Mulvaney and the deserving sick

I don’t like the Kimmel test. Republicans have an easy out if they shovel twenty or thirty billion dollars at presumptive eligibility for birth to three months or birth to six months. It also feeds into the idea of the deserving and underserving poor. I meant to say the deserving or undeserving unwell.

OMB Director Mulvaney explicitly makes this argument:

Dennis Shea makes a very good point. This turns insurance companies back to optimizing on not covering people instead of managing high cost chronic conditions.

I want to personalize for a bit about the administrative complexities of attributing disease states to genetics or lifestyle. There is a very good chance that I have the genetic defect that is Lynch Syndrome given past family history. Lynch Syndrome significantly increases the chance that a carrier will have an gastro-intestinal tract cancer at relatively early ages. My family is slowly and haphazardly doing rule out testing and frequent colonoscopies. I’m not sure if I have it yet as I have not undergone genetic testing.

But let’s assume that I do have a genetic defect that predisposes me to increased risk of colon cancer. I also like to eat red meat. I’m slowly moving my diet towards a good colon health diet.

In the future potential case that I am diagnosed with colon cancer, what proportion of the costs should be covered because I was unlucky to have a genetic combination that predisposed me to this type of cancer, and what proportion of the costs should not be covered by society because I chose to have a good burger in Boston last week with a fellow health policy nerd?

Yeah, it gets messy really fast as soon as we as a society decide that some diseases should be treated by telling people that they can either pay for treatment themselves or that they should die quietly in the corner.

173 replies
  1. 1
    GregB says:

    If they have any dying to do, let them do it now and decrease the surplus population.

    -Ebenezer Scrooge

  2. 2
    CarolDuhart2 says:

    How does “deserving” work with epidemics? Or mass casualty events like hurricanes, nuclear strikes, and a volcano erupting?

    And what if a person lives unknowingly, on top of a toxic waste dump and gets ill because of it?

    “You should have lived elsewhere?”. “You should have chosen other parents? Illness is often just is-I have a family history of diabetes. I have it too? What are people who suffer supposed to do? I have a feeling that this is just a few steps from the discredited notion of eugenics. (Only the flawless shall survive)

    This attitude is a combination of bastard New Thought (yes, I’m Unity) and Calvinist predestination.

  3. 3
    Jeffro says:

    It’s funny because – as conservatives are always bleating – if we want less of something, we should tax it more. So if they don’t feel like paying for folks’ Type 2 diabetes due to sugary sodas, then let’s tax the sodas. And I guess to be consistent, we should greatly ramp up on taxes on tobacco, alcohol, and red meat, right?

    I won’t hold my breath.

  4. 4
    CarolDuhart2 says:

    And people in the past were pretty devout, but the death rate didn’t drop until we did two things: actually observe what was happening, and decide that we would invest in public health.

    There are two churches nearby that are now private housing. Think about that. There were enough people to support two congregations. But the biggest drop in death rates occurred after those churches began emptying out. So it wasn’t piety that did it.

  5. 5
    OzarkHillbilly says:

    I should have known better than to be a carpenter. It’s my own damn fault I have arthritis, bursitis, tendonitis, and a few other itises yet to be named. Also I should have paid top dollar when I was shopping for body parts instead of that cheap off brand pancreas I found on the clearance shelf at Wally World.

  6. 6
    Baud says:

    If there were an administratively feasible way to limit health care to Hillary voters, I would consider it.

  7. 7
    Jeffro says:

    Somebody ought to point out to Mulvaney that the dozen most unhealthy states are red states (the southern states plus WV and OK).

  8. 8
    satby says:

    It’s such a chicken or egg way of thinking too. Yes, we have evidence for the influence of diet and exercise on health outcomes, but studies also have demonstrated that genetic and random mutations are just as likely to predispose or cause health problems. And medical thinking is always evolving. When my dear friend had a heart attack 25 years ago she was told to follow a strict diet that included swapping margarine out for butter; now we know that the transfats that were in those margarine from 25 years ago are much more damaging than butter and some of the drugs she was taking have been implicated in causing the diabetes she now also has. Where do you parcel out “fault” for that?

  9. 9
    OzarkHillbilly says:


    we should greatly ramp up on taxes on tobacco, alcohol,

    We already tax the hell out of them, we call them “sin taxes”, right? (to state the obvious) I’ve been thinking about this more than a little lately. Cigarettes kill 480,000 people per year. Alcohol kills 88,000 per year. The great opioid crisis? A mere 52,000 per year. What we need to do to end the opioid crisis is legalize it, then tax the hell out of it so that all the more virtuous and deserving people can have lower taxes.

    Crisis? What crisis? This is a tax cut opportunity that any Republican can sign on to.

  10. 10
    CarolDuhart2 says:

    @satby: And even if there was a “blame” element, the thing is: “compared to what”?. While some habits are not good, some lives aren’t good either. And as long as public health isn’t what it should be (both access and care of the commons). We shouldn’t be in the business of speculating just what we can do.

    Policy point: this is also a way of introducing means testing and work requirements on the very sick. They are already doing it in England regarding the support the disabled get.

  11. 11
    aimai says:

    There is a washington post article today up about dental care disparities this country and they interview a trump voter (of course) who voted for trump because he was for the forgotten, working, poor like she thinks she is. Her teeth are rotting out of her head because well water/no fluoride, no dental care, no health insurance with dental coverage, no medicaid or medicare coverage for dental care because reasons, and after she fights her way into a free dental clinic (First 1000 people get a million dollars worth of free care!) she looks around, sees everyone else suffering, and says “this is demeaning, its third world, why is this happening to us when we work and we don’t lie around sleeping all day on government handouts?” You still can’t explain to her that when the guy you voted for promises to do something its a fucking government hand out.

  12. 12
    Le Comte de Monte Cristo, fka Edmund Dantes says:


    I’m inclined to agree. There is a hideous relapse rate for all opiate addicts in recovery, but once they’ve graduated to heroin, they are really done.

    May as well mine them while they’re zombies.

  13. 13
    Van Buren says:

    I have heard of some guy who drinks coke and who disdains exercise…Donald something…’l come to me.

  14. 14
    efgoldman says:


    I should have paid top dollar when I was shopping for body parts instead of that cheap off brand pancreas I found on the clearance shelf

    You too, huh?

    ETA: I heard that Ocean State Job Lot’s ad circular for the first week in June is going to have a huge special on kidneys…

  15. 15
    Baud says:


    we don’t lie around sleeping all day on government handouts?

    This is why the GOP will never go away. Everyone has a privilege they want to preserve, and the GOP is in the business of protecting privileges.

  16. 16
    Baud says:

    @efgoldman: Have you tried Craigslist? (Is that still a thing?)

  17. 17
    efgoldman says:


    Have you tried Craigslist? (Is that still a thing?)

    That’s where I shop for my presidential candidates.
    Only on the left side of the screen, though.

  18. 18
    seejanerun says:

    A special touch is that they want schools to serve the kind of lunches that encourage bad eating habits.

