehlers-Danlos Disease – III, at the Guardian and the Economist, as well as on the podcast “Off the Record.” Poems about her disability have been featured in Breath & Shadow. She tweets @mortuaryreport, blogs at, and is the proud creator of Stay Weird, Be Kind (#swbk,

SG: Thank you both so much for taking the time and energy this morning to help illuminate some of the frustration I caused by writing this piece without bringing in the voices of the disabled community.

ESH: (THIS ONE IS HARD) Disability isn’t a monoculture. That’s the first thing we need to be really aware of – I don’t speak for everyone, and I can’t, and I shouldn’t. But what I can do is shed a little light – I know many disabled people who struggle when able bodied writers get attention and praise and are just damn well heard about things we’ve been saying forever. It happens more frequently than we’d like. Many of us have been shouting on Twitter about this for months – and haven’t felt heard by the able bodied community. In addition to when Sarah spoke with both Heather and I independently, Heather and I checked in so we could support one another. These discussions are hard, and having them with your friends is harder.

HR: Elsa’s exactly right: because disability runs the gamut of politics and opinions and life experiences, it’s difficult to pin down any one thing we all agree on. However, I think many of us can agree that the disability community finds extreme frustration when our voices are ignored on issues that affect us and non-disabled voices are uplifted while spreading the same message. It’s a little bit like screaming incoherently into the able-bodied void. You can’t be for us without us, as they say.

SG: I had originally written the piece with a focus on poverty — and something that I’ve come to appreciate after speaking with both of you is how deeply intertwined the issues of poverty, disability, and healthcare are.

HR: Teasing apart where one intersection ends and the other begins is nearly impossible. When Sarah notes in her essay that “those who are not able to afford the cost of healthcare will be eliminated,” a large group of people who will be directly impacted are disabled people, who are more likely to have poor overall health and therefore require access to medical services more often. Those medical services become extraordinarily cost-prohibitive when paying out-of-pocket instead of with insurance garnered through the ACA. When it comes to income, the poverty rate for working-age people with disability is nearly two and a half times higher than that for people without disabilities; people with disabilities are two times as likely to be poor as non-disabled people.

ESH: Many non-negotiable adaptive devices are also brutally expensive. Literally this past week, as the ACA repeal began picking up steam, I was having a prosthetic eye made, which is vital to my quality of life. Pre-ACA insurance wouldn’t have covered it (and didn’t) and the last one cost an arm and a leg. It’s not a choice to have a wheelchair or a prosthetic – and when you don’t have a choice those medical devices can throw you deeply into debt.

People with disabilities are placed in a very weird position by society – we’re supposed to be inspirational public commodities of hope, and yet simultaneously not make any noise or fuss about how hard it is to access the medical devices we need to live and survive and interact with society. Basically – be adorable and childlike, but don’t you ever tell us how much your wheelchair cost.

SG: You’ve both spoken extensively about the ways in which our healthcare system keeps people with disabilities in a state of economic struggle. What are some of the systemic issues that undergird the intersections between disability and poverty?

HR: Part of the issue with poverty and disability is job security and economics. Under the U.S. Department of Labor, it’s currently legal to pay disabled workers less than the legal minimum wage. Even securing those jobs is challenging when you’re disabled: in 2015, only 17.5% of people with disabilities were employed, compared to 65% of non-disabled people. Fewer than 1 in 5 PWD is employed, and disabled persons earn significantly less than non-disabled workers when they are working. The conversation on accessibility of jobs, workplaces, and employment discrimination is another one entirely, but you can see where the cycle feeds itself.

ESH: What Heather said. Additionally, education (which is often necessary to accessing higher paying jobs), is often inaccessible to people with disabilities. Whether it’s universities which still haven’t updated to ADA standards, professors who refuse to accommodate you, or even just the cost of education, getting your foot or wheels in the door is significantly more difficult. Many of us have fought tooth and nail to GET education, to get jobs that are considered “important,” but there’s another piece going on here:

Sometimes we literally can’t even get into the workplace. Many disabled people, myself included, have had the experience of applying to a job, being told they’d be great at it, only to find out that the company cannot accommodate your access to the office, or your needs in the workplace

Again – be a fully participating member of OUR society, but don’t tell us that you can’t get inside the building even though we don’t have a wheelchair ramp.

