Good morning, fellow mortals!
At this pivotal moment in American policymaking, I’m here to remind you of our individual and collective doom. Wellness, like youth, is temporary. In the end, you either get sick, then die—or you die before you can get sick in the first place. It bears repeating, apparently, at a time when the health-care debate in the United States has become so partisan as to imply the population of sick people and well people is just as cleanly divided as Americans are politically split. But this isn’t the case.
You can’t choose to be healthy or ill the way you can choose to be a Republican or a Democrat. You can’t choose for your babies not to be born with medical problems.
You can do everything right to stay in good health. You can be one of “those people who lead good lives,” as the Alabama Republican Representative Mo Brooks put it in a television interview, explaining why healthy people should get to pay less for insurance than sick people. And you’re still likely to find yourself facing unexpected medical costs at one point or another.
If you’re lucky, it won’t be catastrophic. But eventually, everyone’s luck runs out.
On top of the massive bills that can result from unexpected injuries or illnesses, each of us who continues to get older every moment of every day is marching inexorably toward needing more (and more expensive) health care as we age. More than 60 percent of all nursing home residents rely on some Medicaid funding, for example.
This is why the basic principle of health insurance is what it is, and why the concept of high-risk insurance pools, lumping together the neediest people in the population, is so problematic. Younger and typically healthier people subsidize the cost of health care for older people not just out of some moral imperative, but based on the premise that the younger people will someday be old themselves.
Yet the GOP’s Better Care Reconciliation Act would, in essence, penalize the elderly and the poor. Both groups are disproportionately represented among the 22 million additional Americans who would be without insurance a decade from now if the Republican plan passes, according to the latest Congressional Budget Office estimate. And that’s largely because the bill decimates Medicaid, which flows to 40 percent of all American children, 60 percent of children with disabilities, and more than 75 percent of all poor children in America.
By cutting out $772 billion in Medicaid spending over a decade, the Republican bill would save money for the wealthiest Americans by making poor people pay more money for stripped down versions of existing insurance plans. The consensus in the medical community is that these cuts could be ruinous to the one in five Americans who rely on such funding. This isn’t just about poor, disabled kids: Americans nearing retirement age would be hit particularly hard. “Medicine has long operated under the precept of Primum non nocere, or ‘first, do no harm,’” wrote James L. Madara, the CEO of the American Medical Association, in a letter to senators this week. “The draft legislation violates that standard on many levels.”
Many critics have fixated on how cruel it is to draft a bill that squeezes sick people and old people out of the insurance market, and understandably so.
But there are pragmatic concerns, too. Like the fact that populations of people who tend to need health-care services the most—the poor, the elderly, the very ill—are in constant flux. The 5 percent of Americans who account for 50 percent of the country’s healthcare costs isn’t a static group, as Helaine Olen recently wrote for this magazine. “A chronic illness can land someone in this category but, given the increasing prevalence of high-deductible plans, so can something as simple as a broken bone or an emergency appendectomy. Although some people will be in this group year after year, many will cycle in and out, and nearly everyone will be in it for some brief period.”
Nearly everyone means me, and you, and all the people we love. Because, if we’re lucky, we’ll all eventually become very old indeed, and the likelihood that we’ll need expensive health-care along the way is quite high. (An enormous part of this is preventative care in high-risk populations, which can drive down costs—but only for those who have consistent, affordable access to care.)
Many Americans cannot afford to pay for insurance hikes under the Affordable Care Act—the cost of the most popular Obamacare plan is going up 22 percent this year. Senator Mitch McConnell, the majority leader and author of the legislation, has argued he simply wants Americans to be free to make “the best health care decisions for their families on what types of plans they want and can afford.” But who can afford a serious illness? How can anyone plan for such a thing?
“There are no ‘healthy’ and ‘sick’ people,” wrote Ken Norton, a partner at Google Ventures, in a Twitter essay about the death of his 11-year-old son from a congenital heart defect in 2014. “Healthy people can turn into sick people really fucking suddenly... I’m here to tell you that there is no ‘us’ and ‘them,’ no responsible taxpayers and irresponsible moochers, we are them and they are us.”
The men who bristle at the idea of paying for insurance that covers women’s prenatal care would do well to remember that they themselves are former fetuses. And healthy people need to remember that they are future sick people, too.
The question of how to fix the Affordable Care Act—which, indeed, needs attention—isn’t just a question for poor people, or the elderly, or the middle class, or people with pre-existing conditions, or people who don’t have jobs, or the tens of millions more Americans who will be uninsured in a decade if the GOP’s repeal-and-replace plan passes. It is a question for all Americans, because all of us are vulnerable to a change in fortune.