Public service announcement: “Obamacare” and the Affordable Care Act ARE THE SAME THING

President Abraham Lincoln is reported to have commented, in the agony of awaiting election results, “Well, it is the people’s business, – the election is in their hands. If they turn their backs to the fire and get scorched in the rear, they’ll find they have got to sit on the blister.”

We’re gonna be sitting on a lot of blisters.

Possibly among the biggest is the repeal of the Affordable Care Act, which is apparently NOT known to everyone as “Obamacare”, because some people seem to be under the impression that they are not one and the same.

For the record: they are one and the same.

This kind of ignorance is what we get when our candidates who have actual, readable policy positions which can be analyzed on their merits (as Hillary Clinton did) have to deal with a media which would rather give free press to a buffoon with no substantive policy positions (that would be Donald Trump).

It’s also the kind of ignorance we get when we permit one party to reframe the public discussion in such a way that the terms we use hide the actual meaning we intend. Republicans are fond of characterizing liberal speech as “Orwellian”, but then turn around and engage in exactly that sort of rebranding. Much of that is courtesy of Frank Luntz, a professional pollster, who, on at least one occasion, actually redefined “Orwellian” as a good thing. Most famously, Luntz gave us “death tax” instead of “estate tax”. He also gave us “climate change” in place of “global warming” (because it sounds less scary), “energy exploration” in place of “off-shore drilling”, “opportunity scholarships” in place of “school vouchers”, “tax relief” in place of “tax cuts”, “personalizing Social Security” in place of “privatizing Social Security”, and, perhaps most chillingly, “electronic intercepts” instead of “wiretapping” or “eavesdropping”. He encourages Republicans to say “liberal” instead of “progressive”, because it resonates with the idea of loose morals or profligate spending.

At least as long ago as 2009, Frank Luntz counseled Republicans to characterize health care reform in scary terms: “government takeover” instead of “health care reform”.

Government takeover? Today’s Republicans managed to eke out a win in the presidency and both houses of Congress and made repeal of the Affordable Care Act their first priority. If that’s not a “government takeover” of our healthcare system, I don’t know what is.

On the campaign trail, Trump promised to “repeal [Obamacare] and replace [it] with something terrific”.

It damn well better be “terrific”, because the Affordable Care Act, while imperfect, is better than what came before by actual measurement. For one thing, it requires coverage of people with pre-existing conditions. That’s important to several people I know who have chronic conditions which didn’t used to be covered, and now are, thanks to the Affordable Care Act.

Trump said that he was going to keep coverage for pre-existing conditions, because it was one of the ACA’s best points. BUT, apparently not. Let’s hear from Mike Pence:

“We will protect Americans with pre-existing conditions so that they are not charged more or denied coverage, just because they have been sick, so long as they have paid their premiums consistently,” he said.

But that’s not something ordinary people have complete control over, is it? If you’re fired from employment, or have to move unexpectedly, you may not be able to have continuous healthcare. Once you don’t, you’re in the high-risk pool for the long-term.

And there’s the flaw in healthcare, right there: pools. If you sell healthcare in a free market, then as a coverage provider you can’t make money in that market unless you charge more for people who need more. When you’re buying kitchenware, or a boat, that’s fine, because people can choose to economize. But it’s not possible to economize on healthcare by not having an expensive condition. I’m a cancer survivor, and I promise you, I would have economized by not having cancer. But that wasn’t an option.

About 60 million Americans have pre-existing conditions. That’s about 18% of the population. This is not a small problem.

Most Americans believe in meritocracy. Work hard and earn what you get. The implicit promise behind that belief is a reasonably level playing field. Well, when it comes to healthcare, the playing field is not level. A lot of your health is luck-of-the-draw. Some people get cancer. One accident I investigated, during my career, involved a woman who fell asleep behind the wheel and crossed over, taking a car head-on and breaking both of the other driver’s knees and hips, among other things. Let’s hope he was insured, because he’s going to need lifelong healthcare just for that, let alone the fact that he’s just as likely as anyone to draw the cancer card.

Where is the merit in that? Is there any possible way that he could have saved enough to pay for that roll of the dice, while doing the other things we expect of him, like paying on a mortgage and saving for his childrens’ college educations? That’s not meritocracy. That’s rouletteocracy.

How many times have you heard someone say that they hate their job, but they have to stay in it for their family’s healthcare? Conservatives say that they’re all about the entrepreneurial spirit. If our healthcare did not depend on our jobs, if we could know that our basic health was taken care of, so that we could take small risks instead of huge ones, they would see an explosion of entrepreneurs such as they have not dared to dream of.

Instead, they want us to make free-market decisions in circumstances which are famously opaque, where not even experts can get real costs on medical treatments, where parents with no medical training make medical decisions. What if your ten-year-old child falls and hurts their arm? Republican Bill Huizenga says you wait until the next day to take them to a doctor, in order to avoid a costly visit to the emergency department. But hey, don’t worry! Huizenga’s kid’s arm was just broken. Waiting didn’t hurt anyone, right? I mean, anyone besides the ten-year-old?

Republicans want people to make healthcare decisions they are not qualified to make in order to keep their costs down.

What if Huizenga didn’t have health insurance? Then his child would not be insured at all. Rouletteocracy again.

The system we have is ridiculous. We are the wealthiest society in the history of our species, and yet, we do not ensure healthcare for our society’s children. The Affordable Care Act improved our system somewhat. The Republicans are planning to delete it.

Enough of this shame.

We should be improving this system, not dismantling it. Call your representatives and tell them that. Tell them to cover all children, whose healthcare should not depend on the employment status of their parents. Tell them to decouple healthcare from employment.



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