SG: There’s significant history underpinning these contemporary issues around the treatment of disabled people in the United States. In my piece I touched briefly on the history of American eugenics, but not at all on the ways in which that history specifically impacts the disabled community. What are some things you wish more people knew or considered about that context?

ESH: Let’s talk about perception for a second. We live in a country where disability isn’t seen as “wanted” and so when we talk about reproductive history and disability, we have to talk about how disabled babies aren’t wanted. It’s hard, because it makes a lot of people uncomfortable, but we have to talk about the fact that it’s morally acceptable to abort a fetus because you don’t want to have a disabled child.

When I was born with Congenital Rubella Syndrome, my parents were told that they should give me up to the orphanage, that they could always just “have another one” because nobody wants a disabled baby, right?

Fast forward to adulthood, and many disabled people who want to be parents are told they shouldn’t because they’ll “pass on” their disabilities – so if we’re talking about a world where disabled babies parents are asked if they want to get rid of their children, if disabled adults are told they shouldn’t have children – there’s a value judgement being placed on a disabled life.

I mean, let’s be real: In a country where LESS THAN A HUNDRED YEARS AGO the most well beloved Justice of the Supreme Court of our country said, “A generation of idiots is enough.” We have a problem – and that problem reaches well both into the social mindset and the legal one where disabled bodies are concerned.

HR: Coerced sterilization of many groups, including disabled people, is a really disturbing part of American history. Throughout the 20th century, federally-funded sterilization programs took place in 32 states across the U.S. 32! In 1927, as you mentioned in your essay, the Supreme Court ruled to permit compulsory sterilization of “the unfit” as legal – a decision that’s never been expressly overturned.

I live in California, which is a state that sterilized almost 20,000 people from 1909 to 1979. Hitler espoused California’s eugenics programs in Mein Kampf, that’s how successful it was, and his T4 “euthanasia” program, first enacted in 1939, specifically targeted disabled children for murder as a rehearsal for Nazi Germany’s subsequent genocidal policies. The T4 program deemed disabled children “life unworthy of life;” individuals who represented a genetic and financial burden on the German state by virtue of their psychiatric, neurological, or physical disabilities. The program started with infants and toddlers, then was expanded to include teenagers, then was expanded yet again to include disabled adults in institutions – and medical personnel were not just complicit but actively involved in determining who was sent to their death. Over 70,000 institutionalized disabled people were murdered at six gassing facilities in less than two years of the program.

As writer s.e. smith pointed out in a 2014 article for Rewire, “laws regarding sterilization for reasons of disability still remain on the books… [and]… are not simply holdovers from a previous era.” Smith points to cases in 1993, 1998, and 2007 cases where disabled children were sterilized as a “method of convenience” for their parents.

SG: This has all been incredibly illuminating. Thank you both so much for your voices and your work. In addition to your platforms, what are other disabled voices and platforms that people should be listening to and supporting in order to better understand the issues, history, and experiences of disabled people in America?

HR: Alice Wong (@AliceWong) with the @DisVisibility project is amplifying disability stories and culture! Karolyn Gehrig (@KarolynPRG) is bringing invisible disability stories to light with her #hospitalglam project. #CripTheVote is an incredibly active hashtag reflecting disabled involvement in politics. Pretty much you could follow me and Elsa’s entire Twitter feed and find important, integral disabled voices to be uplifted and included!

ESH: Lydia Brown (@autistichoya) and Vilissa Thompson (@VilissaThompson) are both doing important work with regard to the intersection of disability and race. Also, check out David Perry (@Lollardfish) and his work on people with intellectual disabilities, and the interactions of PWD and the police state.

SG: Thank you both so much. And, thank you also to the several people who expressed their dismay on social media over the past twenty-four hours. You are so important, and I can’t tell you have grateful I am for your hard work and for your voices. Keep doing what you’re doing. <3

EDIT: visit to view stories of those who will be affected by the ACA repeal.

36 responses to “Sarah Gailey: Get Rich Or Die Trying — On Repealing The ACA”

    • You draw the line at not allowing people to die when it is in your power to save them. You provide healthcare, sustenance and opportunity. You may choose to do this because in time they will repay the debt; or because you may find yourself in their position through no misfortune of your own; or you may choose to do it simply because watching people die a preventable death is a far worse moral failing than “laziness” or “poor moral fibre” or any of the other accusations thrown at people trapped in a system designed to take advantage of them.

