“Paying Till It Hurts.” “United States Comes in Last Again on Health.” There are many articles like these detailing the human cost of the United States health care system. Intellectually, I understood the potential devastation that a lack of health insurance could bring to so many Americans. But it wasn’t until 2012 that I viscerally felt just how health care policies made in faraway Washington affected the lives of so many.
When I graduated from college, I took an internship with President Obama’s re-election campaign. Eventually, I became a field organizer in Aurora, Colorado. My job as a field organizer was to coordinate a team of neighborhood volunteers to knock on doors (canvass) and call potential voters. Every day I joined them on the trail. On one of those days, I was canvassing an apartment complex. A middle-aged man opened the door, looking as if he had just woken up. We’ll call him “Henry.” When asked, he was happy to put his name down as a supporter for the President. I also asked why he supported President Obama. It was a standard question when canvassing. Henry shook his head wistfully and said, “I’m diabetic and I just got laid off. But because of Obama, I’m still getting health care.” A young girl, no more than five years of age, came walking out of a room right then to hug him.
Another day, one of my volunteers on the team, who we’ll call “Linda,” mentioned to me that her personal goal was to knock on 200 doors in one day, and 1000 doors in one week. I was shocked. She was 60 years old and still employed full-time as a flight attendant. I asked how she would make the time to achieve this. She replied with, “This President is making sure people like my mother don’t go through the hell that we did. I won’t stop until I know he’s going to win.” Her mother was in hospice care and died shortly after the election. Linda buried her mother with a photo of the President.
If this were a movie, those scenes would be panned for being cliché. They are cliché! But those clichés matter. They are Americans whose lives are being shaped by individuals who do not share experiences with them: Congresspersons whose health insurance, through both wealth and deceptive legislation, is guaranteed against the shifting tides of health policy. The stories of these individuals who see firsthand the consequences of health care policy decisions are grounded in the fact that the landscape prior to the ACA was stark and punishing. We often forget that in the scrum of defending or decrying the future of the ACA. But we can’t afford to forget.
That past was riddled with predatory insurance companies who justified actions like denying insurance due to uncontrollable pre-existing conditions, or increasing rates based on gender alone. That is not a clear and level playing field. According to the Kaiser Family Foundation, pre-ACA 52 million human could have been declined from coverage due to pre-existing conditions. Fifty-two million people like Henry were trapped in jobs for fear of losing insurance.
But let’s dive into the weeds of that data point. At any point in time, those 52 million were insured. They had coverage. The point, then, isn’t that they didn’t have coverage and thus we must have the ACA. The point is that those 52 million Americans deserve, in a free and fair marketplace, to move from plan to plan when it most benefits their health. Could this introduce instability into the market? Maybe. But having millions of uninsured treat the emergency department like their primary care doctor definitely introduces an untenable burden that the market has proven it cannot bear. Trapping people in their plans, the way they were ensnared when pre-existing conditions were used to deny coverage, is a marketplace ruled by fear. Not stability.
That is not a reasonable fear to tolerate. That is why the ACA is a landmark piece of legislation. Because the human toll of pre-ACA policy was not just on lives lost, but also on freedoms lost. Henry’s freedom to move from one plan to another when employment took a downturn. The freedom for women like Linda’s mother, and Linda herself, to not be charged extra simply because they are women. The freedom to be healthy and insured at an affordable rate without being trapped.
People like Henry and Linda are indeed anecdotes. They are not written about here as empirical evidence of America’s duty to hold steadfast to the ACA. They are examples of how lives were changed, for the better, with the ACA’s passing. It is not a perfect piece of legislation. Many, many articles have been written about that too. You can read more here and here. But if for nothing else, the ACA should be commended for taking the first step into a complicated world that deserves more scrutiny, less rancor and better judgement from every side of the aisle.
Writer-in-Training
Dartmouth Medical School
Reza Hessabi is a native Southern Californian currently braving the winters of rural New Hampshire. He graduated from UCLA in 2012 with a Neuroscience BS, and followed his passion for service into national politics, working on a presidential campaign as an intern and field organizer. Diligently returning to medicine, he graduated from Tulane University with an MS in 2014. He now attends Dartmouth Medical School with a deer, a few moose, and many, many squirrels.
