Trumpcare, Mental Health, and the Goldwater Rule

Back to politics today for  a moment…because there’s something I want to say, and because I’m struggling with something about Donald Trump and the Goldwater Rule.

Content Note: Ableism, Healthcare, Politics, Trump, Mental Health

Senator Susan Collins, a white woman with short red hair wearing a dark blazer, white blouse, and pearls, stands in front of an American flag background. Keyword: Goldwater Rule

Image Description: Senator Susan Collins, a white woman with short red hair wearing a dark blazer, white blouse, and pearls, stands in front of an American flag background.

Although I have Republican friends that I cherish in spite of our differences in opinion, regular readers know that as a group I’m hard on them. I’ve called them out, sometimes by  name (some have told me unfairly.) I don’t believe that I’ve been off-base.

But I also believe in giving credit where it’s due. So, to Senator Susan Collins of Maine and Senator Lisa Murkowski of Alaska, who’ve stood firm in this round of Obamacare repeal deliberations that what’s been included in the proposed repeal scenarios are not good for their constituents, despite bullying from Donald Trump, thank you. Thank you on behalf of my disabled American friends, and the children, families and elderly people of America that not only depend on Medicaid to keep them happy and healthy, but depend on it to keep them alive. Thank you for insisting that America be a country where everyone is taken care of. Your integrity and courage give me hope.

Senator Lisa Murkowski of Alaska, a white woman with short blonde hair wearing a red blazer, a write blouse, and a pendant on a chain, stands in front of some trees. Keyword: Goldwater Rule

Image Description:  Senator Lisa Murkowski of Alaska, a white woman with short blonde hair wearing a red blazer, a write blouse, and a pendant on a chain, stands in front of some trees.

Thank you also to John McCain, a man with whom I’ve definitely had my disagreements, who came to Washington in spite of his cancer diagnosis, right after brain surgery, speaking eloquently about bipartisanship and the need to work together to craft a plan for healthcare, pushing himself through the week and into the early hours of the morning last Friday night to cast the vote that brought down Trumpcare. Sir, I salute you.

Senator John McCain, a white male in his 70s with white hair wearing a navy blazer and blue dress shirt. stands against an American flag background Keyword: Goldwater Rule
MESA, AZ – June 4: Senator John McCain (R – AZ) appears at a town hall meeting on June 4, 2010 in Mesa, Arizona.

Image Description: Senator John McCain, a white male in his 70s with white hair wearing a navy blazer and blue dress shirt. stands against an American flag background.

I won’t ever forget what the three of you have done for my American friends.

And to the rest of GOP who are struggling with the idea of single-payer as an idea for health care in the US…on one level, I get it.

Didn’t think I’d say that, did you? Well, I’m nothing if not practical. Single-payer isn’t a perfect system. Not by a long shot. Are there wait times? There can be, for non-emergency issues especially. Is it bureaucracy-heavy? Not any more than the bureaucracy created by the American system having to deal with many insurance plans, I’d argue, but I could be wrong. But even though I waited a couple of months for the functional MRI that the AVM Clinic at Toronto Western Hospital needed to decide how to best treat my AVM, I didn’t have to worry about whether my family could afford to have one of the best neurosurgeons in North America specializing in AVM treatment rooting around in my head for 14 hours.

Take our system and make *your* single-payer system better. Show us up. In fact (if it’ll get you moving on this), I’ll bet that you can’t do it. Go ahead and prove me wrong.

Please! 🙂

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Now…why I’m struggling.

Donald Trump, Mental Health, and the Goldwater Rule

Last week, two friends who work in the mental health field, for whom I have a great deal of respect, said that despite their concerns about the Goldwater Rule, they firmly believe Donald Trump has a mental health condition and needs evaluation to determine whether he’s psychologically healthy enough to continue on as President. The American Psychoanalytic Association officially said recently that members shouldn’t feel restricted by the the Goldwater Rule when discussing Trump.

This is a tough one for me. I don’t like Trump at all, simply because I don’t tend to like people that are lying, arrogant bullies.  But I’ve fought hard against the idea that he’s unfit for office because he’s “crazy” because:

  • Even the most qualified mental health diagnostician would need time and access to Trump to make an accurate diagnosis
  • If the policy is that a clean bill of mental health is required to be the President, then Presidents as far back as Lincoln have been in violation
  • It’s ableist. There’s no reason that a President with a well-managed mental health condition should be treated any differently, in terms of perception of ability to govern, than a President with any other sort of well-managed condition.

