This week the AHCA narrowly passed in the House, and we all became one step closer to the dystopian future, and I am terrified.
“It’s Thursday. How many people have lost their healthcare today?”
Not so much of the bill itself. It is terrible, but it still has a few more hoops to go through before it becomes the law of the land. In that time it will undergo many changes. In the end, it might be unrecognizable from what it is now. Not that I am not confident it will come out better I'm just trying not to get too anxious or depressed until we get a bit closer to a final version.
But I'm not here to put your mind at ease. I think we should all be terrified. We should be outraged and angry. We should be fighting this tooth and nail. We should also be talking, about how the hell we got here.
What I am really afraid of is the culture that allowed this colossal piece of cruelty to come into existence. I am terrified of the way we view healthcare in this country. For us, it is a commodity. We say it isn't. We say that no one should have to worry they will die because they can't afford treatments or doctors but if you've ever had to seek treatment without insurance you know the truth. You know what it's like to be patched up and sent away, still sick. You know that doctors don't really care and that they don't really want to treat you and you know that you can die because of it.
If you have always been covered, you don't see the bad side. Those angry and dismissive doctors and nurses and billing representatives don't show their ugly faces when the money is coming in. For those that don't pay up, you know that healthcare is a business and like all businesses this one is all about making money, not saving lives, but times they are a changing. I can feel it.
It isn't just happening in healthcare either. The oil industry must know it's days are numbered. Same as tobacco and sugar and fast food and all the other factions of production that are killing us. Healthcare will be universal some day, paid for through taxes rather than premiums. It will be heavily regulated and forced to be accessible, affordable, and open to all, and they know it. These companies may not be going gently into that goodnight, but they are going.
“Democrats do not regret the day they passed Obamacare. They’re proud of it. Republicans, I predict, will regret this day bitterly.”
My own story is that the Affordable Care Act, or Obamacare, is the only reason I am getting care now.
For many years I either couldn't afford insurance, didn't think I needed insurance, or couldn't be bothered to get through the hassle of finding insurance. When I had jobs that made it easy and affordable, I had it, but that was so long ago. I spent most of my 20s uninsured. I was sick often, but I went to emergency rooms and clinics, of told myself I was okay and powered through it. Or I sat up at night wondering if this pain, this fatigue, was normal, or if somewhere in me there were tumors, cancers, chronic illnesses or defects going untreated, bringing me closer to death.
Then the Affordable Care Act passed, and there was not only a subsidy to entice me but a penalty to pay as punishment if I didn't get it together and get myself covered. So, I did. It was hard. It was often confusing and frustrating, and I'm not sure I got insurance that is exactly right for me, but I got it.
I still had some leftover lazy habits from before, and it still took me over a year after that to make it in for a real look at what has been going on with me, but I am so glad I did and just in the nick of time too. It turns out I have ulcerative colitis and have probably had it for years. I wonder if it had been easier, if it had been more affordable and accessible, and if I had felt the urgency and importance of it, I might have gotten insurance and treatment earlier and my case might not be so severe now.
During my first follow-up visit after my diagnosis, one of the things my doctor made clear to me is that I can never, ever lose my health insurance. Without it, my medication would be unaffordable. Without treatment, and medication, and follow-up exams and screenings and tests, I would get very sick, and my condition could develop some serious complications. I worry about my chances under this new bill.
During my last visit, my doctor tried to make me feel better about having a chronic illness by reminding me that it could be worse. I don't have cancer, my organs aren't failing, and my life expectancy is not affected. In the end, no matter what, something will make me better, whether it be medication or surgery. I can still live a happy nearly normal life one day. Her saying that didn't exactly make me feel better, but it did put a few things in perspective.
If I am terrified and my condition is not one of life and death, how must those who are facing death feeling?
“The biggest joke of our country was getting anyone to feel sympathic to insurance companies - the ones who invented "pre-existing" illness.”
A lot of the coverage around this new bill has been centered around pre-existing conditions, and I think it's already pretty obvious why denying people who are already sick the coverage they need is beyond cruel. But I want to talk about a different part of the ACA that has been attacked, the individual mandate. The part that says we all have to be covered.
No one likes to be told they have to do something, especially if that thing costs money. We all think we know best what is right and best for us, but we don't. I thought I knew what was best for me and I didn't. I made a mistake, one I can never take back. I spent years playing my part in driving up the cost of healthcare, and I spent that same amount of time putting my body at risk. I am not a healthcare professional. Most people are not healthcare professionals. You cannot know without regular screenings and visits and tests if you are doing alright, and you cannot do that without coverage.