  1. This was a very insightful and, unfortunately true, commentary. It’s what no one is saying.
    As I watched Paul Ryan at his town hall meeting outright LIE to the man who’d voted Republican but whose life had been saved by the ACA, outright LIE, I wanted to smack Ryan’s smirking face.

    As a former RN (one who became a nurse in the late 1960s), I’ve seen and cared for people with no insurance: the man who lay in a hospital bed in a sweltering ward as he died of esophageal cancer, the woman who let her face be eaten away from treatable skin cancer, the Diabetic whose sock had grown stuck to the only foot he had left. This is the America that will be great?

    Thank you again for bring into the light, the darkness that surrounds this Republican Congress’ agenda, an agenda based on hate for the man who signed that bill and NO thought for the people of this country.

    As a woman, as a former health care provider, as an American, I am ashamed of what we have become.

  2. You’ve lost your mind, Chuck. To equate the repeal of the ACA with eugenics is revolting and insulting. And completely false. You know this. But this is the war of words, isn’t it? When you disagree with a policy position, instead of admitting there are problems with the ACA and working together to fix it, let’s resort to the most hysterical hyperbole possible. This might surprise you, but there are calm, informed people who don’t believe the ACA is the greatest thing since sliced bread, and indeed needs to be fixed if the current health care system is going to be sustainable for all. Whatever. It’s your blog, you’re free to spread whatever hysteria you think is appropriate for whatever half-baked reasons you might have.
    For me, what I resent the most is how the government told bold-faced lies to sell it. I didn’t get to keep my plan OR my doctor. You want me to support your policy? Be honest about it.
    Don’t lie.
    And sure as hell don’d spread hysterical bullshit like repealing the ACA is the first step to putting people in ovens.
    Good God.

    • First, I did not write the post. So, please pay attention, do your reading, and point your initial agita to the writer who wrote it. Do not rob from her the accomplishment.

      That said, Sarah is right on that the attitude surrounding health care in this country — before the ACA and now during the drumbeats of its potential repeal — is that people don’t view health care as any sort of right. They view it as a privilege, and routinely when I talk about this on Twitter or FB or wherever, people jump in to tell me THEY don’t want to pay for the public good, if someone gets sick, well, they should either have a job with insurance or have the money to pay for it, and oh, sorry if you can’t afford it, but then find a better job, don’t be an artist, don’t be between jobs, whatever. If you’re fortunate to have money, good for you. If you’re fortunate to have good health, good for you. If not? Oh well, then fuck off and die somewhere. We don’t concern ourselves with the health of the nation. A repeal concerns itself only with the health of the rich and the privileged.

      Even the response to fixing the ACA has this Darwinist capitalist bullshit packed in — HSAs? Really? That’s one of the solutions? Those still require money. And given the exorbitant costs of health care, they won’t do much on the face of it to undercut those epic costs.

      I’m not of a mind that the ACA should be kept as-is. It shouldn’t. It’s wildly imperfect, though it got to be that way because of concession made up front to make it more palatable. I am of a mind that the work then is to fix it, to improve upon what’s there and to bring those costs down. That does not involve repealing it, so don’t try to sell it like that’s what’s happening here. It’s not.

      We’re the only first-world country across the globe who treats health care like this, and repealing the ACA backslides us to a time of, like Sarah says, cruel capitalist Darwinism that has good health and wealth and privilege at its core. Which means that people who are disabled, or who have weaker genetics, or who are poor, will be the first either to bankruptcy or worse, to the grave. Which is not “putting them in ovens,” but it is consigning them to an awful fate based on bad luck or circumstances. The ACA helped bridge that gap and with subsidies made health care more affordable for all, imperfect as it was. Without it, people are going to die. And the people who are going to die are not the privileged, and are not the wealthy, so you tell me what that says about the repeal? Still sound like hysteria? It doesn’t to me.

      — c.

    • Decayingorbits,

      I genuinely understand where you are coming regarding your frustrations with the ACA–particularly the part about getting to keep your plan/doctor.