And I think that ultimately I still believe that the Goldwater Rule should apply to the position of the President, provided that some other safeguards are put in place (because we do know that Presidents have had mental health conditions, and even degenerative brain conditions, that went largely unnoticed while they were in office):

  • Any President (not just Donald Trump) gets his or her mental health evaluated by an independent mental health practitioner on a regular basis. (I don’t know if this happens, or how often.) The Presidency is an extremely high-stress job, and it’s not unreasonable to periodically check at the very least whether that stress is having an adverse affect on the President’s well-being.
  • Concerns about the President’s mental health are treated like concerns about the President’s physical health – they are quickly, and thoroughly evaluated and, if necessary, treated. The President takes time off work if necessary, but the assumption is that he or she will be able to return to work, and that it will happen as soon as possible. The public is entitled to no more information than it would be if the President had a physical issue.

In other words: If the White House properly monitored the President for mental health conditions and ensured that if there were any conditions that were affecting the President so much that they interfered with his or her ability to govern that the President took time off (if necessary) and received the treatment and education needed to ensure that the condition was well-managed and no longer an issue…then I’d continue to stand on the Goldwater Rule and say, “It isn’t up to people who’ve never spoken to President to make a diagnosis. It’s up to the White House.”

But I don’t have that confidence in this White House. They can’t even make Donald Trump stop using his phone. They’re not going to convince him to let someone do even a simple mental health evaluation, or start treatment if that was deemed necessary – and Donald Trump is not a man that would step down. Not for the good of his health. Not even, I don’t think, for the good of his country.

So, I Struggle…

I’ve struggled as I’ve watched mental health diagnosticians openly break the Goldwater Rule since Trump’s election with their pronouncements in the media that he’s got any number of mental health conditions.

I struggle now, wondering if they were right to break the Goldwater Rule the way they did.

I don’t think that a mental health condition should automatically disqualify anyone from any job – I know too many people with well-managed mental health conditions that are in high-stress positions and that do an excellent job. But, like my friend said:

Whether someone agrees or disagrees with the content of his inflammatory statements, that is not the issue. This is not a matter of attributing mental illness because of disagreement with his views/statements. If you go back and view interviews with him from decades ago, he’s still the same big jerk, but his behavior has changed.”

It’s one thing to be a seventy-year-old civilian man with no insight into behaviour change and perhaps the need for help, and with apparently no one around you who will call you on that blind spot. It’s quite another thing when you’re the most powerful man in the world.

I think I know now where I land on this. If the White House won’t take action when there are indicators that the President needs treatment for a mental health condition, other people with experience and knowledge in the field of mental health need to be allowed to speak without fear of what it could cost them. It’s ableism to say, “People with a mental health condition can’t be President,” but it’s not ableism to expect Presidents that do have mental health conditions to work with their staff and medical team to manage those conditions so that their ability to govern isn’t affected.

To be clear:  Mental health professionals who are worried that Donald Trump isn’t competent to lead need the freedom to speak about it. Someone has to.

 

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Thoughts About the May 4th Vote to Repeal and Replace Obamacare

I watched far too much CNN last Thursday. But I couldn’t turn it off. I couldn’t believe that the vote to repeal and replace Obamacare was actually happening.

Content Note: Ableism, Healthcare, Politics

Headshot of Canadian Prime Minister Justin Trudeau (white male in his 40s with short, wave brown hair and blue eyes) looking thoughtfully into the camera. "Hey Girl, I'll Cover Your Preexisting Condition" is written across the picture in white block letters. Keyword: Obamacare

Image Description: Headshot of Canadian Prime Minister Justin Trudeau (white male in his 40s with short, wave brown hair and blue eyes) looking thoughtfully into the camera. “Hey Girl, I’ll Cover Your Preexisting Condition” is written across the picture in white block letters.

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Watching from my privileged place here in Canada, where:

  • My mother spent six weeks in intensive care before she died of cancer
  • My father had surgery to fix the three breaks in his leg after being hit by a car and spent two months in a physical rehabilitation hospital
  • My twin niece and nephew were delivered by emergency C-section at 26 weeks and spent the next 3 months in the NICU
  • I had 2 brain surgeries to correct a congenital vascular malformation and spent 5 weeks in the hospital after the ensuing major stroke and nearly six months in inpatient stroke rehabilitation

…I reflect on how we only saw bills for ambulance service and records transfers…and think about where any of us might be if we lived in an America where Trumpcare was the law…and I am appalled.

