Friday, January 27, 2017

The ACA - A discussion between acquaintances

This was a small part of a larger conversation thread on Facebook that started with the women's march. My friend engaged in an exchange regarding healthcare in this country, with several conservative acquaintances of ours.  I had let the conversation go until a particular comment, the first comment in the dialogue below caught my eye.  I had to ask a question.  Unfortunately, the person that prompted the question never really engaged in the dialogue.  The two people who did had a striking viewpoint, one I thought to be worth saving for future reflection, so I'm posting it here.

Conservative 1:  Here's the difference between EMS and insurance. EMS is there to handle accidents or tragedies. Insurance is to pay for healthcare for an individual or family. I choose not to eat healthy or exercise, I choose to have children. Why should someone who it does exercise and eat right pay for my diabetes or heart failure? Why should someone who doesn't have children pay for my children being born or their health care? Healthcare costs are based on the individual's, their lifestyle, their choices. I don't smoke why should I pay for someone else's lung cancer? That is vastly different than my house catching on fire or I get into a car accident.
Me (The Liberal): Wow, I've been out of the loop for a while on this thread. Hi Conservative 1, can you clarify for me, was my son's heart defect my choice or his choice? Which of us is to blame? What about my genetic condition? I wasn't aware of it until after both my kids were born, but what did I, or my parents do that caused it and what did I do that caused it to be passed on to one of my kids? What about my second perfectly healthy pregnancy where my water broke and the placenta started to die leading to an early delivery and 83 days of intensive care for my daughter. Which of us were responsible for that?

Conservative 1: It's an awful thing that your son has that condition. It's an awful thing that my friend's son was born with a genetic condition that caused him to die at the young age of 5. But we choose to have children and when we do that their Healthcare becomes our responsibility. I truly am sorry that your son was born with that and I truly hope he is doing well.


Conservative 2:  I wonder how these people would think if I showed up at their job and told them they should make less money because they "Owe" me their profession.

Me (The Liberal): Conservative 1 Ok, I do want to understand your position, if insurance companies are businesses, whose goal is to make money and they should be allowed to discharge people who are expensive because they affect the bottom line, and tax payers shouldn't be penalized for the decisions of others, is it your belief that only those who have enough money to pay cash for care should have advanced, life-saving care?


Conservative 2, Same question for you :)

Conservative 2: A) Your argument is moot. Hospitals and EMS providers can't turn down someone on their inability to pay. They have to perform life saving care. So this argument has nothing to do with insurance.

B) You have to eat food to survive. If you don't eat, you WILL die. Should I be able to go to the premier restaurants in my area and demand their best entree despite my inability to pay for it?

Me (The Liberal): Conservative 2 A) They have to stabilize and transfer to a county hospital where taxpayers foot the bill, they do not have to provide care beyond stabilization at their facility. If WE the taxpayer are not supposed to have to pay and insurance should not have to pay, what should a person who needs expensive care do?
B) You have to eat food to survive, again, those who cannot afford food are provided a safety net by the taxpayer in the current system, however, this is a red herring. No one is saying you must be flown to the best hospital in the country for treatment, the question is, if neither insurance companies nor taxpayers should be responsible for healthcare, who is, or are those who cannot pay supposed to die by your philosophy.

Conservative 2: Stabilize would be life saving care. And insurance will pay, if you have kept your premium up. You aren't owed insurance though, it's a business arrangement. And you should probably pay for your healthcare just like you pay for your nice house, and your nice car, and your everything else. It's a part of life, you should budget for it accordingly.


Conservative 2: Well despite the world having an overpopulation problem and some people dying might be good for the world... we won't get into that. No I never said that those cannot pay are supposed to die, you are hearing what you want to hear. I said hospitals and EMS are already forced to perform life saving care. I'm not sure how to break this down any simpler... do I need to get crayons?

Me (The Liberal): Before the ACA, insurance used a number of strategies to retroactively remove insurance from people who cost money, or provided coverage that excluded systems that had pre-existing conditions, or declined to provide coverage for people who are sick. To my understanding, your world says, Insurance companies are business intended to make money, they should be able to make decisions about who they care for based on their own bottom line. Your world also says, that taxpayers shouldn't have to pay for those who cannot afford insurance. Also, that there is overpopulation in the world and death is useful.Therefore, are you advocating for the death of anyone who cannot pay for their own healthcare?

