Some medical situations hit you like a kick to the gut. A friend has a car accident with injuries requiring hospitalization, surgery and an extended recovery. A heart attack kills a loved one. You hear cancer is likely.
And then there are those that shake you up with the knowledge of mortality and the prospects of physical and emotional pain. A diabetes diagnosis. High blood pressure. An eye disease that could lead to blindness.
Unless you have lived an incredibly fortunate life, you’ve had to cope with these issues or others just as difficult.
In dealing with them, our families and communities help us get through tough times. People bring us meals, maybe moving in for awhile to care for the sick, injured and bereaved. Our friends, family and people in our religious and other communities pitch in, bringing folks to medical appointments, sending cards and flowers, and expressing their concern.
Having just had major surgery myself, I’m very grateful to those who have helped me and my family.
Yet it’s troubling how some have romanticized these private and familial sources of solace and claimed they’re threatened by Medicare and Medicaid.
Rep. Paul Ryan, chairman of the House Budget Committee, writes, “Limiting government leaves more room for the exercise of economic freedom, and greater vitality in the other key institutions through which Americans live, including family, community, vocation and faith. When government expands, it encroaches on one or more of these institutions.”
Cutting federal health programs, believes Ryan, would make people more reliant on state and local government, charities and our families and communities. Getting coverage from Medicare and Medicaid makes people less free.
But while our private, state and local support systems are so very important, they are not enough.
For one, some can’t count on getting help from their families and communities. Think of a military spouse who is new in her community, an elderly person who has lived beyond the lifespans of close friends or someone whose family simply can’t help him.
Charities are already stretched to the limits and can’t take on more. So are state governments. And for decades, it has been the federal government that is the ultimate guarantor for Americans’ needs.
If the federal government didn’t do most of it, no one else could pay for medical care for the elderly and people with low-incomes. Most of these people have worked long and hard but don’t have other health insurance.
Ryan’s proclamations sound like a theoretical exercise, disassociated from what people experience. They’re an example of what a self-study issued by the national Republican Party says: “Our ideas can sound distant and removed from people’s lives.”
And what we know from our lives is that undermining health coverage doesn’t help families and communities. Our families, friends, communities and charities have never been able to pay for surgeries, hospital care, CT scans, night nurses and MRIs. Having less health care doesn’t increase liberty but diminishes it.
But we’ve heard similar claims in Maine. Who could forget when Gov. Paul LePage claimed that the Internal Revenue Service’s role under Obamacare was reminiscent of the Gestapo’s actions, threatening life and freedom?
Now the governor says he is considering expanding Medicaid in Maine.
Still, odd arguments continue from his administration. Mary Mayhew, the commissioner of the Department of Health and Human Services told Florida legislators that Maine’s Medicaid expansion had not significantly reduced the number of uninsured.
But this is misleading. Maine’s record must be counted as a great success since, as Maine’s numbers of uninsured declined, nationally they soared.
In addition, the deal LePage says he wants – 10 years of the federal government paying for the entire Medicaid expansion plus the freedom to structure the program anyway the state wants – is wholly impossible.
The Affordable Care Act funds three years fully. Getting from three to 10 years is not an administrative detail that the White House can negotiate but would require changing the law. LePage’s opening proposal looks more like political positioning so far, an attempt to look less extreme.
But for Mainers who are ill, real solutions from the state should include Medicaid expansion — because communities and families can only do so much.