Appalled

I’m appalled by the bill itself, although I’m fairly confident that despite making it through Congress, it’s dead in the water when it reaches the Senate. It barely got enough support from the GOP to squeak through the house. It *won’t* get the support from the Democrats that it needs in the Senate without major changes. Paul Ryan was so desperate to push this through that he didn’t wait for a ruling from the CBO about the cost of the bill and who it will affect (although we know that the CBO’s analysis of the first bill that Ryan failed to shove through Congress six weeks ago indicated that 24 000 000 people would ultimately lose their health care because of it.) Trump was twisting arms to get people to vote for it up until the morning of the 4th. Representative Chris Collins told CNN’s Wolf Blitzer that he didn’t even read the whole bill before voting “Yes” on it and he was not the only one.

Process-wise, this was a nightmare, and it will continue to be a nightmare for the GOP.

And for what? As Nancy Pelosi said on the floor of the House last Thursday, the people who voted for this will “glow in the dark”. The Democrats will make sure that everyone remembers who voted to repeal and replace Obamacare also voted take away health care for the Americans that need it most. Because I am furious on behalf of my disabled American friends, and scared for their future, here’s a list of who voted which way on the Trumpcare bill. Make the people who voted “Yes” glow in the dark for midterm elections in 2018.

What The Fight to Get Rid of Obamacare Is Really About

Obamacare sure as hell isn’t perfect. It needs to be fixed so that healthcare becomes and remains affordable and accessible for everyone. But it’s only in the minds of a group of Republicans who want to obliterate anything with Obama’s stamp on it that it needs to be repealed and totally replaced with something else, instead of tweaked so that the people who got healthcare coverage under Obamacare could keep it and so that coverage could become more affordable for those that are paying far too much for it right now. In their zeal to repeal and replace, with the bill they’ve presently voted on, they’ve thrown an alarmingly large group of Americans that includes the elderly, disabled people, people with cancer, people with mental conditions, people addicted to drugs, and women who have been sexually assaulted under the bus and pretty much said, “We don’t mind standing back and watching you die.”

According to the Kaiser Family Foundation’s list of pre-existing conditions that have universally been used to deny people insurance in the past, and that have raised premiums in the past, if I lived in US I’d be at risk of outright losing my insurance or a premium hike for factors that I can’t control, several times over. So would friends and loved ones, including my baby niece and nephew, who didn’t ask to be born three months premature.

Conclusion

I don’t believe that this bill will become law. But if it did, people who depend on getting health coverage through Obamacare would die. It is simply unfair that ability to obtain healthcare be tied to how much money you make. It’s more than unfair. It’s barbaric.

American friends, tell your representatives that when you call them — that the world is watching, we’re judging, and we’re using words like “barbaric”. Ask them if they can live with that.

Not sure what else to say about this right now. Just know that there are Canadians who are watching what’s going on and talking about it amongst ourselves, and that we will help however we can.

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Jason Chaffetz, Health Care, and Privilege

CNN has been out at my place since yesterday, and I didn’t get a chance to get caught up on newsletters or internet because I was at work…but even from the little bit that I picked up about Trump’s new healthcare plan, I’m seeing problems.

Content Note: Classism, ableism, poor shaming, Trumpcare

Image Description: Red medical bag with a with white cross on it and a stethoscope resting on it. Keyword: Jason Chaffetz

Image Description: Red medical bag with a with white cross on it and a stethoscope resting on it.

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I like Obamacare. I was happy to see that so many people, particularly disabled people and people with pre-existing conditions, finally got healthcare. If I’d been American when my brain arteriovenous malformation was discovered, I doubt that any health insurance that my family could have afforded could have covered the cost of the surgery to repair it, let alone the cost of hospitalization and rehabilitation after the post-surgery stroke and the years of medical follow-ups. My surgery wasn’t emergency, but it was important — given that I was only 22 when my AVM caused my first brain bleed, it was likely to cause another, potentially much more serious one, but no one could say when. Would we, had we been Americans, decided to take postpone a costly surgery as long as possible, or not do it at all, and just hope for the best?

