There's a terrible beauty in that moment when a politician accidentally tells the truth. Take Jason Chaffetz, a Republican congressman out in Utah. On March 7, 2017, he went on CNN to talk about Trump's replacement for the Affordable Care Act, but instead of bullshitting like he was supposed to — like he was trained to — he accidentally told the truth. "Americans have choices," he said, "and so maybe rather than getting that new iPhone that they just love […], maybe they should invest in their own health care." It was a monumentally stupid thing for him to say, and it was perfect, because it revealed the proposal's actual logic. That wasn't supposed to happen.
I'm not formally trained in policy, but I do know my little brother's 2016 hospital stay for acute liver explosion cost about five hundred thousand dollars, give or take a hundred grand. So I wrote to Mr. Chaffetz on Twitter, asking him the most prudent way my brother could sell his iPhone, which is worth about $200, maybe $300 if the screen got fixed. For some reason, Chaffetz did not answer.
Chaffetz eventually walked his iPhone comments back, but it was just to cover his own ass. The fact is that he's a docile (and spineless) Republican. He doesn't support the individual mandate of the Affordable Care Act, which means he doesn't support making health care compulsory and penalizing those who don't have it (which any economist will tell you means he doesn't actually support making health care available to everyone). Walking back the iPhone comment did not change his core belief that the poor should not have access to medical care if it represents even a shadow of a threat of a tax on the wealthy.
The Congressional Budget Office estimates that in 2018, if the American Health Care Act passes, 14 million people will lose their health insurance. Republicans have refuted this by calling the number too high, as if it somehow invalidates the estimate (though the White House’s figure was reportedly even higher). This holds no water. I mean, great, maybe 14 million people won't lose their health insurance. Maybe it's way lower. Maybe it's only 9 million. So? The point still stands. We're looking at millions of American citizens who won’t have care.
They won't have it because the tax penalty for not getting health insurance will be gone. Lots of people will bail right there, because several hundred dollars a month is a major strain, one a lot more pressing than the worry that one illness or accident could turn catastrophic. Republicans will then call this a choice, made by free citizens. Later, in private, if they think at all about this choice, the one made by free citizens, they will spout the same sort of bullshit Chaffetz said. "Guess they wanted iPhones more." This erases moral culpability, and is a strategy not unlike removing all the lifeguards from a public beach.
Let's dispatch the baldest lie first. "Guess they wanted iPhones more" is just a repackaging of the old racist and classist trope that all welfare recipients buy luxury televisions. It's the new "welfare addicts are living like kings while I work for a living." And it's fiction. Technology is cheap now. All of it. Our fancy glowing screens are no longer markers of prosperity or even risky spending: Smartphones are an affordable alternative to personal computers. They democratize access to the internet and therefore to jobs; you can't play ball in the modern (read: gig) economy without one.
But the iPhone line is a sideshow when you stack it against the big issue, which is how financially fucked most people actually are. When people opt out of health insurance, it is not because they don't want health care. It's because they don't have enough to get by in their daily lives. It's because $200 tangibly represents gas money or rent or utilities. When I opted out of health care, it was because I was making minimum wage and minimum wage is not enough to live on. It’s not.
“This is a strategy not unlike removing all the lifeguards from a public beach.”
My brother survived his hospital stint for exactly one reason: the Affordable Care Act. Without it, he would not have had health insurance when he started dying. He'd have been stuck in a small-town emergency room, hoping to get transferred to the city, to a team of specialists he needed to survive. It would have taken longer to get him into a room in a hospital with the means to fix him, and he probably would have died during the process.
What the Republicans are planning to do to health care will turn more cases like my brother's into tragedies. It is not advocating for communism to say that this reflects a lack of empathy, a necessary civic virtue that, under Trump, is wilting within the American right.
Politics is not a game, no matter how easy it is to treat it like one. What the hell good is a government that would let its citizens die when they don't need to die? Health care is outrageously expensive and poor people can't afford it and their employers will do cartwheels on a cliffside to avoid offering it. Obstructing access to health insurance, even a tiny bit, is cowardly and selfish and will lead to deaths, deaths reported in passing in local newspapers, deaths of friends of friends and people you stopped seeing at the bus stop. Republicans are right now planning to cut Medicaid — that's the one that keeps poor people from dying — by $880 billion. That's an unapologetic fuck-you to, well, everybody, but mostly states like West Virginia, where almost every third citizen is on Medicaid and where a majority of voters are constituents of those same Republicans pushing to sink health care.
“Obstructing access to health insurance, even a tiny bit, is cowardly and selfish and will lead to deaths, deaths reported in passing in local newspapers, deaths of friends of friends and people you stopped seeing at the bus stop.”
But that doesn't matter to the White House, somehow, because the nonpartisan estimate is wrong, and therefore worthless. And that talking point will evolve. Soon there will be a new institutional lie designed to make people think it's morally acceptable for their fellow Americans to get sick and die without doctors.
The Affordable Care Act was not ideal. There were big problems. It was confusing, complicated, too expensive for lots of regular people. But conservatives tend to purposely conflate their visceral hatred for Obama with hatred for the things he did, refusing to interrogate whether that hatred is grounded in any facts or reason. Hatred for the Affordable Care Act is mostly an emotional reaction, egged on by conservative media, to the notion of being ordered around by an elite. But the fact is that the mandate to get health care was morally necessary. It kept people alive, something government is supposed to give a shit about.
The notion that people will "choose" between their monthly insurance premium and owning a smartphone is a ludicrous false equivalency based on relative cost alone (I recently spent five iPhones on stitches). But it's also a malicious mutation of the lie that the poor choose poverty. Choosing between health care and anything is not a real choice. Going to the doctor is part of staying alive, not part of our discretionary spending habits. The freedom to opt out of health care is not like the freedom to abuse alcohol or smoke cigarettes after we’ve abused enough alcohol. It’s the freedom to run into a wall painted by Wile E. Coyote. We should be able to choose what kind of medical care we need, but we shouldn’t ever have to pretend we don’t need it.