      But that does not change the fact that if the ACA is repealed, people WILL DIE. Not be inconvenienced, not have to pay a little more….DIE.

      The obvious counter here is that Congress will try to replace it with something better, but even you have to admit that doesn’t seem to be anywhere near as big a priority as repealing it does. While the ACA slides over a cliff into the abyss, no clear plan has emerged to take its place.

      For folks like us who have insurance through an employers, that’s an annoyance–yet another example of politicians not able to follow through on their promises.

      For people who were able to finally afford medical care, however, this is literally life and death. I think it’s safe to say that we’d both be “hysterical” in that situation, as well.

      • How does it always come back to “keeping my doctor”?

        What these people are basically saying is that because they didn’t get to keep their preferred doctor, that it’s OK if thousands of people die so they can have their doctor back.

        • It comes down to being lied to — strait-faced by the President — to sell this law to the American public. We also know this administration’s disdain for the truth and the ease with which they use lies to sell Policies they know are hard, or if not impossible, to defend on the merits (see Ben Rhodes interview on how they mislead the American people through the press to sell the Iran deal).
          The “You can keep you doctor” line was not a one-off. It was one of the main talking points to defend the ACA — and it was all a big, fat, lie. What else were they lying about? Not hard to figure out when you see the poor shape the exchanges are in.

    • My prescriptions alone exceed my income. Without coverage, I will die. That is the cold reality. My health is not what it was in 2012 when I could decide whether to take my meds or not. Now, I medicate for my life and for my ability to walk and work. If my survival is not better than my death, you are deciding who is worthy to live, and yes, that is eugenics.

  3. The hungry should be fed. The homeless should be sheltered. The sick and injured should be treated.

    These are the precepts upon which any just government should be built, and all other initiatives should grow from these seeds. I, and all other good-hearted Americans, of which there are many, am willing to pay more in taxes to make that happen.

    Healthcare should be a right, not a privilege. It should’ve been all along, but we can still do the right thing.

  4. The GOP is playing a reckless game of chicken with the lives of American citizens. There are several conservative replacement plans–a few are well fleshed-out (Tom Price’s), most are non-specific (Paul Ryan’s). In general, these plans favor the healthy, young, and wealthy over the sick, old and poor. Some of them want to put the onus of healthcare policy on the states, providing them with funds through block grants and allowing them to dictate care, taking a state’s values into consideration (meaning, no birth control in the South). They keep some, but not all, of the protections of the ACA.

    Rather than reform the ACA, trying to fix constituent complaints with conservative solutions, they are choosing to repeal, increasing the importance of pounding through a new law. This will force GOP lawmakers to rally around a single plan. Additionally, it will force Democrats to either vote *against* healthcare or accept a plan that is worse than the ACA, but still provides some protections.

    One of the things we’re going to have to decide is if we’re going to support a plan that lacks some of the aspects of the ACA, but still provides citizens with some healthcare, or if we’re going to go all-or-nothing, leaving people with their butts in the wind until we elect new representatives. Honestly, I don’t know what to think. If someone steals a child’s coat in the middle of winter and offers them a flannel shirt instead, should they take it?

  5. It’s the GOP form of Death Panels, a concept that they claimed was behind the ACA (or any government health-care program.) I wrote about this on LiveJournal. ( And yes, eugenics is certainly part of it, for the reasons stated here. (You might think the GOP determination to fight contraception and pregnancy termination is an odd bedfellow to eugenics, but it makes sense in light of Coulter’s statement that “single mothers should give up their babies for adoption.” Adoption by wealthier white women, she means. Poor and single mothers should bear plenty of children for rich white women to choose from when they can’t, or don’t want to, get pregnant themselves. To the GOP, women exist to produce babies…as one of their members said “It’s like cows…they can carry a dead calf until it comes out, so should women.”)

  6. Well said, Sarah Gailey! Well said.

    Ever since I was a child I had a hard time understanding inequality. Now that I’m an adult and I understand the reasons why inequality exists I still struggle to swallow that pill. Health Care (which down to basics is simply caring for someone when they are sick or injured) should be a basic human right to all. Not a privilege based on your bank account. Thanks for taking the time to shed light on this issue.

  7. Health care *is*…something anyone with any common decency wants to extend to just about any human being we know of any way to help.

