I was reading “Life in Obamacare’s Dead Zone“, about poor Americans stuck in a coverage gap that arose because the Supreme Court made it possible for red states to refuse the Medicaid expansion. I’ll get to their stories, but first, I have to vent about the appalling subhead:
“Excluded from the Affordable Care Act because of politics, thousands of poor Americans grapple with the toll — physical and psychological — of being uninsured.”
Whether the author meant it this way or not, the phrase “because of politics” is a masterpiece of obfuscation. It makes it seem as if there was no agency or culpability for this outcome; as if people were being blocked from coverage by some natural force, like the weather. In reality, millions of people are being excluded not because of abstract “politics”, but because of choices that their neighbors made, and in many cases, choices that they themselves made.
The article itself underscores this point. On the surface, its aim is to describe the misery of Americans with chronic health problems and no insurance. But many of these stories share a different underlying theme. See if you notice what I noticed:
“I’ll take my chances with dying, if that’s what it comes down to,” the patient, Brenda Hannah, told me, sitting in the living room of the home she shared with her husband, Bill. “We have no money. We live on Bill’s disability.” She had been working at Walmart when the pain first started to become unbearable. She couldn’t stand long enough “to make a sandwich.” By the time she finally connected with Stewart, she had to quit working, and had already racked up several emergency-room bills. “The pain would just become unbearable,” she said. “It got to the point where I told Bill to hide the guns — I didn’t want to know where they were.”
There’s a grim irony in this which the story seems to overlook. Despite their poverty, the Hannahs apparently own multiple guns (note the plural), but can’t get health care for a debilitating illness. This is a perfect microcosm of 2016 America: you can have all the guns you want, but you can’t see a doctor!
This is no coincidence. It’s the intended result of policy choices. In many states, conservative politicians, with the consent of the voters, have fought ferociously against all efforts to restrict or regulate gun ownership. Thanks to them, you can take guns onto college campuses, into churches, even into bars. But they haven’t shown any comparable passion for making health insurance accessible or affordable. The relative availability of guns and health care in these states is a reflection of voter priorities.
Here’s another example: a physician named Julie Stewart, who works at one of Kansas’ besieged safety-net clinics:
“It’s very hard to know that because of a lack of resources, someone will die,” Julie Stewart, a physician at the center, told me. “To have to look in a patient’s eyes and say: ‘Your prognosis is different than that of someone who lives in another state. Your prognosis is less because you don’t have access to insurance’?”
That sounds heartbreakingly compassionate. But when you read on, you find out that Dr. Stewart is an evangelical Christian who’s vocally supported anti-abortion bills:
The groveling praise for religious belief (“conviction and eloquence”) fails to make an obvious point. There’s no “disconnect” here at all. The political party that cultivated this mindset (and it was cultivated) has turned ending abortion into a crusade surpassing all other issues in importance. They’ve trained voters to believe that whether a candidate is pro-life is the only thing you need to know about them. No surprise, when people go to the polls with that mindset, other issues fall by the wayside. Again, this outcome isn’t accidental, it’s deliberate.
An evangelical Christian, Stewart was featured heavily in state and national news accounts of the coverage gap over the last year, and she spoke with the conviction and eloquence associated with the tradition of religious testimony. “There’s a disconnect between politicians and people’s lives on the ground,” she said. “I’m strongly pro-life. I testified for the fetal-pain bill because I believe God created life. I’ve said babies can feel the same pain as adults, and that position was applauded, so why, when adults are experiencing the kind of severe debilitating pain that I am seeing because they cannot afford the care they need, are the same people not also working to do something about that?”
Granted, we don’t know how these specific people voted. Despite what the statistics might suggest, maybe the anti-choice evangelical or the elderly couple with multiple guns are staunch Democrats who support an expansion of the safety net. In that case, they’re not guilty of inconsistency. They aren’t responsible for what’s happened to them.
But you can’t say the same for the woman interviewed in this similar story, about the effects of Obamacare in Kentucky. Her husband has cirrhosis and is on the waiting list for a transplant. The ACA has literally been life-saving for them, and yet:
They voted for Trump because they were concerned about other issues — and just couldn’t fathom the idea that this new coverage would be taken away from them.
“I guess I thought that, you know, he would not do this, he would not take health insurance away knowing it would affect so many peoples’ lives,” says Debbie Mills, an Obamacare enrollee who supported Trump. “I mean, what are you to do then if you cannot pay for insurance?”
But when the reporter points out that Republicans can take away her health care, and in fact campaigned on a promise to do so, she starts getting queasy:
Our interview began to make her a bit nervous.
“You’re scaring me now on the insurance part,” she said. “I’m afraid now that the insurance is going to go away and we’re going to be up a creek.”
This is what I wrote about in “You Get What You Vote For“. The people who voted for Trump, and more generally the people who’ve been electing Republicans for years, aren’t innocent victims of circumstance. They’re willing participants in an ideology which holds that banning abortion, flooding the country with guns, safeguarding Christian supremacy, and cracking down on immigrants are causes more important than living wages, universal health care, quality public education, or clean air and water.
Millions of people believed this and voted accordingly. Now they’re faced with a country that reflects those priorities. If they stand to lose everything because of that, who do they have to blame?
“Politics” isn’t some balky machine whose gears occasionally get jammed. It’s the sum total of the decisions we collectively make about what to value. If we as a country treat our poor with cruelty, if we neglect them or abandon them to the tempests of life, it’s because some large coalition of our fellow citizens wanted that outcome.
There are millions of people from all walks of life who didn’t vote for Trump and the incoming Congress. It’s neither fair nor just that they stand to suffer from the decisions their neighbors made. But there are millions of people, even people who are poor and needy themselves, who did vote this way – who communicated, with their votes, that this is what they value. It’s both fair and just that they get to live in the world they built for themselves.