To the North Carolina Republicans who voted to repeal the ACA

May you drop dead and rot in hell for eternity.

And in the meantime, here's a Facebook post from a friend.


As I'm sure you all know, the House of Representatives is voting on a healthcare bill today. The particulars of the bill don't matter right now, for two reasons:

1. It may not pass, and if it does it will be close.
2. Even if it or a successor bill passes, it will then go to the Senate. Whatever comes out of that chamber will look very different, and we have no way of knowing what it might look like.

What is almost a given is that, whatever passes, it will begin to roll back a lot of very popular Obamacare protections, particularly for those with pre-existing conditions.

"BUT," I hear many of you saying, "that's not a bad thing. I work hard, I earn my healthcare. Why should I work hard to pay for coverage for someone who doesn't?"

It's a fair question. And it both deserves and has an answer.

First, a little logic:

1. All people get sick and injured. It's not a question of if, just when and to what degree.
2. Not all people can afford coverage. Right now, 10-15% (30-45 million) of the country is uninsured; before Obamacare, it was 30-35% (100-120 million).

These aren't political points. They're just givens. Facts of life. In the 72 years since WWII ended and the era of modern healthcare systems began, the best we've ever been able to do is the 85-90% coverage we have right now.

Based on those 2 givens, we are then faced with two more choices:

1. We can choose to treat those who can't afford coverage
2. We can choose to turn away those who can't afford coverage

Those are the only two options. There is no 'don't get sick or injured', and there is no 'magically have money'. They are GOING to get sick or injured. Like any anyone else, they are GOING to want medical care. The question isn't, 'will that happen?' it's 'how often, and how much will it cost?'

To date, our solution has been a sound one on paper, but a bad one in practice. In theory, we all get care through our employer, Medicaid, or Medicare, and if none of those do it, the emergency room isn't allowed to turn you away. In practice, people are expensive, and employers have steadily sought to shed the costs of retirement and healthcare wherever possible. This has been especially true at the lower end of the socio-economic spectrum, where entire classes of employment that make up tens of millions of jobs either get no insurance, or get such poor insurance that it isn't worth the expense. If you wait tables, work in fast food, work in retail, work as a laborer, or drive for a living - sectors that combine to make up 25-35% of the workforce depending on how you define them - odds are high you get little to no insurance through your employer, and it was even worse before Obamacare.

But those people still get sick and injured. In fact, given their work, they're statistically more likely to get sick and injured than a comparably aged office worker. If they don't have coverage and the emergency room can't turn them away, it means they limp along if they can, then they go in to the ER when they have no choice. The result is, instead of getting affordable preventative care at a general practitioner, they only get catastrophic care at the ER. This both clogs up the system for the rest of us, and costs us all money.

And it's that last point that really bears repeating: *we are all already paying to cover those people*. Hospitals aren't made of money. If they're forced to take in people they know can't pay, and that treatment is on average more expensive than it would be for someone with preventative care, then the cost is necessarily passed along to everyone else. This is why healthcare prices rise year after year, and this is why premiums are hundreds of dollars per month.

You have been, and will always continue, to pay for those who can't afford. Until and unless we agree to let hospitals turn people without coverage away, there is no other logical possibility. And anyone who tells you otherwise is lying.

This is not a question of 'will you pay for those who don't work as hard as you'. You already do. This is a question of 'how efficiently or inefficiently will you choose to continue doing so?' It doesn't matter if the system is public, private, for-profit, or handed down by the Man in the Moon - so long as hospitals have to take them in, you're still going to pay for them.

So I ask you, which do you prefer more: turning away people to get better or die? Or paying for them like you've already done your entire life, only far more efficiently? I'd like to think that, for most people, option #2 is the only rational choice.

Some math to consider:

• There are 35 countries in the OECD - the 35 wealthiest, most developed, and most stable countries in Earth. The largest and wealthiest OECD country is the US.
• 34 of them cover 100% of their citizens, cradle to grave, and have for decades. The exception is the US, which has never done better than 90%, and then only recently.
• The OECD average for healthcare expenditures as a percentage of GDP was 9.3% in 2014. The second highest nation for expenditure, Switzerland, spends 11.1% of GDP. Canada spends 10.6%. The US spends 16.4%.
• The OECD per capita average was $3453. Germany, an upper quartile nation, was $4819. Canada was $4351. The US was $9086.

In short, we are spending twice as much as any other developed country, both as a percentage of national income and on an individual basis, to not even cover everyone. That's not a political talking point, that's arithmetic. I advocate for no party, no candidate, and no particular healthcare system. All I say is, where I come from, paying twice as much as the next guy to get less of the same quality of thing is called "getting ripped off".

Something to think about. Thanks for your time.



Just kidding Republicans.

Just kidding Republicans. I don't really believe in hell.