Esquire

Thoughts From a Hospital Bed

And what it means to be healthy, or unhealthy, in the United States of 2017.

By Charles P. Pierce    May 3, 2017

I wasn’t awake for 30 minutes Wednesday morning before the panel on MSNBC’s Morning Zoo Crew made me wish that there was a procedure by which they could put my gallbladder back, just so they could take it out again. The subject was Hillary Rodham Clinton’s appearance at a woman’s conference on Tuesday. First, Harold Ford came on—and who’s more of an expert of losing winnable elections than Harold Ford, Jr.?—and said that, instead of talking about the election just passed, HRC should be out there talking about “what she would be doing as president.”

Just thinking about the reactions in many quarters, from this bunch, from The New York Times’ Washington Bureau, if she actually did this—She’s Delusional! She Thinks She’s President!—made me long to be back on Toradol again. (By the way, if you know anyone who wonders why NFL players do what they call “riding the T train” before every game, send that person to me. Toradol is very good at its job.) Then, Mika informed us that one of the major blunders of the Clinton campaign was that it didn’t realize that the arrival of Donald Trump “changed the moral calculus” of the race and would sideline Bill Clinton as a political asset. That got me longing to start the whole process again, perhaps with a rusty lawnmower blade.

I can’t leave you alone for a minute, America.

So anyway, this happened. Last Tuesday, I awoke in the middle of the night feeling as though I’d swallowed an ankylosaurus, spiked tail and all. (It was a good day for dinosaur news, because it’s always a good day for dinosaur news, but it wasn’t a good day for metaphorical dinosaur news.) That brought me to the emergency room. The next afternoon, I felt as though someone was pounding a railroad spike into my right side. After a series of tests that covered 14 hours and included an endoscopy, an ultrasound, an MRI, and a more elaborate MRI, it was determined that the ol’ gallbladder had run the race, that it had to come out, but that it had not made the argument for its removal in a conventional way. I had, as they said, “an atypical presentation of a common condition.”

New title for the memoirs!

So, anyway, this happened. Before relieving me of the offending organ, the surgeon and I were chatting, and he mentioned that, in college, he’d played defensive tackle at Trinity College in Connecticut, in which capacity he annually ran into a plucky offensive lineman named…Bill Belichick. So that was weird.

The staff at Newton-Wellesley Hospital, all of them, will always have my thanks and prayers. But although Jimmy Kimmel beat me to this by a couple of days, what continued to strike me over the past week was the fact that the critical element in my care was that I could afford it.

The critical element in my care was that I could afford it.

After a while, the Toradol and I conjured up a guy in Mississippi who worked in a plastics plant. (He also works at the local Piggly Wiggly to make ends meet.) Last Tuesday, he wakes up in the middle of the night with the anklyosaurus in his gullet. He probably downs an over-the-counter stomach medicine. The next day, at work, he feels the railroad spike’s being driven in. He has to make calculations in currencies with which I am not familiar and in which I am not fluent. Antibiotics exchanged for food, school fees bartered for an ultrasound. Or maybe he just soldiers through, day after day, until a chronic condition becomes catastrophic and the ankylosaurus breaks through into his life like the critter from Alien leaping from John Hurt’s chest. I really got to like this guy. I wished him well.

From this standpoint, with my Mississippi plastics worker hanging out at the side of my bed, I watched the Republicans fall all over themselves trying to destroy the Affordable Care Act while pretending they weren’t doing that very thing. (An atypical presentation of a common condition.) For a good, long, healthy while, I was completely one of The American People, my privileged view of our democratic follies clouded for a moment by more than just the pharmaceuticals. I was looking through a haze of frustration and pain, and considerable anger, for me and for my phantom pal from the plastics plant. Human health is not a commodity, to be bargained and sold and traded as though it were any other consumer good.

I was lying in a hospital, doped to the gills, chatting in my mind with an imaginary fellow citizen, and I could figure that out. Why in bloody hell can’t they? They’re out to wreck the only piece of effective legislation that made this a little easier for me and for my pal that has emerged in the last half-century. Everything about the proposed replacement is cruelly inadequate, because that’s what it was designed to be. The pre-existing conditions protections are cheesecloth; the high-risk pools are guaranteed to bring us back to the days of generally unaffordable premiums. It’s still a tax bill dressed up as healthcare reform, which is like calling a crop subsidy a law enforcement measure.

