A look at why JD Vance’s proposed “high-risk pool” health insurance proposal is inhumane.
“It just feels so unfair,” my patient said, her eyes bright with tears she did not shed. I nodded, sitting quietly in the shared space. I could guess what she meant: At 33 years old, she was thin, with the ripples of lithe muscles showing in her bare arms. Because physical activity is such a core piece of mental health and stress management, we’d spoken before of her workout routine: vigorous exercise three days each week, moderate exercise on three more. She reported eating mindfully of a balanced diet, denied smoking or vaping, didn’t drink.
And yet her case isn’t unusual in my office. In fact, it’s tragically common. Young, active, and diagnosed with a chronic autoimmune disease. Daily routines altered by the burdens of unpredictable pain, deep fatigue, and sudden weakness. Or facing early mortality due to aggressive cancer during the parenting years. These physical assaults are the all-too-common sequelae of psychological trauma; the assault after the assault.
“I think I need to leave my job,” she confided. “I keep having to call off sick, and they’re getting impatient with me. The truth is I just can’t keep up, and when I push myself, my symptoms flare and I crash harder. But if I leave my job, or drop to part-time, I won’t have healthcare. I don’t know what to do.”
In this backward healthcare system the United States persists in, medical insurance is generally available for those healthy enough to work full-time. Except when you become permanently disabled by cancer or Parkinson’s or a freak accident that caused paralysis and are no longer able to work. Then you have to go buy your own insurance. As a sole-proprietor clinician, that’s what I have to do, too. It’s not cheap, but thanks to the Affordable Care Act (aka “Obamacare”), it’s doable.
Under JD Vance’s proposed health insurance system (representing, we can only assume, the details of Trump’s “concepts of a plan” for the healthcare replacement system he promised eight years ago), sick people will be placed in a high-risk pool, not outright denied healthcare1. How magnanimous. Stopping short of completely pulling back protection for having insurance, his proposal is to make insurance outright unaffordable to exactly those people unable to work full-time and needing it most. Insurance boards won’t be allowed to drop them as before, but nothing would stand in the way of charging premiums 500x higher, effectively preventing care for all but the richest of sick people.
Of course, if people would just schedule their life-altering illnesses and accidents better by waiting until age 65 and retirement eligibility (or 70, if the conservatives have their way), Medicare would kick in and cover that gap. How short-sighted of the millions of sick people to not think of this.
And sure, there’s Medicaid for the low-income. But are we really okay with a society in which we force people into poverty in order to access needed healthcare? Is that really the world we want to create?
Because there’s that second side to why it all feels so “unfair,” as my client lamented. It’s not just that the formula of exercise-and-eat-well failed; it’s that something out of her control – that history of childhood trauma – primed her for the system to fail her.
The majority of the “too expensive to pay for insurance” high-risk pool would be comprised of people who have already survived trauma and abuse.
Conservative politicians like to blame disadvantaged people for not being advantaged. Can’t afford rent or groceries? Should have got a better job. (As though every person in the country could have a high paying job and their arrogant selves would still be waited on in the restaurants they frequent, their online shopping parcels delivered, their houses still cleaned and their lawns manicured [without immigrant labor, because they are “stealing jobs” from Americans who surely want to work for those low wages that lack healthcare and other benefits].) Can’t afford your tier of healthcare because you’ve got a chronic condition? Should have been healthier. Probably a fat2 smoker who doesn’t exercise.
Except that’s seldom the true or full story. In most cases, those who are sickest physically are those who have endured the most childhood trauma.
From 1995-1997 the Kaiser Foundation and the Center for Disease Control (CDC) conducted a massive research study called the Adverse Childhood Experiences Scale (ACES)3. Through combing the data of 17,000 patients, they found the more traumas a person endured in their first 18 years, the higher their rate of illnesses, from autoimmune disorders to cancer to heart disease. Through no fault of their own, children grow up in violent, drug-using families, they watch their parents’ marriages split apart, they have a parent in prison, they suffer neglect, they are molested, AND THEN they grow up and suffer in disproportionate numbers the secondary injuries of fibromyalgia, multiple sclerosis, dysautonomia, endometriosis, Hashimoto’s, Parkinson’s, cancer, heart disease, and so much more.
I’m not saying if you have any physical illness such as these it is evidence you suffered childhood trauma. But the higher the number of childhood traumas out of the ten identified categories, the greater the chances you will suffer one or more diseases. It’s a cruel kick to the stomachs of those already knocked down by factors they could not control.
A healthy, civil society protects its weakest members, recognizing their value and the unfairness of suffering. A cruel society punishes and abandons those who have already been punished the most.
- https://www.nbcnews.com/health/health-news/vances-obamacare-plans-include-high-risk-pools-pre-existing-conditions-rcna173610 ↩︎
- An abhorrent stereotype and superficial judgment, to be sure ↩︎
- https://www.cdc.gov/aces/about/index.html ↩︎