Healthy people pay for sick people, and that may seem unfair until you realize that every healthy person will at some point in their lives become a sick person. People who are using fewer services have to pay for the people using more services, and that may seem unfair until you consider what the cost will be when you are the one using more services.
Without the individual mandate, without us all paying in somehow, the system becomes unstable. Premiums and costs keep going up, and by the time it's you who needs care it's unaffordable. The only way to keep us all healthier for longer and to keep it from costing everything you have is to have us all pay in now. We have to accept that there is no way to keep healthcare affordable and accessible without the healthy paying for the sick and we have to accept that al of us will land on both sides of the equation.
The truth is, we all need to be told at some point in our lives to do what is best for us and everyone. It is not something that comes naturally to humans.
We need to be told that healthcare doesn't start with your doctor's visits. It starts with the way we treat ourselves. It starts with our culture and our culture right now is do whatever you want, whatever feels good, and deal with the consequences later. The problem is we are fighting against some very big forces, and we are set up to fail, and become sick.
Corporations do whatever makes the most money and what makes the most money is engineering food and technology to be addicting. We can't stop eating sugar, and fast food, and looking at our phones or watching TV because the greatest minds of our time are paid to keep us doing things day after day until our bodies can't take it anymore. Then the government, who stand by and take the money and do nothing to protect us or inform us tell us that the reasons we are obese, and suffering from heart disease and diabetes and depression are entirely our own fault. Not to mention the fact that you are poor, that is your fault too, and now you must figure out how to get care now on your own.
The only way to get better is for all of us to start taking care of each other. That means making it a little easier to understand and make good choices. Charging 5 cents for a plastic bag magically reduces people's need for them versus when they are free. Charging a few extra dollars for a pack of cigarettes, a bottle of soda, a sugary treat, these things don't keep us from having what we want, but they give us the extra second we need to think about what we really want and what impact we are having on ourselves and the world.
I was a burden on the system before I got health insurance.I was getting care and not paying in because I had no reason to. I was young, and I couldn't fully understand my choices or my impact, but a penalty made me rethink what I needed and why.
“Should it pass, never forget that it took making the AHCA more cruel and fiscally irresponsible to secure additional Republican support.”
Here in America, the problem isn't the ACA, or this bill, or what the next iteration of this bill, it is our culture. The problem is that we try to make healthcare a commodity all the while believing it is also a right. We can't have it both ways. We have to decide what comes first, people's lives? Or corporations and their profits? We have to decide who it is we are woking for and protecting when we make these laws. We have to stop lying and say plainly what we are doing and what kind of future that will lead to.
And in the same way that personal healthcare shouldn't start with a doctor's visits, conversations about healthcare coverage policy shouldn't start with insurance premiums either. It should start with what our values are. What kind of country do we want to be and what kind of life do we want to give our citizens. It should start by saying people are more important that corporations. And just like people have to be told, and encouraged, and discouraged sometimes, so do companies.
Insurance companies do not pay for your procedure, your medication, or your preventative care out of the goodness of their hearts. That is not what they are in the business of doing. They are in the business of making money and treating you only makes them money when either you or the government is paying them to do so. They will do the least amount possible and charge you the most that they can until someone tells them to stop.
Politicians are not in the business of making sure that you are covered and cared for either. They are in the business of getting votes and giving people better lives is not necessarily what leads to getting their votes. We vote with fear and anger, so politicians spend all their time feigning outrage to keep your emotions high and your vote where they want it. So, for our part, we must tell them what to do, encourage and discourage with protests and votes. We can never forget where our representatives stand, and if they do not stand with us, they have to go.
We have to make better choices. We have to become more aware. We have to hold ourselves and everyone accountable because this bill and its consequences are on all of us. We have to start over with health care, from the very beginning. It has to start with what we eat and where we live and what we do. It has to start again from compassion and caring. We have to start again by choosing what is important, and that should always be human life.
“Let us be the ones who say we do not accept that a child dies every three seconds simply because he does not have the drugs you and I have. Let us be the ones to say we are not satisfied that your place of birth determines your right for life. Let us be outraged, let us be loud, let us be bold.”
― Brad Pitt
P.S. I'm late I know, but also, maybe it's better to send these on Sundays? Let me know what day's you like to kick back and read these, or other newsletters, and I'll work on getting them out when it's more convenient for us both.
“What if the democracy we thought we were serving no longer exists, and the Republic has become the very evil we have been fighting to destroy?”
— Padme Amidala, Star Wars Episode III: Revenge of the Sith