  19. 19
    debbie says:


    Why not? It’s what our kids want! We cherish our kids!

  20. 20
    Aunt Kathy says:

    “Come together as a community” doesn’t even have to include insurance, does it? It could mean Go Fund Me’s. And donation jars at the 7-11. These people are awful.

  21. 21
    Baud says:

    @Aunt Kathy: Don’t​ forget forced churching.

  22. 22
    trnc says:

    While republicans like Mulvaney wag their fingers at consumers of fat and sugar, they mock Michelle Obama’s (or anybody’s) attempts to teach kids how to eat healthier and they put a morbidly obese sack of shit with no scientific background in a lead science role over nutrition n the USDA.

  23. 23
    OzarkHillbilly says:

    @efgoldman: Yep. Just got diagnosed as pre-diabetic. My grandfather had it, and I’ve been waiting for it all my life. My blood sugar has always been wacky. Hypoglycemic attacks have been a problem I don’t remember living with out. Learned at a very young age to stay away from high sugar foods because the attack always followed. Stopped drinking soda when I was in my 20s, and most other sweets too. I still miss donuts.

    I don’t expect I will have much problem with adjusting to the knew diet, I just need to cut back on the starchy stuff really. Told the dietician I might as well lose some weight while I’m at it.

  24. 24
    SufferinSuccotash says:

    @Aunt Kathy: You’re neglecting the fact that “coming together as a community” involves making the recipients of your charity dependent on you. That doesn’t happen with guaranteed health insurance, which enables people to become independent and therefore uppity. IOW, none of this is really about health. It’s about power.

  25. 25
    OzarkHillbilly says:

    @efgoldman: Kidneys? I already have a spare.

  26. 26
    OzarkHillbilly says:

    @Baud: Somebody else’s privilege, sure as hell not mine.

  27. 27
    Le Comte de Monte Cristo, fka Edmund Dantes says:

    So while we in America seem to be rushing headlong into a regime of putting old white men back in charge of everything While shoveling all national wealth into their hands because n****rs and sp*cs, inspiring a neofeudal economy marked by noncompete agreements down to the lowest level employees and stripping the ability of labor to organize, China has been doing amazing things by assuming the mantle of global leadership. This Belt and Road initiative promises to do that via mutually beneficial pacts and investment in infrastructure across Asia, Europe and Africa.

  28. 28
    Baud says:

    @OzarkHillbilly: If you’re white or male, they are protecting your privilege, even if you are a good enough person to reject their help. (Which you are!)

  29. 29
    Patricia Kayden says:

    @OzarkHillbilly: And you were especially silly not to have been born into a wealthy family who could have taken care of all of your healthcare needs no matter how bloated and orange and unhealthy you became a la Trump. For shame!!

  30. 30
    SFAW says:

    @Van Buren:

    I have heard of some guy who drinks coke and who disdains exercise…Donald something…’l come to me.

    Who cares? His “doctor” WROTE A LETTER! On his own LETTERHEAD! Saying that the obese (but not yet morbidly, like his “top scientist” Sam Clovis, who isn’t a scientist) Shitgibbon is the mostest-and-bestest-in-shape Preznit since forever, and in better shape than Daley Thompson, Cristiano Ronaldo, and Michael Phelps COMBINED!

    But it’s all good, if they can deny coverage to all “those” people.[Not sure if there needs to be a variant to Cleek’s Law, addressing which group gets shit on each day.]

    I swear, these motherfuckers make me wish for a Just God. There would be shitloads of smoking holes in the ground all around DC.

  31. 31
  32. 32
    maryQ says:

    I like David’s example-what do you charge for the part from genetic predisposition, and what from the part of eating red meat (and lets introduce another variable-it’s not completely clear that red meat is a problem, but the corn that is everywhere in the SAD probably is).

    “Heart disease” is a nice catch-all. The other day, I saw a flier for the “Heart Walk” fund raiser at my work (I work in a med center). The goal of the organization that the heart walk is supporting is “to eliminate heart disease by educating people about healthy life styles”. In other words, if you have heart disease, it is because you don’t live a healthy life style, so let us educate you out of your heart disease. This is the nice, liberal, educated way of saying “Your heart disease is your fault”.

    Did I mention that I work in a medical center?

    I happen to know, though unhappy circumstances, that there are more than 150 genetic mutations associated with one particular kind of “heart disease”, arrhythmogenic right ventricular cardiomyopathy .

    My husband developed a-fib in his early 50’s. He’s had a few procedures, lives a reasonably healthy life style (though he drinks a lot of beer), doesn’t eat crap, exercises regularly, doesn’t drink caffeine. He’s doing great on meds.

    A year ago, we discovered our teenage daughter has an irregular heart beat. Several tests later, we learn that she has two of those 150 gene mutations associated with arrhythmogenic right ventricular cardiomyopathy . She’s on her way to developing a serious cardiomyopathy. She has an ICD, pacemaker, and will one day need a transplant.

    So then they tested my husband. He has the same two mutations. When an otherwise healthy kid shows up with symptoms like that, you start looking for “not her fault” explanations. When a 50 year old man who likes beer shows up with those symptoms, you pretty much write it off as “get off your lazy ass, stop eating bacon double cheese burgers, and lay off the beer”. Now, don’t get me wrong, everyone benefits from a healthy life style. My husband’s condition has improved since he has taken an active role in improving it. My daughter will do better by continuing to walk away from the Ding Dongs and Slushies. But they BOTH have a genetic condition, it just showed up differently in them (genetics works that way, sometimes).

    I don’t think most people get this about heart disease. Or other things.

    Did you know that 1/3 of lung cancers occur in non-smokers? Most people don’t know that. Any my mother is an 80 year old chain smoker. No lung cancer. No cancer of any kind.

  33. 33
    Patricia Kayden says:

    @Jeffro: Not sure if Mulvaney would care about that. Like many of Trump’s Cabinet, he probably cares only about people just like him: 1%-ers. After all, if AHCA is passed, 1%-ers will get a huge tax break. That’s all that matters to Trumpers.

  34. 34
    Baud says:


    The goal of the organization that the heart walk is supporting is “to eliminate heart disease by educating people about healthy life styles”. In other words, if you have heart disease, it is because you don’t live a healthy life style, so let us educate you out of your heart disease.

    Your description seems uncharitable to the organization. I’d need more information before concluding they were being judgemental about heart disease.

  35. 35
    OzarkHillbilly says:


    If you’re white or male, they are protecting your privilege,

    Truer words never spoken. My bad.

  36. 36
    Patricia Kayden says:

    @Le Comte de Monte Cristo, fka Edmund Dantes: But his hippie looking Doctor assured us that Trump would be the healthiest man to ever hold the office of Presidency. Doesn’t Trump look like the healthiest human specimen ever?!

    Interesting how everyone who surrounds Trump is a professional liar.

  37. 37
    MattF says:

    The whole business of genetic testing is problematic for health care expenses. Do ‘bad genes’ count as a pre-existing condition? Who pays for testing? How do individuals decide whether to pay for long-term care insurance if they have x percent higher probability of getting Alzheimer’s? (Hint: it’s not a trivial calculation.)

