Occam's Razor

There is a little irony that a day after the Supreme Court narrowly decided the Affordable Care Act was constitutional after all, that I would undergo surgery. The surgery to correct a deviated septum (known as septoplasty) was actually scheduled six weeks earlier. My mother in law’s untimely death and my plastic surgeon’s busy schedule meant I had to wait until today for the outpatient surgery. It went well, but my time in the recovery room took longer than usual, perhaps due to aging. While waiting for the surgery, the TV playing in the waiting rooms was all about the Affordable Care Act decision.

My surgery was theoretically elective, but that did not seem to be the case for others in the waiting room. They included a ninety plus woman, virtually deaf due to plugged inner ears, who needed to get some tubes put into her ear so she could hear again. She looked miserable and her son acting for her largely could not communicate with her. Yet she was lucky. She was covered by Medicare. I was lucky too as I am covered by Blue Cross, and they approved my surgery. Even so I know there will be a whole slew of bills waiting me. It was nearly $900 just for the hospital to admit me. Doubtless the anesthesiologist and surgeon will bill as well, and there will be substantial copays for their services too. I’ll be lucky to escape this surgery for less than $2000, and that’s just for the copays. Blue Cross pays 85%.

I was back home by noon, my septum duly aligned and with various sinus polyps removed. Maybe this surgery will mean that I won’t need to spend my sleeping life tethered to a BiPAP machine for my sleep apnea. It’s a big maybe. Most likely I will continue to need the machine, but with the improved airflow, perhaps I can adjust the pressure settings downward, which would likely make sleep far more restful. Meanwhile I am downing Keflex and extra strength Tylenol every six hours and wearing a guard over my nose that is attached to little diapers to capture the bloody discharge from the surgery. Recovery from this sort of surgery is generally straightforward, and involves lots of use of QTips and hydrogen peroxide.

Mostly I am lucky because I am insured. My employer cares enough about me to provide it as a benefit, with me providing about a third of the cost of premiums. I am even luckier because even before the ACA I was already in a plan that required insurers to accept all comers. You see we federal employees have been been enjoying “Obamacare” for decades, and those employees I might add include members of Congress eager to repeal the ACA. And I must say, I like it. For decades I have been covered by health insurance, as has my wife and daughter. Insurers in the Federal Employees Health Benefit Plan have to accept people into their plans regardless of age and preexisting conditions. There are dozens of plans to choose from. On rare occasion, a health insurer will drop out of FEHBP, but it is a very rare occurrence. Mostly, health insurers are glad to cater to our market.

As I age, unsurprisingly, I have been using more health care services. I am quite certain that in spite of premium and my voluminous copays, we consume more in services than we pay in direct costs. It’s likely to be this way for the rest of my life. I don’t feel guilty about this. I feel grateful. I also feel like I’ve paid my dues. For the first twenty years or so that was likely not the case. I was paying for those older and sicker in the system. I did not resent this. It comes with the insurance territory. Health insurance only works if we are all in this together.

Essentially, the Supreme Court agreed yesterday. While Chief Justice Roberts surprisingly voted with the majority to uphold the law, and while he was silent about whether he personally thinks the ACA is a smart decision, he decided it is constitutional. This is good for our nation because by upholding the law at least for the moment he has likely fended off our devolution to a second world country.

Republicans are always anxious to vote more dollars for national security. I find it sad but curious that they don’t understand that national health insurance is also vital to national security. Most other first world countries figured this out decades ago, but we dithered. It is not surprising to me that since then we moved from greatest creditor country to greatest debtor country, and that our standard of living has devolved. National security is measured in many ways and it’s not just in the strength of our armed forces and intelligence. It is also measured by our willingness to invest in the human capital of its citizens so we can stay a prosperous country. In this we have been getting failing grades for some time.

We seem unwilling to pay the freight when it comes to education. We cheapen our public schools by increasing class sizes and shortening school years. We shortchange our public universities and expect students to mortgage more of their future by increasing tuition rates so they need to take out larger and larger student loans. This is keeping many from even attempting college, although many also have the talent. We also dumb down our curriculums. Courses like art, music and civics are considered expendable. Instead, we push highly structured and dumbed down standardized tests. Colleges are not immune from the phenomenon. As The Washington Post reported recently, college educations are becoming dumbed downed, or at least less time consuming. The Internet certainly makes research faster and more efficient. For most majors, the need for a full time college student to spend twelve hours a day on education, including often on weekends, as I did, is a thing of the past. I suspect this is to our detriment.

Education is vital to our national capital, but so also is our national health. It baffles me why this is not completely obvious. A healthy workforce is going to be more productive than a non-healthy one. If you are suffering from a health condition, your productivity is going to be compromised. If you suffer from a chronic condition, you may not be able to work at all. Where’s the good in that? Aside from inflicting needless misery on our citizens, why throw away the talent of so many of our citizens because they have a chronic condition? It’s such a tragic and needless waste and speaks poorly about what we really think about our fellow Americas. By throwing away our most precious asset, the skills of our own citizens, we guarantee our devolution as a nation. This is equally as dangerous to our national security, if not more dangerous, than securing our borders from illegal immigrants.

Mostly though while I waited for my surgery today I felt a mixture of relief and anger, not nervousness. The ACA, if we can keep it the law of the land, will do enormous amounts to make us a healthier and more productive nation, not just those like me still lucky enough to have health insurance. It will also relieve incredible amounts of unnecessary misery. Mostly though I felt anger that so many of my citizens are so ideological that they can no longer see our common humanity, who appear to think sadism is a virtue. These people, in the name of ideology would, like that heckler at a GOP debate last year, be enthusiastically rooting for people to be miserable and die.

The ACA gives us the opportunity once again to show our better nature. Let’s hope we find it again.