In an interview Monday on CNN, Rep. Mo Brooks, R-Alabama, said one of the advantages of the Republican’s proposed repeal-and-replace plan for the Affordable Care Act would be that healthy people wouldn’t have to pay for sick people.
He then attempted to justify that approach on moral grounds.
“It will allow insurance companies to require people who have higher health care costs to contribute more to the insurance pool that helps offset all these costs, thereby reducing the cost to those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy,” Brooks told CNN anchor Jake Tapper. “And right now, those are the people who have done things the right way that are seeing their costs skyrocketing.”
Brooks acknowledged that many people have medical problems “through no fault of their own,” and he said society should help them — but he didn’t explain how that should happen.
A widespread belief
Brooks’ view that getting sick is some kind of personal moral failing is, sadly, widely held — by people on the political left as well as on the political right. I’ve heard plenty of left-leaning people try to link the news that someone they know developed cancer or dementia or had a heart attack or stroke to the person’s lifestyle: They point out that the ill person was a meat-eater or worked too hard or spent too little time exercising or weighed too much.
As if vegetarians and Zen Buddhists and marathon runners and thin people don’t develop serious health problems.
But at least people on the left who think like this aren’t trying to make it difficult for others who have either a chronic or acute illness — or who have been ill in the past (those with “pre-existing conditions”) — to get affordable health care.
That can’t be said of Brooks and his like-thinking Republican colleagues.
Behavior not the only determinant
Writing in the Huffington Post on Monday, reporter Jonathan Cohn makes an important point that everyone — left, right or center — should keep in mind before assuming that people get ill because they did not “do things the right way” (as Brooks put it).
“Although the precise link between lifestyle choices and health status is fuzzy,” writes Cohn, “the best available research suggests that behavior accounts for no more than half of existing health problems and most likely a lot less ― especially since ‘behavior’ includes factors like obesity that, research has also shown, has a lot to do with environment, genetics and policy choices.”
And let’s not forget that making healthful lifestyle choices — “doing things the right way” — is much, much more difficult when you don’t have the time or the money to make such choices.
Too many of us judge other people’s health-related behaviors through the prism of our own lifestyles.
Take the issue of regular exercise. We may live in a neighborhood with safe and accessible sidewalks and streets on which to walk, run or bike. But many people don’t. We may also have the time each day to devote to exercising. But many people don’t. They commute long distances to work. Or they work more than one job. Or they are a single parent with small children in the home. Or they are the sole caregiver for a disabled relative. Or they have depression or another mental illness that makes it extraordinary difficult to simply leave their bed in the morning.
These are not excuses. These are the realities of daily life for millions of Americans.
I thought of how little we understand and empathize with the struggles of others’ lives (but how quickly we are to judge those lives) when I read a report about Ivanka Trump’s new book. In it she describes — with complete tone-deafness — how she goes into “survival mode” during “high-capacity times,” such as during her father’s presidential campaign last year.
"Honestly,” she writes, “I wasn’t treating myself to a massage or making much time for self-care. I wish I could have awoken early to meditate for 20 minutes and I would have loved to catch up with the friends I hadn’t seen in three months, but there just wasn’t enough time in the day.”
Not enough time to get a massage or to meditate. Many working women in the United States don’t have the time or the money — or the paid sick leave — to see a doctor for important preventive health screenings, like a Pap test or a mammogram.
The randomness of illness
Of course, Brooks’ comments on CNN had another huge and much more obvious flaw: Illnesses and medical conditions are often inherited or congenital, or they occur as the result of an accident or other incident over which the person had no control.
People have been attacking Brooks mercilessly about this point on Twitter:
On Monday night, ABC late-night talk-show host Jimmy Kimmel underscored the randomness with which illness can strike when he told the poignant story of how his newborn son had to undergo emergency surgery in late April for a severe heart defect, diagnosed immediately after birth.
Kimmel then argued — with both compassion and passion — that no one should be denied health insurance for a pre-existing condition:
We were brought up to believe that we live in the greatest country in the world, but until a few years ago, millions and millions of us had no access to health insurance at all. Before 2014, if you were born with congenital heart disease like my son was, there was a good chance you’d never be able to get health insurance because you had a pre-existing condition. You were born with a pre-existing condition. And if your parents didn’t have medical insurance, you might not live long enough to even get denied because of a pre-existing condition.
If your baby is going to die, and it doesn’t have to, it shouldn’t matter how much money you make. I think that’s something that, whether you’re a Republican or a Democrat or something else, we all agree on that, right?”
Apparently, we don’t. But we must hope we will, and soon.