  38. 38
    debbie says:

    @Le Comte de Monte Cristo, fka Edmund Dantes:

    We need to dedicate ourselves to burning up whatever is left of that finite energy.

  39. 39
    John Waldron says:

    Okay these ideas have been kicked around for decades and it always comes down to the most effective health care is some form of universal health care period. However, once I thought a good version of the so called “sin tax” would be an individual tax, like social security, based on personal consumption. So if one purchased a packed of cigarettes there would be a set tax on it based on some formula based on clinical statistical reasoning that indicates x amount of future health care cost and that tax would go into your health care account, for your future use. This concept would be expanded to all sorts of health risks, alcohol, sports (yes if you rent skies or play rugby), and possibly to certain occupations. Now of course the tax would be quite minimal, maybe even hardly noticeable, but the accumulative effect over 30 years could be quite high; I’m thinking you couldn’t access your account until your 30.

  40. 40
    randy khan says:

    And the reality is that we all have *something* that’s congenitally wrong, whether from genetics or a problem during gestation. Some of those things are minor and won’t affect health; others inevitably manifest themselves at some point; and some might or might not have an impact, but when they do it’s pretty devastating and/or expensive to fix. The idea that there’s nothing objectionable about forcing people to play this lottery is insane.

  41. 41
    Patricia Kayden says:

    @aimai: You know quite well who she’s referring to as the lazy people who sit around all day collecting government handouts and that they don’t look anything like her. As Trump continues to drag this country down, we will see an island of White folks clutching to their red MAGA hats shouting, “It’s the Negroes!!!! T’is all their fault, I tell ya!” That’s the one thing they’ll always have.

  42. 42
  43. 43
    Spanky says:


    There would be shitloads of smoking holes in the ground all around DC.

    There will be. Just give the North Koreans a little more time.

    Signed, Suburban DC resident.

  44. 44
    amk says:

    Earlier this week, caught a clip of Kimmel talking with some rethug senator on his show, who was spouting some anodyne bs how everybody deserves a good healthcare but it’s “not really fair” to ask the “tax-payers” to pay for it and how murkans don’t like mandates. The thug framed it as if every tom, dick and the precious wwc was paying thousands in taxes and mandates. Kimmel didn’t do any favors to himself or his cause by inviting a con rethug on his show. Couldn’t he have brought some strong advocate for good public healthcare instead of this rethug?

  45. 45
    Baud says:

    @🐾BillinGlendaleCA: That’s pretty.

    @Patricia Kayden: Didn’t someone coin the term “white socialism” for these types of folks?

  46. 46
    Kay says:

    I don’t like the Kimmel test.

    I don’t either. I love the town halls though. Good protest! I’m going to one Wednesday. I’m kind of excited about being able to say “cuts 880 billion from Medicaid”. That’s my plan. I’m just saying that over and over. There are a lot of ways to say it. Phrased as a question, as a response to a question, as a challenge….

    Just plug it in anywhere.

    “Are you actually saying that $880 billion in cuts, according to the CBO, however you want to talk about that not being a cut, that that’s actually not going to result in millions of Americans not getting Medicaid?” Tapper finally asked.
    “Absolutely not,” Price said. “And we believe strongly that the Medicaid population that will be cared for in a better way under our program — because it will be more responsive to them.”

  47. 47
    OzarkHillbilly says:

    @maryQ: I once read of a centenarian who credited his long life at least in part to his smoking habit.

  48. 48
    Baud says:

    @Kay: You get ’em, Kay!

  49. 49
    Elizabelle says:

    I’ll read this thread later, but we have to beat these people back. We have to talk to them, with their vocabulary, again and again and make them hear that it’s cheaper and better to have universal healthcare. We have to be relentless. The forces arrayed against us have been.

  50. 50
    MattF says:

    @Kay: FYI, here’s some details about Price’s claim.

  51. 51
    OzarkHillbilly says:

    @John Waldron: It would never work. Schools need funding. (they would just raid the funds, like they do with lottery proceeds, pensions, ad infinitum)

  52. 52
    satby says:

    @maryQ: my friend’s heart disease was caused by a genetic condition that had killed her father at age 36 and her grandmother while giving birth to her father at an even younger age, but she was told for at least a decade that the signs she was experiencing was “panic attacks”. It was finally diagnosed correctly after she gave birth to her third child at age 43, and suffered a heart attack that went undetected for two days until she went into complete heart failure after she was discharged. Because 25 years ago they believed that pre-menopausal women were virtually immune to heart disease due to estrogen levels.
    We now know that’s not true.
    Since then, her younger brother has also died, leaving two school aged children. All of the kids in the family will or have been tested for the same mutation. But if they have it, does that mean they shouldn’t be allowed to have children themselves? How draconian do we want to get?

  53. 53
    debbie says:


    Ah, the Doctrine of Magical Thinking! Demand a spreadsheet from the bastards showing this would be a benefit. I always had to show my work in math class, why don’t they?

  54. 54
    Kay says:


    I know a lot about Medicaid, locally. He better prepare :)

  55. 55
    ThresherK says:

    @aimai: Keith Olbermann was quite involved in promoting “Dentistmobiles” on his MSNBC show. I don’t know when this was exactly, but it really spoke to the “rich healthcare/poor healthcare” split.

    They weren’t literally in big vans like the old bookmobiles, but they did setup short-term, en masse clinics in big places, and they were always full of people.

  56. 56
    satby says:

    @Baud: I’m getting to be fairly judgemental about organizations to “raise awareness” of common diseases. They seem to mostly be grifts, al la Komen.

  57. 57
    Baud says:

    @Kay: I’m scared of you, and I won’t even be there.

    @satby: Maybe. But the fact that an organization promotes healthy living is not enough information for me to label that organization as one who blames the sick for their illnesses.

  58. 58
    FlipYrWhig says:

    @Patricia Kayden: Yup. She voted for someone to lash back at black people (who are lazy) and brown people (who shouldn’t be here). That’s it. That’s all it’s ever been.

    @amk: Those fucking idiots all think they pay a buttload in taxes because they’re thinking of withholding from their paycheck. They never think about how what they’re doing when they file a tax return is _getting a refund for what they overpaid_. The number of people who understand that’s what tax filing is is minuscule. And it never, ever, ever occurs to them that _they_ might be among the people who don’t pay income tax and are thus on the wrong side of Mitt Romney’s 47%.

  59. 59
    Randall Bott says:

    My family has Lynch Syndrome and I’ve lost two brothers, a sister, father and numerous cousins to it. My brother and I have the gene defect. We each had five colonoscopies last year. These are keeping us alive. Luckily we have good insurance. My daughter hasn’t been tested yet.

  60. 60
    Kay says:


    I love how people don’t think about what happens if there’s no Medicaid for their elderly parents. Where do they think these people will go? They will go to their adult children. It’s almost a direct subsidy for middle aged, working class households.