    Health care *does not* involve participation in any capitalist corporate gambling scheme.

    Did either Chuck Wendig or Sarah Gailey see my post? We do need a safety net for anyone, even a formerly wealthy person, who needs e.g. autologous marrow transplants–they’re not cheap, and if (heavenforbidandfend) your parent needs one, you know they’re necessary. But we can’t afford to confuse the insurance racket with that safety net.

    We need to get back to a system that pays the actual cost of treatment, without authorizing third parties to practice eugenics *and* profiteering at the same time.

  8. IMHO The ACA is unaffordable. I’m by no means wealthy, but I do work full-time for a small business that does not provide insurance to its employees. Therefore I don’t qualify for any free or discounted health insurance. I was on my wife’s plan from her work last year for $175/month. This year it doubled to $345/month, so I was forced to get the crappy government insurance for $250/month.

    Universal healthcare would be a wonderful thing, BUT the ACA is NOT UNIVERSAL HEALTHCARE, it’s simply, you are LEGALLY OBLIGATED to PURCHASE healthcare or you PAY A FINE. What is so great about this? Nothing. It’s bullshit. And it’s EXPENSIVE. And it’s crappy coverage.

    As long as they KEEP the pre-existing conditions clause (which THEY ARE), IMO they cannot REPLACE the Unaffordable Care Act fast enough. IT’S GETTING REPLACED, but it has to be repealed first. This is a good thing.

    • You cannot keep the pre-existing clause and lose the mandate to procure insurance.

      That has been tried, and it was a disaster when implemented.

      The ACA is imperfect, and so it demands to be fixed. Or, sure, scrapped in favor of Universal Health Care — but I cannot imagine a world where that passes the current batch of monsters stirring in Congress.

        • The idea that the VA is a mess is another Republican-sown (sewn?) effort toward privatization. In point of fact, the VA scores extremely well on service delivery metrics. It is not perfect but of course it also could use more funding and who’s stomping on that? (Answer: Republicans.) If the VA were privatized it would, as do all privatization schemes, start reducing services and cutting salaries in pursuit of profits. Veteran’s care would be subordinate to investor returns.

          I’ll tell you what, if I was given the option I would be choose to get my healthcare through the existing VA rather than through a private insurance company.

  9. Thank you so much, Sarah, not only for your initial post, but for also demonstrating an amazing example of how to humbly listen when other people point out something you’ve missed. I’m often paralyzed by the fear of missing something and offending someone, which means that I also often stay silent (and don’t always spend that time in silence listening to a diverse range of voices). You spoke out boldly, then listened when corrected. That’s rare, so I wanted to thank you for it.

    Thanks also to Elsa and Heather. I appreciated the opportunity to learn from both of you.

  10. Maybe the answer is to look at what they charge for health care. I set up an appointment to see a doctor, spent 25 minutes talking to healthcare professionals (a nurse for 15 minutes while she measured and weighed me before taking my blood pressure the ten with the doctor) this visit cost me over $300 dollars. I would go to another provider except that they are all owned by the same corporation. When are we going to wake up and look at the monopoly and price setting these corporations are doing in our country. I think the real problem is the cost of the care provided. If we want to regulate something let’s regulate that. $300 for a conversation and getting information I already know is ridiculous.

    • I wanted to add that I also spoke with a parent of a child who has leukemia. She told me that a one-hour session for chemotherapy cost her $40,000. What do they use for the treatment, platinum? Did they have to perform the procedure in outer space? How can this “care” cost so much? Who is benefiting from these high health care costs? Why not take over and regulate the milk farm instead of having everyone pay for the delivery service for spoiled milk? If healthcare is our right why don’t we regulate the cost of healthcare?

    • This will make you ill, but I live in a country with state provided healthcare. Ten minutes with the doctor costs me around $25 (and she manages to take my blood pressure during that time). It might cost me double if I’m unfortunate enough to get ill in another city.

      And I pay $5 per prescription item. And get free hospital care. Including surgery and chemotherapy, should I ever need it.

    • They DID look at what’s being charged — they looked at everything which is why the law was some 2800 pages plus. The problem was they were trying to retain the employer-based, for-profit system while trying to make it cover everyone AND be “affordable”.