Conservative 2: No, actually I've stated repeatedly insurance shouldn't be able to drop someone who becomes a bad bet. That's the only part of the ACA that I agreed with at all.

But yes they should be able to decline a customer who they don't want to insure because there is no way they will profit off of them from the get go. They should not be forced to throw away money. Should I be able to show up at your house and force you to invest your money poorly?

Me (The Liberal): So if insurance companies don't have to cover someone with a pre-existing condition in your world, what happens if your company changes insurance companies, as an example. Without the removal of yearly caps, lifetime caps, coverage exclusions and pre-existing condition clauses, millions cannot have insurance. If taxpayers also won't cover them, they are still left with death as their only option.


As for the requirements of law in a life threatening medical situation, stabilize and transport is the ONLY requirement. They do not have to treat or repair, just stabilize the patient and transport to another facility. If the patient can't pay, they are transported to the local taxpayer funded hospital that provides the care.

You are making a great argument for why healthcare shouldn't be a for profit industry.

Conservative 2: We get it. You're selfish and worry about what's in it for you and think the world owes you something. You've made that clear. Maybe nothing should be for profit right? I mean, you will keep being owed things.

Me (The Liberal): the fact that me wanting my children to have access to healthcare despite the fact that they have medical conditions makes me selfish in your eyes is an indictment of you and your belief system.


In my eyes, you are the selfish one for caring more about a few hundred dollars more a month than the lives of millions who would be saved by your contribution.

Conservative 2: No, it makes you selfish. You are worried about how it effects YOU. You think anyone else is selfish for not wanting to pay 50 dollars a month for YOUR needs. But you worry about you. I don't owe your kid 50 dollars a month. I don't owe you 50 dollars a month. Maybe you shoudl live in a less expensive house. Maybe you should drive less expensive cars. Maybe you should live on a different scale. But you don't do any of those things, you just think it's other people's responsibility to foot the bill. I reject that idea.

Me (The Liberal): Between my husband and I we haven't made over 4 million dollars in our lives. If we walked, never ate and lived in a box we found in a dumpster that was gifted to us by a samaritan, we STILL couldn't afford our healthcare.


We have very different definitions of selfishness. Your 50 dollars (or even 500 dollars, to be more fair about the actual costs these days) is worth more to you than a human life, which is your prerogative, but does say something about your value system.

Conservative 3: Me (The Liberal) - Comparing your unique situation of 4 million in medical debt is the exception, not the rule. Most of Americans do not have 4 million in medical debt. Expecting the government to shell out money to cover you for this is unrealistic.

Conservative 2: Apparently your definition of selfish only applies to other people.

Me (The Liberal): Millions of americans are in this situation. Anyone who uses an ICU, has cancer, has a heart condition (the most common health condition in the US), has a genetic condition, is disabled, the list goes on. It's about 25% of the population.

Conservative 2: Well this conversation has proven to be less intelligent then the one I'm having with Dave about who would win if Batman fought Darth Vader. So I'm gonna walk away from this one. Luckily we have a president and a congress who agree with me.

Me (The Liberal): Conservative 2 - This is less about selfishness and more about what is more important, 500 bucks a month for each person or millions of people who could be helped by that 500 bucks a month.


Sorry you backed yourself into a corner you couldn't get out of... enjoy Batman V Darth Vader, I'm sure it is an intellectual conundrum.

Me (The Liberal): Conservative 3 - If it was just me, it'd be an easy decision, because realistically, 4 million isn't that much in the federal budget, but it isn't just me, it's millions of americans in my position, that's why this is a national crisis that needs to be addressed. That's why healthcare reform is on the national agenda.

Conservative 3: What you are trying to debate, in the usual roundabout way, is the perspective that we should live in an entitlement culture with a socialist agenda. As a socialist, you want everyone to pool all their resources together for the betterment of civilization - from your viewpoint. That's not how we operate. People in this country work for a living. We earn money through a job and use that money to pay for things like insurance. The debt I accrue in life is not your responsibility, nor is yours mine. Again, the medical debt you have is a result of making a conscious choice to have children. You would not have this medical debt if you elected to not have children.