  61. 61
    OzarkHillbilly says:

    @Kay: Did Tapper collapse into uncontrollable fits of laughter? ‘Cause I would have,

  62. 62
    Kay says:


    “Price said that spending would increase “equal to the cost of medical care,” but the CBO projected that Medicaid spending per enrollee would grow faster than the medical inflation rate, so it’s clear that less money every year would be available to serve this population. In any case, it’s all but impossible to predict how much pressure the aging of the baby boom generation would place on Medicaid. (About 25 percent of Medicaid spending goes to nursing home and long-term care.)

    Thanks. That’s really helpful. I know this local area really well- we have a lot of elderly people. The fact is lots and lots of working and middle class younger people depend on Medicaid, because their elderly parents depend on it. I have to get them to make that connection.

  63. 63
    Baud says:


    uncontrollable fits of laughter

    Preexisting condition. No insurance for you!

  64. 64
    Marci Kiser says:

    The Mulvaney criteria is a fine dodge, because you can always take it just as far as your heartlessness demands and no further.

    “Dementia? Maybe you should have been doing a few more daily Sudokus.”
    “Melanoma? Wouldn’t have happened if you hadn’t insisted on living in Miami. What’s wrong with Alaska?”
    “Shot in the head? Well, that’s what happens when you go shopping at Wal-Mart without your AR-17.”

    (Curiously, these criteria never apply to exceedingly dangerous manly activities such as motorcycling, ATV riding, or hunting. All of that said, I would like to hear how we, and especially an expert like David, respond to the charge of not only enabling but actively subsidizing unhealthy lifestyles, as it’s a critique that needs a real answer.)

  65. 65
    debbie says:


    I love how people don’t think about what happens if there’s no Medicaid for their elderly parents.

    Or children of not-wealthy parents. Did these Christians really want them to be saved just so they could suffer?

  66. 66
    A Ghost to Most says:

    Schumer on CNN called out the GOP for putting party over country, and that they didn’t need to repeat twitlers lies.

  67. 67
    Baud says:

    @debbie: Suffering has been a Christian virtue since the middle ages.

  68. 68
    SFAW says:


    There will be. Just give the North Koreans a little more time.

    It sounds like they’re doing their best to piss off Russia AND China, all in one swell foop. Probably not the smartest thing Kim Jong-Un has ever done.

    Of course, Shitgibbon will be upset that he couldn’t nuke NK himself, but will still claim that it was HIS doing that they pissed off Russia, etc.

  69. 69
    Patricia Kayden says:


    We have to talk to them

    Good luck with that. If Republicans gleefully passing a bill that will strip them and their families of access to affordable healthcare and reinstituting pre-existing conditions doesn’t change their minds from supporting Trump, nothing will. Certainly nothing that I have to say to them as a Black progressive female will change their mind.

  70. 70
    Matt McIrvin says:

    Kimmel immediately objected to the Kimmel test.

  71. 71
    OzarkHillbilly says:

    @Baud: Damn. I’m practically a saint.

  72. 72
    SFAW says:


    Couldn’t he have brought some strong advocate for good public healthcare instead of this rethug?

    Betsy McCaughey was probably unavailable.

  73. 73
    aimai says:

    @John Waldron: Why wouldn’t the sin tax money just go straight into the health care system to pay for the care–it shouldn’t be assigned to you individually at all.

  74. 74
    Lizzy L says:

    Mulvaney is a monster. They are all monsters.

    Personal note: I received word yesterday afternoon that my aunt Judith, my father’s brother’s wife, has died. She would have been 95 in July. My father had three brothers, my mother one sister. All of them, my father, my mother, my aunts and my uncles, kin by blood and kin by marriage, are now gone. Judy was the last.

    I am the matriarch, the oldest of my generation. How quickly that happened! Dust in the wind.

  75. 75
    Barbara says:

    Mulvaney may care how you got sick but insurers don’t. If you have a history of illness of any kind that predisposes you to higher health costs the insurer sees that as a pre-ex. Likewise, people with a history of disease can have emergencies and developments that are totally outside their control. The point being that even if you could control for virtue or vice when it comes to eating or smoking or driving or exercise or weight — it wouldn’t make a dime’s worth of difference to insurers and most Americans would flunk most or all of that test anyway. But, you know, quelle surprise. Another highly ranked American official talking out of his ass about a subject he doesn’t have a clue about.

  76. 76
    Spanky says:

    @Baud: Yes! But a persecution complex has been a central characteristic since Roman times. I have had a coworker tell me that Christians are being targeted for somethingsomething today. Here in America.

  77. 77
    🚧eric says:

    @OzarkHillbilly: could not disagree more. they are working to create the ILLUSION among the rubes that they are protecting white privilege. They are really protecting the right to make unlimited money with no social obligations. feeding the rubes some feel-good racism is a means to the singular end of maximizing money in the hands of the few.

    ETA: i am NOT making the Sanders argument that our focus should just be (primarily) on economics and not on social justice. We can walk and chew gum at the same time.

  78. 78
    Baud says:

    @OzarkHillbilly: How many miracles have you performed?

    @🚧eric: The rubes aren’t victims. They are co-conspirators.

  79. 79
    Spanky says:

    Hey jackals! There’s a WaPo article about us.

    From death row to adoption: Saving animals by car, van, bus and even plane

  80. 80
    HRA says:

    What universe are we on while Mulvaney touts healthy life styles and Purdue takes away the healthy school lunches for children?

  81. 81
    Barbara says:

    @Marci Kiser: To say, again, insurers are not interested in spending money to investigate whether your colon cancer was the result of eating too much meat or just random bad luck in order to determine whether your poor history should count against you. Insurers do try to run wellness programs to get people to live healthier lives but mostly what they want is as big a pool of insured people as they can get.

  82. 82
    Karla says:

    @Baud: A plain reading of “to eliminate heart disease by educating people about healthy life styles” is that unhealthy life styles are the sole cause of heart disease, because, otherwise, addressing only life styles would fail to eliminate heart disease. Whoever wrote that for the flyer is unlikely to mean that, but that they didn’t see that reasonable interpretation indicates, at best, tone deafness and/or misplaced priorities.

  83. 83
    debbie says:


    Except back then, it was oneself who was supposed to suffer; now, it’s all about how many others can one cause to suffer?

  84. 84
    Le Comte de Monte Cristo, fka Edmund Dantes says:


    If you really want to have fun with fundamentalists, the next time you hear about how pagan ways brought down Rome, remind them that Rome was officially, repressively for 150 years prior the the deposition of the last Emperor in the West.

    They’ll deny it vehemently.

  85. 85
    Baud says:

    @Karla: Ok, that’s a fair criticism.

    @debbie: In their minds, they aren’t causing people to suffer because they are not affirmatively making people sick. They are simply making people personally responsible for their own situation. I don’t think that’s so different from the traditional dogma.

  86. 86
    Scott P. says:

    Let it be noted that Republicans are beginning to advocate actual death panels.