      If we want to regulate prices — which is fine with me btw — you start down a path that lots of stakeholders and citizens don’t want to go down. We get all entangled in capitalism vs. socialism, public versus private, stockholder values, FREEEEEDOM as it is understood by people who can’t be bothered to learn anything and by people who take advantage of other people’s ignorance, and on and on.

      If you are prepared to say “you can’t charge more than X for this service” you have to be able to answer “why?” And the answer, in the case of healthcare, is, in the end, that it is immoral to withhold services associated with life/health from people due to an inability to pay. That’s where the winding river ends up. OR, you can say profit is more important than people, and therefore you can’t regulate pricing because profit trumps all. Its one or the other.

      For me, it’s the first, so I support Single-Payer, Medicare for All, or any other version of publicly funded healthcare for all because I believe, both morally and logically, that approach creates the best outcomes. But people have to be willing to follow the arguments to their conclusion and choose. But that argument has never actually happened in this country — when the ACA was being worked on they refused to have a true hearing about Single Payer, etc. Why? Because too many people make money with the current system and THEY spend a lot of money keeping the public in a state of confusion over the issue.

  11. HELLth. Another word for sICKness, another word for inSUREance. If I were The Queen Of The World, I would put a chip in every human to make them feel responsible for self in the same measure that they feel responsible for others who compose their reality. Then I would issue each baby a scroll that would be theirs to keep from birth to death, and I would wave my magic wand over each young child (when they were in the witness of another person) to enable their ability to read and comprehend. Everyone’s Birthright Scroll would contain the same language, in every language spoken, written or understood, and it would be this:
    Welcome to Earth. It is your mission to appreciate who you are becoming, the lessons you are learning, the gifts you are giving, the creations you are creating and to be appreciated by those who witness you. It is necessary that you understand the activity of your heart, your emotions, your thoughts and your physicality and how they interrelate. While love is a wonderful emotion, feeling and reality, it is your mission to learn what it means to be free: to use money as a grace and an exchange, to understand the difference between want and need and to create your own beneficial reality so that yours contributes to the mass consciousness of all humanity. The duality that must exist on Earth is yours to explore, appreciate and expand in ways that make all things true, good and beautiful.
    If you read this, I am sending you a particle of love, and donating a particle of love to the idea that all of this can be resolved through perception, witness, love and freedom to act on behalf of everyone’s and every thing’s best and highest good.

    • I shall explore Earth’s duality from my bed, where I am confined by an incurable chronic illness. It doesn’t need love or freedom. It needs science.

  12. As I noted in a previous thread, the ACA did not set out to implement “the best” system for delivering healthcare affordably, it set out to deliver the system most likely to cover the most people with the least disruption of the current profit-centered system.

    Depending on the goals of the system you have very different constraints and incentives. If the goal of the American people is widespread health, you emphasize preventative care, all sorts of good habits (which, themselves, need supports which require additional changes on many fronts), an honest look at what really works and what doesn’t with respect to medications and treatments, etc. You cover everyone and you make access to care easy. That results in problems being solved in the earliest, easiest-to-treat stages, but it also reduces opportunities for profits.

    If the goal is allow providers of medical products/services to make absolutely as much money as can be sustained, you get what we used to have: insurance companies focused on covering the healthy and rejecting the sick as well as pricing for everything as high as will be tolerated. You also allow emphasis on pharmaceuticals over other responses to many conditions and you allow unnecessary surgeries, etc.

    The compromise was the ACA.

    The nonsensical stuff about “selling insurance across state lines” and “more choice and competition” is just Republicans flapping their jaws about solutions that were rejected previously because they didn’t accomplish anything meaningful. “Competition” was what we used to have — and we found companies competed at finding ways to reject people, not pay for treatments or meds, etc.

    The problem is profit and healthcare are ultimately incompatible. When you combine them, as we have, you get a deformed system one way or another. The ACA was tilted towards covering everyone, but was hamstrung by Republicans in many states who refused the options offered by the Feds. And every complainer about the ACA should have to announce what state they live in and what the nature of their previous coverage was before they complain about implementation. There ARE problems, but you have to correctly identify the nature of the problem to solve it and Republican rhetoric on the topic involves a whole lot of misdirection, inaccuracy and outright dishonesty.

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