Me (The Liberal): What I am trying to debate, in a very straightforward way is that there are certain things such as roads, healthcare, fire suppression, public safety, education, etc, that should use shared resources because in the end, they provide a public service and benefit everyone. Yes, people work for a living and some have more than others, but there is a base standard of living every citizen should have. No one should die because they don't have the money to live.

Conservative 3: I do not agree with you. No one is entitled to a base standard of living. Again, we are back to socialism. No one is entitled to wages. No one is entitled to have their medical debt paid for by everyone else because you are unable to pay it back. You want to talk about selfish acts? Consciously making the decision to have children when there is considerable risk is a selfish act. You are saying "fuck it" I'll have kids because I can and because I want it. Damn the consequences, someone else will pay for this if it goes wrong. Society will pay for my own selfish decisions because I am entitled to a safety net in everything I do. Stop asking what your country can do for you and ask what you can do for your country.

Me (The Liberal): Also, I personally have a condition that requires a medication that costs 10,000 per dose... even without kids, we'd have a dire medical situation.


Consciously deciding to live as part of society means pooling your resources for the good of that society. If you don't want to pool your resources, go live somewhere that doesn't have anything made by other humans.


If you want to live in a world where only the fit survive and no one helps each other, pick one where we don't have a cooperative society.


No one should HAVE medical debt to payback, that's the fundamental difference in our belief system.

Conservative 3: No. That is YOUR definition of being part of society. I am not a socialist. You are the one with the problem trying to force-feed your political viewpoints on to the rest of us, along with the remaining fractured and broken democratic party. I am not the one with the problem complaining about why everyone else cannot pay for my shit and my problems. Now that we have Republican dominated branches in both Legislative and Executive, we will finally rid ourselves of this entitlement culture absent of accountability.

Me (The Liberal): You use shared roads, police, fire, and a whole host of other services. we are all part of a social contract, your belief that only those with money deserve to live is a reflection of the relative wealth you were born into. They day you choose death over uninsured medical care for yourself or someone you love, I'll believe you actually hold this worldview. Until then, I'm going with you talking about something you don't actually have any personal experience with or knowledge of..


Thanks for clarifying that you would prefer my children had died rather than burden the American taxpayer it really crystallizes the import I should place on your opinion.

Conservative 3: I work at a job to pay for those roads, police, fire. My contribution comes in the form of tax deductions from my biweekly paycheck just like every other working American including you. Your inability to take responsibility for your own issues is what we are debating here. From your perspective anything that goes wrong with you or your family medically is not only my problem, but the problem of every other American. I disagree. If we make our beds we should have to lay in them. Don't want 4 million in medical debt? File for bankruptcy like many others have done. It washes everything away I am told save student loans - also something the government is not responsible for. You can imply whatever you want about my own viewpoints and will usually end up being wrong, as you are wrong about the United States being a socialist state. For someone who does not value my opinion you sure do try your bestest to argue with me in just about every political post on social media, including this one which has what - 100 or so replies?

Conservative 2: Liberal, there are plenty of people without homes. When you decide to invite those strangers into your lavish home to live with you, then maybe we will believe that you aren't selfish. Until then you're just as full of shit as anyone else. You aren't giving up things you have for other people, but you expect others to give up for you. It's why you liberals are such a fucking joke. If you want to live in a socialized country, go move to one. America has obviously rejected this idea, repeatedly and emphatically.

Me (The Liberal): Conservative 3 - Are you kidding, filing for bankruptcy screws everyone for whom you owe money. It is the ultimate abdication of responsibility and something that should only be done under dire circumstances. I am advocating for a solution that means those in the medical profession will get paid for their services. You are advocating for a system where people use those services and then do not pay, but instead declare bankruptcy and wipe that debt.


The level of selfishness inherent in the idea that bankruptcy is a valid remediation for debt is appalling.