  87. 87
    Barbara says:

    @HRA: There is no CLEAR relationship between most facets of lifestyle and disease. Smoking, of course, and increasingly, consumption of soda are linked to disease, which is why taxing sugary beverages is a correct policy. But nearly everything else is either just a bunch of noise or flat out wrong. You might have a lot of arguments for not eating meat related to the environment and animal welfare, for instance, but it is just dishonest to say that you are hands down making a choice that is unhealthy, especially when you consider what many people would eat as an alternative.

  88. 88
    Villago Delenda Est says:

    It only gets messy if you’re an honest broker.

    Mulvaney is not.

  89. 89
    debbie says:

    The only Church dogma I know is from the art history classes I took, so I’ll spare you that mishmash, and instead stick with Hillel: What is hateful to you do not do to your neighbor. Standing by and doing nothing is as much as doing it directly.

  90. 90
    MomSense says:

    Having spent the last few days with a lot of worried family memebers in the ICU waiting room, I do not think it would be safe for me to be in the same room with Mulvaney, Ryan, Labrador, or any of the other GOP monsters.

    Heading back to the hospital in a couple hours and I’m hoping to see two of the moms who are hoping their kids survived the night.

  91. 91
    Elizabelle says:

    @Patricia Kayden: Oh, I know. And not to say they’ll actually listen or learn. But we need to push back, because they live in a bubble of selfishness and actually no reasoning — they seem to have adopted bad stuff through osmosis and tribal identity. So simple words and back in their faces, cannot hurt. When we have the time. Because I suspect other people lurk and maybe it gives them courage.

    Saying this because was tangling with a friend’s Facebook “friends” from Nebraska, and Jebus, are they deplorables 101. It’s kind of funny, actually.

    ETA: Why yes, the topic was healthcare. Burn them down on that topic. Make them own their nastiness and selfishness and self-righteousness. I’d suspect all these deplorables consider themselves Christians, too.

  92. 92
    Le Comte de Monte Cristo, fka Edmund Dantes says:


    Jesus will provide succor to the deceased in the great bye and bye, and will forgive the perpetrators for their greedy decisions.

    It is a perfect win-win in Christianity!

  93. 93
    Barbara says:

    @Baud: I guess the saving grace here is that going further down this road is likely to unleash the fury of Soda, Inc., not to mention Meat, Inc. and every other kind of lobbying interest that depends on the unhealthy eating habits of ordinary Americans. And the ultimate irony is that health conscious urbanites are probably among the few Americans who will actually pass this test.

  94. 94
    OzarkHillbilly says:

    @🚧eric: How many times has a white man been pulled over for DWB? (just one that I know of and it was very darkly complected, kinky haired me- one look at my very Caucasian face and the hand came off the gun and he was very apologetic for pulling me over) A white man with a felony conviction is more likely to called in for a follow up interview than a black man with a spotless record. I have gotten a # of jobs because I wasn’t black and at least one because I was white. As the only white person in the kitchen of a high end restaurant, I was supposed to inform on all the evil those evil ni**ers in the back were doing. How many white people have to “whiten” their resumes? Everything from giving themselves a new name (Teresa instead of Ayeisha, Kevin instead of Tupac) to scrubbing it of merit scholarships from notably black organizations such as the NAACP.

    Our privilege as white people is everywhere and we take it for granted, because that’s how every one is supposed to be treated, we just don’t notice that blacks don’t receive that treatment.

    As to

    They are really protecting the right to make unlimited money with no social obligations. feeding the rubes some feel-good racism is a means to the singular end of maximizing money in the hands of the few.

    You are absolutely right but white privilege is very real too.

  95. 95
    A Ghost to Most says:


    Suffering has been a Christian virtue since the middle ages.

    The rich usually contract that out.

  96. 96
    Barbara says:

    @Elizabelle: Aren’t Mulvaney and Price from Georgia, where Coca-Cola Co. is located? There is so little self-awareness here that it counts as a negative number.

  97. 97
    artem1s says:

    gah! Kimmel test. what idiocy. can we just agree that any means test that a GOPer comes up with just means s/he has figured out a way to twist it to mean less taxes for the rich, more bonuses for CEO and directors, and that everyone else will just die and quit bothering the asshole 1%ers.

  98. 98
    Patricia Kayden says:

    @Scott P.: Paging Sarah Palin.

  99. 99
    OzarkHillbilly says:

    @Baud: According to my wife, thousands in the garden, thousands more in the house and that doesn’t even include my breads.

  100. 100
    Baud says:

    @OzarkHillbilly: I would be honored to have one of your bones as a relic.

  101. 101
    Jim, Foolish Literalist says:

    @Barbara: Soda Inc is already nervous. Coke is running ads about all the healthy drinks they make! And I believe McD’s stock has plummeted in the last couple of years
    ETA: just checked and, no– McD’s dropped hard in 2016 but it’s more than come back in the last six months. Maybe on the strength of the WH replacing federal employee cafeterias with happy meal gift certificates

  102. 102
    Jeffro says:

    @Patricia Kayden: oh I know, I was just kidding – they don’t listen to anything other than the multiple voices in their insane little heads

  103. 103
    OzarkHillbilly says:

    @Le Comte de Monte Cristo, fka Edmund Dantes: You should also tell them how Christians appropriated several Pagan holidays.

  104. 104
    Jeffro says:

    @debbie: I think we are doing pretty well on that front, actually!

  105. 105
    Woodrowfan says:

    @Patricia Kayden: he runs away from, or drives away, anyone who’s not​a professional liar.

  106. 106
    Monala says:

    @Le Comte de Monte Cristo, fka Edmund Dantes: why Princess rather than Prince Manbaby? Why feminize the insult?

  107. 107
    mai naem mobile says:

    @Patricia Kayden: that’s all it is. They want their tax break. Everything else is noise. It’s all about $$$. Always. Deregulation is about making more $$$. Weakening OSHA is more $$$ for them. Getting rid of the employer mandate is more $$$ for them .

  108. 108
    Jeffro says:

    @A Ghost to Most: The thing I like is that the “party over country” mantra is all that Republicans are going to hear until November 2018, possibly November 2020. And they’re only going to hear it more loudly, and from more people too.

  109. 109
    Woodrowfan says:

    @Lizzy L: close to the same here. My mom and a cousin are all that’s left of the elder generation

  110. 110
    OzarkHillbilly says:

    @Baud: You’ll have to take that up with my wife. She will do whatever she wants with my body after I’m done with it.

  111. 111
    OzarkHillbilly says:

    @Monala: I think Trump would find it triply insulting to be called a possessor of pu$$y as opposed to a user of them.

  112. 112
    Doug R says:

    So we market garbage food and smoking to these people and then punish them for believing it and consuming?
    Profits at both ends?

  113. 113
    Kelly says:

    @Lizzy L: My oldest uncle died at 95 last week. The last WWII vet I knew personally. Navigator on a B29 over Japan.I had 2 other uncles that were bomber crew and one that landed on Omaha Beach. Our next door neighbor when I was a child was in the 101st Airborne. My father in law flew a PBY in the Pacific.

  114. 114
    Le Comte de Monte Cristo, fka Edmund Dantes says:

    @A Ghost to Most:

    If you ever notice, when conservative pols talk about “tough choices” and social benefit programs, none of them, nor their supporters will ever suffer the “tough” part of he choice.

