An Ounce of Prevention

This post is inspired by the following opinion piece written by Republican House member Cathy McMorris Rodgers:

My son has a preexisting condition. He’s one of the reasons I voted for the AHCA.

The title of the article alone is preposterous enough ( unless you believe families that rely on health insurance coverage for preexisting conditions would benefit if their health insurance premiums were increased to unaffordable levels ) , but what really got me upset about the article is that it claims the following is major flaw of Obamacare:

"With Obamacare, our health- insurance system relies on younger, healthier people subsidizing the costs of the older and sicker."

Wait a minute!  Isn't that how insurance is supposed to work?  Isn't that the only way insurance can work?  If the healthy don't subsidize the sick in Representative McMorris Rodger's ideal health care system, by what mechanism does she believe a health care system should subsidize care for the sick?

The simple answer is, she doesn't believe healthcare for the sick should be subsidized.  It is more than likely she is philosophically opposed to the government transferring money from from one group of people to another for any reason

She's certainly not an outlier in that regard.  Most Republican politicians feel that way.  If you don't believe this, think back to 2008 when Republicans branded Barack Obama a socialist for being in favor of the United States' progressive income tax system.

Republicans have a fundamental belief that a system that transfers wealth from the well-off ( who they generally believe have earned their success through hard work and wise decisions both in life and business ) to the poor ( who they believe have not worked as hard as those who have achieved success ) is unfair.  They believe it is unfair to the point of being immoral.

I'm not just guessing that Republicans feel that way, I know they do, because more that 3 decades ago I was a Ronald-Reagan-worshiping conservative Republican who felt exactly that way.  The story of how my own political philosophy changed is a story for another day ( though I believe a big part of it had to do with growing up ), because for now I'd like to focus on the flaws in the conservative ideas about fairness.

Regarding the conservative idea of fairness, I've written before about how conservatives seem to ignore the role luck plays in success ( Note: The post in the link to the left is not trying to claim that hard work is not a big part of any success, but it is pointing out that we should not ignore the role of luck in any success story ), how assisting the poor actually makes our nation more competitive than pure social Darwinism ever could,  how "fairness" cannot exists without equal opportunity,  and how even policies that could be unfair to a given individual create a net benefit to society as a whole.  However, rather than revisit all of that here, I'd like to focus on the concept of fairness in healthcare explicitly.  This brings me to the following quote from Republican Representative Mo Brooks that has to be seen to be believed.  See the YouTube clip below ...



For the sake of context and fairness, I'm also going to reproduce his full quote below:

"My understanding is that it ( the AHCA ) will allow insurance companies to require people who have higher health care costs to contribute more to the insurance pool, That helps offset all these costs, thereby reducing the cost to those people who lead good lives, they're healthy, they've done the things to keep their bodies healthy. And right now, those are the people--who've done things the right way--that are seeing their costs skyrocketing.  In fairness, a lot of these people with pre-existing conditions, they have those conditions through no fault of their own, and I think our society, under those circumstances, needs to help. The challenge though is that it's a tough balancing act between the higher cost of these mandates which denies people coverage because they can't afford their health insurance policies...and having enough coverage to help those people truly in need."

I've highlighted the awful thing he said in red and the the reasonable compassionate thing he said in blue.  However, it's worth noting that AHCA policy on pre-existing conditions matches the red part of the quote so the blue part of the quote doesn't really carry any weight.

The AHCA is designed to make sure that those people who have led "good" healthy lives don't have to subsidize a significant amount of health care for the kind of people who have presumably led bad lives.  That idea, in a vacuum, can certainly seem fair to a lot of people.  After all, in theory if guy A and guy B start life with the same genetic advantages and disadvantages, is it fair for guy A to subsidize guy B's healthcare, if guy A works out 5 times week and eats kale every other meal and guy B sits on the couch all day eating chips and drinking soda?

I can understand the appeal of the argument, and I can certainly recognize that under a system like Obamacare, there are certainly some kale-eaters who are subsidizing the health-care of some chip-eaters.  However, despite what Representative Brooks said about helping those with pre-existing conditions, there are no policy prescriptions in the AHCA  that distinguish between the couch-potato who ruined his health one Twinkee at time and a child who is born with a disease.  The AHCA prescribes high risk pools as the solution to the issue of pre-existings conditions without making sure those pools are properly funded.  So, if the AHCA doesn't cover pre-existing conditions in any practical sense of the word "cover", and Republicans have overwhelmingly supported the AHCA ( which they have ), then you really have to question the Republican definition of "fairness".

Is it fair if a child born with a disease cannot get the treatment that he or she needs?  More specifically, is fair if a child of rich parents can get this treatment, while a child of poor parents cannot?

When I was a child, I had very bad asthma - bad enough that I needed to be hospitalized for a week when I was four years old.  My parents were by no means rich, but I was fortunately that my father's job came with good enough health insurance that my family could afford my hospital stay and all the drugs I needed to manage my asthma until I was a young adult.

I'm now a 47-year old man blessed with good health, a good job, a great wife, and two wonderful kids.  I'm convinced that I would not have had all these blessings in my life if my asthma had not been controlled as a child.  I was lucky to have access to the health care I needed, but the health care of a child should not have to rely on luck.  I want every sick child to have access to the kind of health care I had.  Every child should be able to dream of a bright future.  Allowing a manageable/curable childhood illness to take that future away is about the most unfair thing I can think of.

I think of my own children's futures a lot.  To be honest, it keeps me awake at night sometimes, because I'm not 100% sure that their lives will be as fulfilling and fortunate as my life has been.

Both of my boys are on the Autism spectrum.  Thankfully, they've made great strides since the days they were both severely speech-delayed and my wife and I feared the worst and worried that things might never get much better.  They both talk up a storm these days, are taking honors classes, have reports calls full of A's ( straight A's for both of then in the last marking period  ), and have demonstrated the discipline and focus to get their brown belts in jujitsu.  There are still plenty of challenges ahead of them ( neither of my sons have any close friends, Peter has big issues with food and many social issues that require regular sessions with a psychologist, and both boys will probably always be socially awkward. )

Still, as much as I worry as a parent, I'm thankful for all the progress they've made, and know none it would have been possible without the help of all the wonderful speech therapists, child neurologists, psychologists, and teachers ( particularly the Special Ed teachers and Early Intervention teachers ) that have been part of all our lives for past decade-plus.  We've been extremely lucky to have all these people in our lives to help.  I know that not all families are as lucky.  Not every state has Special Education and Early Intervention resources as good as our state, and not every family has the financial resources ( and advocacy resources ) to fill in the gaps that the government is not providing.

It is painful to imagine what my children's lives would be like right now if I were a single parent without many financial resources.   I'm tearing up now just thinking of the tears and frustration they've suffered through over the years and I can't even imagine how painful their life would have been if they had not gotten help.  No child should every have to suffer when help can be made available.

Obamacare isn't perfect, but it made some of that help available for millions of kids.  Now the Republican party wants to take that help away.  In what world does refusing to "share the wealth" to help sick kids qualify as "fairness"?  I don't know, but I know it's world I refuse to live in.

Rich

P.S. Here are some photos of my boys during one of their speech therapy sessions.