Progress, Sure, but Whence Come We?


“Woo-hoo! I can go to the doctor now? I’m serious. I need to go.”

Jeff Fletcher

Good news isn’t always … happy? … reassuring? It is hard to explain, of course, but amid the vicious politics echoing throughout the Beltway, it is easy to forget minor details such as the notion that there really are human stakes in this fight. As Jason Linkins recently reminded:

[T]he promulgation of an “Obama’s Katrina” metaphor firmly underscores the basic lack of real stakes involved for all of the people having that conversation. Obama is going to live well and without concern for the rest of his life. The vast majority of the lawmakers involved in the ongoing debate over the matter will as well. So will most of the pundits currently batting this meme back and forth. They’ll all be fine. Really, super fine, actually. They’re going to have terrific, largely worry-free lives ….

…. There has to be a great story out there about what life is like for normal human Americans who aren’t affluent political celebrities or who don’t enjoy a luxurious sinecure in Beltway punditry. But the saddest part of all of this is that the Affordable Care Act’s woes have created only a brief interest in the woes of ordinary Americans, and just how terrifying it can be for one’s life to depend on the kindness of insurance providers in the individual market. Right now, if you can proffer a letter attesting to the fact that you’ve lost your health insurance, chances are you can finally get a reporter who had never previously evinced interest in the matter on the phone.

It wasn’t always this way. A July 2009 study conducted by Families USA found that between January 2008 and December 2010, in the teeth of the economic downturn, over 44,000 Americans were receiving notice that they’d be losing their health insurance every week. The same people breaking story after story about those losing their coverage now had better things to do back when it really mattered. As with almost any story that we could tell about the rampant, constant, tragic economic insecurity of the average American, it only seems to swell up as a Thing That Matters when such plight can play a role in the Beltway parlor game of who’s winning and who’s losing.

That’s what makes the whole “Obama’s Katrina” construction such a multi-layer insult to normal people. It makes the assumption that Bush actually suffered some real material loss in the hurricane that hit New Orleans. He didn’t. It further assumes that some similar hardship is coming to Obama’s doorstep. This is only true if we define “hardship” as “no hardship at all.” It glibly trivializes the real people who have suffered in both instances—those who suffered some sort of devastation in the Gulf region, or those who have been dealt a hard blow in the insurance market. Finally, it only underscores the wholly transient nature of the media’s concern for the welfare of ordinary people. If their suffering can’t be translated into a telenovela about the electoral troubles of affluent political celebrities, it doesn’t merit coverage.

And there are important stories out there, good and bad, in the PPACA transition. Stephanie McCrummen provided The Washington Post, this weekend, with just such a compelling story. And, to be certain, it is good news out of Kentucky, but at the same time it’s heartbreaking.

The per-capita income in Breathitt is about $15,000, and the rates of diabetes, hypertension and other health problems earned this part of Kentucky the nickname “Coronary Valley.”

Lively, who has been signing people up since the exchanges opened in early October, said one woman cried when she was told she qualified for Medicaid under the new law. She said people have been “pouring in” to her office, an unused exam room in the back of the clinic, where her set-up includes a table, a two-drawer filing cabinet, manila folders, a planner to track her schedule, a notebook to track her numbers and a laptop that connects to the state health-insurance exchange, Kynect.

Clinic doctors often send patients without insurance her way after their visits, but most come by word of mouth. Lively has signed up fathers who then sent their sons, and mothers who sent aunts. She signed up one Subway sandwich shop worker, and soon what seemed like the whole staff showed up.

There are smiles, such as the thirty-five year-old man getting health insurance for the first time in his life: “Well, thank God. I believe I’m going to be a Democrat.” But there are also horrors:

“All right,” she said to her next client, a 52-year-old disabled master electrician who said his mother, two brothers and two sisters all died from lung cancer. He had been ignoring a spot on his lung discovered during a visit to the emergency room after he had broken his ribs several years ago.

He also vaguely recalled being told at the time he had something called “wedging of the spine.”

“What do I need here?” said Jeff Fletcher, who was being sued for those medical bills. “Proof of income?”

“Yep,” Lively said, and Fletcher pulled out documents showing that he and his wife live on about $500 a month in food stamps and her disability check.

“You smoke?” Lively asked, going through a few routine questions.

“Right- and left-handed,” he quipped as she typed.

“All right,” Lively said after a while. “You are covered.”

“I’m covered?” Fletcher said. He slapped the table. He clapped twice.

“Woo-hoo! I can go to the doctor now?” he asked Lively. “I’m serious. I need to go.”

Yes, I reserve the right to find that exchange depressing. Not because I’m going to knock on the guy with a shadow on his lung, multiple relatives who died of lung cancer, and a serious smoking habit. Nor am I going to ask what the hell anyone is thinking trying to raise a family with five children on a pretax income of fourteen thousand dollars. And I swear unto you, not a word on the thirty-six year-old mother of eleven.

Point of political order: I’m a liberal; it’s not my job to wag my finger at these people. Indeed, if I want to make any sort of criticism, it has to do with socio- and behavioral economics, psychology, the still disdained dialectic of neurosis, and that nasty, inherent class struggle that has dogged history from the outset.

Whatever else I might fear of poverty and its human consequences, the only route out is health and prosperity. We have buried so many sacrificial lambs along the way, virtually harvesting them as a natural resource as our nation tramples through the human experience.

There is only so much the village can do for itself and its people. But how fast can we teach people to fish, and should their bellies rumble with hunger in the meantime? Breathitt County, Kentucky is a bluegrass bastion of pride and fascinating historical trivia, such as the notion that “Coronary Valley”, once upon a murky time known as World War I, was the only county in the whole of the United States that met its service quota without a draft, and that Kentuckians in general, including those from Breathitt, were among the most physically fit. Those days are dusty memories in ledgers and history books; as Courtney Lively described, Breathitt County today is, “Just poor.”

There are all sorts of political considerations, including the notion that these people’s U.S. Senate delegation is actually troubled by the notion that they should have access to health insurance. And while the words quality of life might mean nothing in the Beltway bickering, they mean the world to the people living those lives. We see those stakes in sharp relief in Breathitt County, Kentucky. And we can be quite certain one need not travel across the country to find such outcomes.

Is it fair to ever wonder how we got ourselves into this mess?

The good news in Breathitt County is a sharp contrast against the pervasive horror of what stories brought such need to that or any other community.

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