    In America, the comfortable are always comforted more under conservatism; conversely, more affliction is brought upon the afflicted. And don’t even get me started on the notion that the CEO class are motivated solely by greater financial awards while the workers at the lower to middle rungs are only motivated to achievement via privation.

  115. 115
    OzarkHillbilly says:

    @Doug R: It’s a win/win.

  116. 116
    Monala says:

    @OzarkHillbilly: yeah, but he’s not likely to hear folks at BJ calling him that. So why make it gendered?

  117. 117
    Le Comte de Monte Cristo, fka Edmund Dantes says:


    Because I’m a neoliberal corporatist shill secretly in thrall to the anti-womyn powers within the cisnormative patriarchy is why I feminized it – duh.

  118. 118
    OzarkHillbilly says:


    Navigator on a B29 over Japan.

    My old man was a radar operator on a B-29. Flew out of Saipan. Went back in for Korea too.

  119. 119
  120. 120
    Baud says:

    @OzarkHillbilly: Craigslist it is. Thank your wife for me.

  121. 121
    OzarkHillbilly says:


    but he’s not likely to hear folks at BJ calling him that.

    He’s not gonna hear us call him the shitgibbon, his Orangeness or any of the other insults we sling around here either, so why don’t we just call him Mr Trump? Because that would be respectful and we are not respectful to those we want to insult in the most personally damaging way possible in the hope that he might, just might, actually read it in an email a friend forwards him sending his blood pressure thru the roof and he has a stroke and dies.

    Or at least, that’s what I tell myself.

  122. 122
    Citizen_X says:


    Hey jackals! There’s a WaPo article about us.

    I still ain’t putting on pants.

  123. 123
    randy khan says:

    @Matt McIrvin:

    Kimmel’s own articulation of the Kimmel test seems a lot better than what the Republicans want it to be:

    Since I am Jimmy Kimmel, I would like to make a suggestion as to what the Jimmy Kimmel test should be. I’ll keep it simple. The Jimmy Kimmel test, I think, should be: No family should be denied medical care, emergency or otherwise, because they can’t afford it. Can that be the Jimmy Kimmel test — as simple as that?

  124. 124
    Monala says:

    @OzarkHillbilly: oh, I have no problem with insulting Trump. Insult away, the more creative, the better! I just take issue with using a female insult for a man, because it suggests that there’s something insulting about being female.

  125. 125
    OzarkHillbilly says:

    @Baud: It should be cheap too. By the time I’m done with it, there won’t be much left

  126. 126
    ThresherK says:

    @Barbara: Coca-Cola in this case is perfectly evil. By that I mean that Atlanta is the home of the company but few people are employed there for the co’s size, and also the dirty work doesn’t take place there.

    Bottlers are widespread, as shipping water (mostly) gets expensive. It’s almost a holding company in ATL. Imagine if Massey Mining could have a HQ hundreds of miles away from mine tailings.

  127. 127
    Monala says:

    @randy khan: yes!

  128. 128
    Honus says:

    @CarolDuhart2: certainly, republicans in Florida, Oklahoma, Texas, Louisiana and on the outer banks should no trouble with an excise tax to pay for hurricane and storm relief.

    I’m also sure Mullaney has consistently supported government programs and regulations whose purpose is get people to eat a healthier diet, stop smoking, etc. let’s review all his kind words about Michelle Obama’s efforts on that front.

  129. 129
    OzarkHillbilly says:

    @Monala: If you’re a man, there is. It suggest homosexuality or a lack of manly virtues or whatever. The same can be said for attaching masculine qualities to a woman. We’ve all heard the “She’s really butch.” or “She’s such a Bull dyke.” It goes both ways.

  130. 130
    HeleninEire says:

    @debbie: Hi Debbie. Saw your Q from the previous thread re: the Royal drama. It was on here last week. I lasted exactly 15 minutes. At the onset they establish that Camilla is a ambitious bitch, Kate is a dumb airhead, and Harry is a sad, lonely playboy.

    That’s all in the first scene. Scene 2 is Harry being picked up in a bar by an anti monarchy trouble maker on the night of the Queen’s funeral.

    Scene 3 is Charles with the PM. Apparently Chuck is the hugest socialist in the history of the world and will fight for the people of England no matter what the PM says.

    Yeah, soap opera city! Hey, maybe it got better after 15 minutes, but I didn’t sit around to find out. There are too many pubs to go to!

  131. 131
    Ella in New Mexico says:

    What is chilling about Mulvaney’s latest sociopathic rant is that it’s based on incomplete, sometimes incorrect information and assumptions that can be applied to literally all health care problems.

    As a nurse, I know A LOT about prevention of acute and chronic illness–it’s one of the core differences between the nursing model and the medical models of health care provision. Of course exercise, healthy eating, not smoking, moderate alcohol consumption can all help our health, whether by preventing conditions such as obesity or lung disease that lead to expensive, disabling chronic illness, or by making any of those illnesses impact you far less negatively.

    But I simply cannot name a single illness that someone, somewhere, could not blame on the “choices” of the person suffering from it (or that person’s parent’s choices, in the case of birth defects). I know this because I literally hear it every, single day from not only lay folks who believe every single latest poorly sourced “research” announcement about how easily you can avoid colds if you just drink apple cider vinegar and honey to doctors who still blame heart disease on eating too many eggs in the diet (which research is now showing is actually pretty much unrelated to serum cholesterol). Want to avoid Cancer? Eat organic and avoid all sun exposure. Thyroid disease? Take iodine supplements. Arthritis? ingest tons of turmeric and glucosamine. See? you just didn’t do the right things so you got sick!

    When Mulvaney mocks 30 year-old overweight Coke drinkers for their diabetes, he also ignores tons of research that says that while they do no good for their bodies with their behaviors, they may actually have underlying susceptibilities from genetic, infectious or even gut flora causes that make them more likely to become diabetic from the exact same behavior as their peers who do NOT become diabetic. If our society was more consistent with it’s messages, if these people had access to great primary healthcare providers from early on, we’d be able to get them to recognize their own vulnerabilities and make changes to avoid complications of disease. Instead, we mock and blame them.

    The key is to implement widespread public education early on in folk’s lives to help them make smart choices to minimize the potential for serious chronic illness. Individually, folks need primary care and health education that a more comprehensive national health policy should be providing so that we intervene early in people’s illnesses and help them shape their lifestyle choices, not blame and shame them.

    Which is why a modern, first world nation that relies totally on a health “insurance” model for the deserving and emphasis on moral fortitude as panacea for all illness will never cease to have to deal with the enormous costs associated with delayed attention to chronic illnesses and providing expensive interventions in the later years of life.

  132. 132
    Woodrowfan says:

    @OzarkHillbilly: my wife told a coworker how the Puritan banned Christmas and was told that was “liberal history”

  133. 133
    OzarkHillbilly says:

    @Woodrowfan: I always wonder what Jesus put on top of his Xmas tree.