And hand things back to the states? To Sam Brownback’s Kansas, or Scott Walker’s Wisconsin, or even my phantom companion’s Mississippi? Somehow, doing this, bringing millions of Americans back to the brink of a cliff they’d almost forgotten over eight years, makes those Americans more free? This is crazy. I turned on the hockey game.

Human health is not a commodity, to be bargained and sold and traded as though it were any other consumer good.

The debate on the essential American political identity—which I contend began in all modern contexts with the belated acknowledgement of the rights granted to African-American citizens in the wake of the Civil War—has not even half-begun. The question of who we are as a nation is as unresolved as it ever has been. The value of the political commons—and the distribution of the benefits thereof—is still in a perilous place. The notion that the American republic is an ongoing experiment in self-government is one to which I still subscribe, but, dammit, these days, we seem to be closer than ever to the moment when that experiment turns to one of complete devolution, as we walk the republic back through all the mistakes of the past from which we’d thought we learned. Hell, the Greeks knew that social inequality was the route through which democracy turns to oligarchy. We were supposed to have learned that in 1787.

Also, in case you haven’t noticed, the president* of the United States is bughouse bananas and he’s getting worse.

So, anyway, all this happened. My family and I would like to thank you magnificent bastids, one and all, for the great outpouring of thoughts, prayers, good wishes, and raisings of the glass that came to us from all across the Intertoobz. There’s something stirring out in the land, I swear to god there is, and I’m glad we’re all here in this thing called life together.

So, anyway, that all happened. The shebeen is open again, praise be. God bless all here!

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A look at the House Republican health care bill

Associated Press May 4, 2017

WASHINGTON (AP) — House Republicans on Thursday passed legislation to roll back much of former President Barack Obama’s health care law. The legislation would rework subsidies for private insurance, limit federal spending on Medicaid for low-income people and cut taxes on upper-income individuals used to finance Obama’s overhaul.

The nonpartisan Congressional Budget Office estimates that the Republican bill would result in 24 million fewer people having health insurance by 2026, compared to Obama’s 2010 statute.

Here are key elements of the bill:

__Ends tax penalties Obama’s law imposes on individuals who don’t purchase health insurance and on larger employers who don’t offer coverage to workers.

__Halts extra payments Washington sends states to expand Medicaid to additional poorer Americans, and forbids states that haven’t already expanded Medicaid to do so. Changes Medicaid from an open-ended program that covers beneficiaries’ costs to one that gives states fixed amounts of money annually.

__Erases Obama’s subsidies for people buying individual policies based mostly on consumers’ incomes and premium costs. Replaces them with tax credits that grow with age that must be used to defray premiums. The credits are refundable, which means they can go to people with little or no tax liability. Credits may not be used to buy policies that provide abortion coverage.

__Repeals Obama’s taxes on people with higher incomes and on insurance companies, prescription drugmakers, some medical devices, expensive employer-provided insurance plans and tanning salons. Obama’s law has used the revenue to help pay for expanded coverage.

__Requires insurers to apply 30 percent surcharges to customers who’ve let coverage lapse for more than 63 days in the past year. This would include people with pre-existing medical conditions.

__Lets states get federal waivers allowing insurers to charge older customers higher premiums than younger ones by as much as they’d like. Obama’s law limits the difference to a 3-1 ratio.

__States can get waivers exempting insurers from providing consumers with required coverage of specified health services, including hospital and outpatient care, pregnancy and mental health treatment.

__States can get waivers from Obama’s prohibition against insurers charging higher premiums to people with pre-existing health problems, but only if the person has had a gap in insurance coverage. States could get those waivers if they have mechanisms like high-risk pools that are supposed to help cover people with serious, expensive-to-treat diseases. Critics say these pools are often under-funded and ineffective.

___Provides $8 billion over five years to help states finance their high-risk pools. This late addition, aimed at winning over votes, is on top of $130 billion over a decade in the bill for states to help people afford coverage.

__Retains Obama’s requirement that family policies cover grown children to age 26, and its prohibition against varying premiums because of a customer’s gender.

___

Sources: U.S. Congress, The Associated Press, Kaiser Family Foundation