Conservative 3: Liberal - Take responsibility for your actions. You choose to have children, not the American people. Maybe we should turn to our government and have permits to have children? Our government, all knowing and all powerful, can conduct "studies" on who is healthy and in a position to benefit society by having children and only those couples are allowed to spawn? I digress... Your moralistic viewpoint that when you spill milk the rest of the country should clean it up for you does not sit well with me. It strikes me to the core as someone who relies on others rather than owning the problem and taking care of it myself.

Screwing over your credit temporarily in order to wash away the debt is still a choice. Don't complain because you don't like the choices before you because of a decision you made.

Me (The Liberal): Conservative 3 Bankruptcy doesn't screw me long term, it screws the people who gave me the services that I'm abdicating responsibility for... They lose millions, I recover in 7 years... Bankruptcy isn't a solution, it's the outcome of a lack of solution.


This isn't about my children, this is about whether a human being of any age has the right to live when sick whether or not they have money. I am understanding your answer to be that no, they should not live if they do not have money. I disagree with that base premise.


I think at this point, we're going to have to agree to disagree.

Me (The Liberal): Conservative 2 - Quit employing logical fallacies to try to mask the fact that you do not have any substantive talking points for your position

Conservative 2: Oh, so you don't have an answer. Again, you're not willing to give up anything, you just want others to give you more because you think you're entitled.

Just so you know... that makes you "selfish".

Me (The Liberal): Conservative 2 I am willing to give up the exact same thing I'm asking everyone else to give up for the exact same service we'd all receive. You are using strawman arguments and red herrings in an attempt to derail the discussion, which is counter productive.

Conservative 3: Liberal -  this is about selfish choices, gambling and losing, then asking everyone in the country to take a bite out of your shit sandwich that is 4 million in medical debt. Don't shine a turd. Choices have consequences good and bad both. You, as a socialist, believe everyone is obligated to pay for your problems. I disagree with this viewpoint. In our polarized society and a dwindling democratic party continues to fling itself around violently in death throes, I hope the people who are not happy move elsewhere to a utopia rather than try and continue to cram their viewpoints down our throats. Such thinking is why you lost the last election. People are sick of it and now we have a President who will put an end to it. Thankfully.

Me (The Liberal): Conservative 3 It isn't just my kids, it is me, even if my kids were healthy, we'd be talking about tens to hundreds of thousands of dollars per year based on my own medical condition.


The gamble you are talking about is living, not having kids. Anyone who is alive may need catastrophic medical care. Quit trying to confuse the issue. We're talking about humans who need medical care, which is an inevitability, not a chance.

Conservative 3: Liberal the ACA is toast. Accept your loss and accept that society has rejected your way of thinking by majority, as our democracy has dictated. You lost. We will go back to a healthcare system not ran by our broken government. Pick a plan that makes sense and works for you and maybe if you are in a situation of dire need, you will have a plan in place that will not leave you with another 4 million in debt. Instead of ranting, wait and see what the replacement plan will look like. The democrats had their chance and fucked it up. We have rejected the values and ideals to which you hold dear. Deal with it and move on.

Conservative 2: [animated gif depicting a man saying “Bye Felicia”
Me (The Liberal): Conservative 3 - Not even close to a majority of Americans. The democrats implemented the plan the Republicans first introduced during the Clinton administration. I don't have 4 million dollars in debt, my children required 4 million dollars in care. This discussion hasn't been about what congress will do, but rather what you believe should be done, those are two very different things

Me (The Liberal): Conservative 2 - No, just no... you obviously don't even know what that means.


Conservative 3: [Animated gif depicting a logo purported to be for the democratic party with a crying baby]

1 comment:

  1. I really wish we could make the "I don't owe you anything" mindset take some history classes. Not just sit and listen and maybe pass a test but really truly study events and understand them because history has proven time and time again that the every man for himself attitude leads to violence. When the working class has no or limited access to food, shelter, and medical care, its only a matter of time, you know? French Revolution, the downfall of the Czars in Russia, medieval uprisings, even the American Revolution. You can get bogged down in the nuances of the political climate and talk about vacuums in power or charismatic leaders or fights over political ideology but it really all boils down to the mindset of the working class. The unrest and anger of those kept in poverty is typically the driving force behind the downfall in government and leadership.

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