  134. 134
    Woodrowfan says:

    @OzarkHillbilly: a little judas.

  135. 135
    A Ghost to Most says:

    Yep. Lather, rinse, repeat.

  136. 136
    OzarkHillbilly says:

    @Woodrowfan: With 30 little pieces of silver tastefully arranged around the tree. What do you think he got in his stocking?

  137. 137
    H.E.Wolf says:

    Thank you for noting this, Monala. I agree. We need some pithy pejoratives for that poophead, that aren’t pudenda’ed. “Putrid Manbaby”, perhaps? “Porcine Manbaby”? (My apologies to swine.) Or, FSM please make it so, “Pariah Manbaby”.

  138. 138
    Chet Murthy says:

    @H.E.Wolf: I’m becoming partial to “Reverse Midas” (b/c what else does he love?)

  139. 139
    Jim, Foolish Literalist says:

    @H.E.Wolf: @Chet Murthy: Manbaby Midas? Though I do hate to lose “Putrid”

  140. 140
    henqiguai says:

    @Le Comte de Monte Cristo, fka Edmund Dantes(#84):

    If you really want to have fun with fundamentalists, the next time you hear about how pagan ways brought down Rome, remind them that Rome was officially, repressively for 150 years prior the the deposition of the last Emperor in the West.

    What does this even mean?

  141. 141
    Baud says:

    @henqiguai: I think he a word.

  142. 142
    OzarkHillbilly says:


    “Porcine Manbaby”

    Now you have gone too far. SWINE UNITE!

  143. 143
    Jim, Foolish Literalist says:

    @henqiguai: I think there’s a “Christian” missing between “repressively” and “for 150 years”

  144. 144
    CarolDuhart2 says:

    @henqiguai: I think he left out the word “Christian”. Emperor Constantine and all of that.

  145. 145
    Le Comte de Monte Cristo, fka Edmund Dantes says:

    @Chet Murthy:

    “Poop Midas”, coz everything he touches turns to shit…

  146. 146
    Elizabelle says:

    Poop Midas works for me.

    You don’t even have to explain it to people. They will think about it and come to their own conclusion. Which makes it even more powerful.

  147. 147
    debbie says:


    Thanks for the warning! Guess it’ll be doing laundry to the Simpsons.

  148. 148
    Le Comte de Monte Cristo, fka Edmund Dantes says:


    Yeah, sorry

  149. 149
    Quaker in a Basement says:

    @CarolDuhart2: Those are judgments of God against sinners. NOT COVERED!

  150. 150
    rikyrah says:

    they will come up with any excuse to..



    They are trying to get around informing you of that, because it makes them look like the sociopathic muthaphuckas THAT.THEY.ARE.

    Which is why they always try and hide their intentions. When you are slapped with the REALITY of their intentions, you recoil in horror and disgust. Our side always knew this. They try and hide it from THEIR side until it’s done, and then they’ll just have to suck it up.

  151. 151
    hovercraft says:


    While republicans like Mulvaney wag their fingers at consumers of fat and sugar, they mock Michelle Obama’s (or anybody’s) attempts to teach kids how to eat healthier and they put a morbidly obese sack of shit with no scientific background in a lead science role over nutrition n the USDA.

    Michelle is black, and she’s fat, Rush told me she’s as big as a heifer!
    Telling corporations to not fill their crap with salt, fat and sugar is tyranny, telling people not to eat said crap is the government trying to destroy capitalism and nannystatism!
    Feedum means allowing corporations to poison us and not tell us how dangerous it is to our health, and then because people eat the crap and get sick, they have the freedum to die.

  152. 152
    Another Scott says:

    I don’t like the Kimmel test.

    I don’t either.

    I keep seeing more ads on TV like this – AARP’s “drive to end hunger”. There was a USPS food drive this weekend, too (I put a bag out).

    We’re the richest country on Earth, and the richest in the history of the planet. It’s great that we donate so much to charities, (and I try to do my part), but it’s obscene that private charity is being pushed as a replacement for sensible government policies. And that gatekeepers are being put in place for what should be guaranteed social goods (public education, food, housing, government funded and provided social insurance, public health, livable baseline retirement, etc.)

    It’s dangerous and shouldn’t be normalized.



  153. 153
    amk says:

    Looks like Merkel is winning bigly today.

  154. 154
    Another Scott says:

    @HRA: “Cognitive Dissonance” isn’t a bug, it’s a feature.


  155. 155
    StringOnAStick says:

    @Ella in New Mexico: Thanks Ella, very well said. It isn’t just the lay people, it is health care people too. My oldest sister the Christianist RW nutjob is also an RN (retired thankfully, since she was a mean one). Up until her son developed a brain tumor, every illness anyone came down with was their fault in some way; his illness rattled her world view, hard. As someone said here before, conservatives never see the nuance in any situation or how they could ever need help or understanding until something bad happens to them, instead of to all those deserving others.

  156. 156
    Steeplejack says:


    This is really good! Sometimes your “distant” cityscapes seem a little “flat” (maybe because I’m looking at such a small image), but this one seems just right. I especially like the splashes of color in the fountains.

  157. 157
    Mnemosyne says:


    If we still lived in a society with no antibiotics or other modern medical care like they did in the Middle Ages, I can see how a concept of “redemptive suffering” would be socially useful to keep people from becoming murderously enraged at their fates.

    But to insist that we continue that ideal in a world where we do have modern medicine available is just fucking evil.

  158. 158
    Mnemosyne says:


    Yeah, I like the insult, but now the genderizing is starting to bug me.

    I’m going with Prince Manbaby from now on. Pampered Prince Manbaby when I feel like it.

  159. 159
    Uncle Cosmo says:

    @Elizabelle: “Midas” reversed is “Sadim”; therefore,

    Sadim Insane

    Yeah, I known it won’t catch on, but it’s the thought that counts…

  160. 160
    rikyrah says:

    Get him, Kay!!!

  161. 161
    Mnemosyne says:

    @Jim, Foolish Literalist:

    Pampered Prince Manbaby.

  162. 162
    Neldob says:

    @Le Comte de Monte Cristo, fka Edmund Dantes: not true. About 25% of heroin users never stop until they drop. The rest get bored and get back to something more interesting, school, family, mountain climbing, and such.

  163. 163
    Arclite says:

    Yes, genetics are a huge cause of disease. We need single payer for this reason. That being said, so many illness are caused by/exacerbated by/ accelerated by poor diet. Given our genetic predisposition to seek sweet, oily, and salty foods, we need a multiprong approach of disincentivizing their consumption.

    For example, San Fran, Berkeley, and other places have instituted a sugar tax. The result:
    A study published last fall in the American Journal of Public Health showed that SSB consumption decreased by 21% and water consumption increased by more than 63% in Berkeley after the SSB tax.

    Having an education campaign as well as government sponsored sports, exercise, meditation, yoga, and other programs can go a long way in preventing many diseases especially the most common ones.

  164. 164
    Woodrowfan says:

    @OzarkHillbilly: a tangerine and some little chocolate gold coins

  165. 165
    Barbara says:

    @Arclite: Consumption of soda is declining, especially diet soda, but many non-soda beverages have just as much sugar. It is not just soda.

  166. 166
    Arclite says:

    @Barbara: While that may be true in general, consumption is still way too high, especially among the poor and less educated. And liquid sugar is especially bad for you:

    Liquid sugar affects the body in a unique way that increases the risk for diabetes more than sugar in food.

    What the Berkeley tax did was this:

    Measure D focuses on the distribution of sugary soda, energy drinks, juice with added sugar, and syrups that go into sugary drinks at cafes like Starbucks (like Frappuccinos).

    100% juice and drinks with milk as the first (primary) ingredient are exempt because of their nutritional value. These drinks are not the cause of the huge increase in sugary drink consumption, especially among children. Measure D is focused on high-sugar, low-nutrition drinks. Coconut water, contrary to the opposition’s insistence, is NOT taxed unless it has added sugar. Diet soda is exempt because it does not have added sugar, the subject of this tax. Alcohol is exempt because it is already taxed.

  167. 167
    Davis X. Machina says:

    because I chose to have a good burger in Boston last week week

    Aha! Caught you! True progressives know there’s no such thing as a good burger.

  168. 168
    Mel says:

    @satby: Agreed. I am so afraid for all of us.

    Those with illnesses are at risk, as are the young, the healthy, and those with hidden health issues. My closest friend worked in a small, non- profit women’s medical clinic for 18 years. She loved it, but as a single mom raising two children on her own, she had reached a point where she had to make some difficult choices. The kids needed more space than their very small apartment could now provide, and she needed to be able to add more to their college funds which she just couldn’t do on her current salary. She was also terribly worried that she would be a burden to them in her retirement if she didn’t get a job that allowed her enough income to build a small, stable nest egg.

    This was about 12 years before the ACA. She was then hired for a job at a large medical practice that was part of a series of affiliated regional practices. The pay, benefits, and retirement plan would allow her to meet her monthly expenses and still have enough left over to not be literally counting change at the end of each month. She took the job, understanding that there would be a 2 month “waiting period” before the next open enrollment benefits period at her new employment. Cobra benefits for herself would have cost too much at that time, and she assumed that she would pay to keep her boys’ coverage, and just buy herself a barebones stop gap plan, since she was in generally good health, was a runner and a yoga enthusiast and ate a pretty healthy diet. Even the barebones catastrophic policies were brutally expensive, and covered no scrips, no basic med visits, no testing except in the case of hospitalization incidents, etc., but she really had no choice but to take the gamble, if she was to keep her boys covered under good policies and still be able to keep the family afloat during the transition.

    She began having some headaches during her first month on her new job, and decided to pay out of pocket to see her family doctor. Since she had never had headache issues in the past,and her blood pressure was not normal as it had alwsys been before, and the headaches were fairly intense and focused in one particular area, he advised that she get an MRI if the headaches continued to occur for more than an additional week or so. She was concerned, but when she called to price the MRI, she found that it would be over $2,000 out of pocket for just the imaging . Add to that the facility fee, the radiology fees, fees for contrast administration, and the follow up visit fees, and she was facing over $3,000 in expenses. She decided to wait it out, as her new insurance would kick in in a little over 2 weeks. She thought, maybe it’s just stress headeaches: new job, financial worries, trying to scrape together a down payment for a slighyly bigger place to live, two teenage children…

    That weekend, her children were having an overnight stay with their grandmother, and my friend spent her Saturday out with friends, enjoying a rare day off. A visit to a local festival, paddleboating on a local lake, dinner and then home.

    At 7 am the next morning, a friend who had stayed the night found my friend sitting on the floor of her living room, dead. She had dressed to go for a morning walk, and had suffered a sudden aneurysm rupture, not unlike what happened to Cole’s wonderful friend Holly. I am so thankful every day that Holly was able to access care, because without it, another beautiful person might have been lost to this world.

    So many “ifs”. If my friend had been able to obtain real, affordable coverage in the gap period. If insurers had had to provide the basics of reasonable access to care in all policies. If people didn’t have to work 60 hours a week and still have to worry about being able to provide basic security for themselves and their families…

    It is almost certain that that diagnostic MRI would have identified the aneurysm prior to its rupture. According to several specialists, there was a very good to excellent chance that a surgical repair would have prevented rupture, and with basic monitoring and generic blood thinners, my friend would have continued to live a normal, healthy, and productive life.

    Two teenagers children lost their mom and had their young lives turned upside down. Her community, her local library, her children’s school, her local animal rescue, the local Meals-on-Wheels – all lost a bright light and a tireless advocate. Her other friends and I lost a woman who was a sister to us all, a warm, compassionate, brilliant, tenacious person who brought hope to everyone she met.

    I can’t imagine the breadth of the tragedies we will all experience if things revert to pre-ACA conditions and worse. Repubs obviously feel that she and so many others deserved to die simply because they couldn’t afford outrageously expensive insurance. In their eyes, apparently all the people who have a chronic or serious illness also deserve to die, but so many healthy people who I talk to don’t seem to understand that we all are potentially just one accident, illness, hidden genetic quirk, job-related injury, etc. away from a potentially serious health issue. They see themselves as “deserving of health care” because they haven’t yet been ill, or they “chose” to work in a low-risk profession, or they can afford to live in a safe neighborhood without contaminated water, lead paint hazards, or exposure to industrial toxins. All this “deserving versus non-deserving” nonsense now being thrown into the mix is just a lethal, terrifying smokescreen, but I am truly, truly worried that the majority of Trump voters will just eat it up, not believing for a second that they are all included in the “undeserving” category along with the rest of us.

  169. 169
    Another Scott says:

    @Mel: :-( Thanks for telling her story. It’s painful, doubly so for you, but it needs to be told.

    There are far too many people who end up disabled, or have their lives needlessly shortened, or end up dead because they can’t afford the medication and medical surveillance needed to keep their blood pressure and other vitally important health indicators under control. It’s horrible what we do to people under the excuse that we as a society “can’t afford it”…. :-(

    And the previous (and potentially future) lack of a national, portable health-care system means too many people aren’t able to move to better jobs, or a safer home, or …, because they can’t risk losing their work-provided (as part of their compensation), or state provided (as part of their taxes) benefits. It’s a drag on the economy, it keeps people in jobs they don’t want or are miserable in, etc., and there’s really no excuse for it.

    Consider telling her story at as well. They’re collecting stories about how important the PPACA is.

    We’ve got to fight them every single day.


  170. 170
    Duane says:

    You know who doesn’t deserve health care when they get sick? Mulvaney.

    As Goldman says, fuckem.

  171. 171
    Robj says:

    @Van Buren:

    Two scoops of ice cream for dessert, also.

  172. 172
    dg says:

    Sounds like Mulvaney just came out in favor of death panels.

  173. 173
    Victor Matheson says:

    @maryQ: Francis Collins, head of the Human Genome Project, has a great quote that says, roughly, we will eventually find that every hospitalization is either genetic or trauma.

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