It might not have been an option. As a Canadian, I was able to make my decision based on the risks of having the surgery or not having it, and cost wasn’t a factor. Given that there was a 75% that they could treat the AVM with no ill effects, but later in life I might have another bleed while driving down the highway or holding a baby and potentially lose control of my left side, the choice seemed easy. I just hit that 10% that comes out of a major surgery in that area of the brain with severe damage, and that’s what happens when you play the odds. At least the AVM is fixed, and I didn’t have to worry about whether my healthcare was going to bankrupt my family.

I can work, but it’s complicated (ultimately because of my disabilities.) The jobs that I can do are usually part-time, low-wage, with no benefits. I’m one of the lucky ones — because I live in a low-rent building and because a government program covers the cost of my medications, I can still pay all my bills.

Jason Chaffetz, Healthcare, and Class Privilege

One of the bits about Trump’s new plan that I did hear yesterday (because it’s all over my Facebook feed) was the Jason Chaffetz interview with CNN. If you haven’t had a chance yet to hear the very definition of class privilege, take a listen (or read the transcript below the video, from 1:47 to 3:02):

Alisyn Camerota: What if it leaves lower-income Americans uninsured?

Jason Chaffetz: Well, we want them to be able to provide, have a method so that they can get access to it. There are things that we really do like, for instance dealing with pre-existing conditions, allowing people up to the age of 26 to —

Alisyn Camerota: You’re going to keep those tenets?

Jason Chafferz: Yup, these arbitrary lines of states —

Alisyn Camerota: Sure.

Jason Chafferz: So I think there’s a lot of good things that we need to —

Alisyn Camerota: But access for lower-income Americans doesn’t equal coverage.

Jason Chaffetz: Well, we’re getting rid of the individual mandate. We’re getting rid of those things that people said that they don’t want. And you know what? Americans have choices. And they’ve gotta make a choice. So maybe rather than getting that new iPhone that they just love and that they want to go and spend hundreds of dollars on, maybe they should go invest in their own healthcare. They’ve got to make those decisions themselves.

Alisyn Camerota: So, in other words, for lower-income Americans you’re saying that this is going to require some sacrifice on their part.

Jason Chaffetz: Well, we’ve got to be able to actually lower the cost of healthcare. I mean, one of the things we’re concerned about is healthcare inflation is just consuming the American budget, both for the families and and at the federal government. We have to be able to drive those cost curves down and provide good quality access. We do think that with more choice, that you will get a better product at a lower price, and that’s good for everybody on the entire spectrum of income.

Chaffetz goes on to say later that a potential outcome of the plan is more access, less coverage (3:54).

Let’s run down Jason Chaffetz’s assumptions about lower-income Americans and their lives, as indicated by this conversation:

  1. They’re frivolous and don’t make good spending decisions.
  2. They have money that they can put into saving for healthcare and just aren’t doing it.
  3. They should sacrifice even items that arguably aren’t even luxury (many people don’t use a land line anymore and depend on a cell phone) to bring down health care costs for everyone, when it doesn’t seem that he’s holding higher-income Americans to the same standard.

There’s also an implication that giving up that cell phone should be enough to provide people savings enough to get all the coverage they need, when the new plan has shown no proof of that so far. This tweet talks about the cost of a phone vs the cost of a young woman’s ankle surgery.

The GOP Doesn’t Like Low-Income Americans

It’s a relief that Trump has decided to keep the Obamacare regulations on pre-existing conditions and staying on parents’ plans until 26, and that he’s committed to making the plan portable across state lines. And when Jason Chaffetz went on FOX to further explain his comments, after social media exploded, he said that, “What we’re trying to say — and maybe I didn’t say it as smoothly as I possibly could — but people need to make a conscious choice and I believe in self-reliance. And they’re going to have to make those decisions.” That sounds much better than the plan he described on CNN.

However, I wouldn’t forget his words in that first CNN interview. GOP policies regarding low-income Americans tend to be punitive, assuming that all low-income people are either out to scam the system or irresponsible, and that higher-income people are deserving of better treatment. When we consider that the GOP also wants to cut Medicare, this healthcare bill as described by Chaffetz on CNN is all those things; even though he’s tried to walk it back, we shouldn’t be shocked if that’s exactly what Trump’s healthcare plan turns out to be.

The American Medical Association agrees that the current version of “Trumpcare” won’t provide adequate health care for vulnerable Americans. AMA President Andrew W. Gurman said in a press release about Trumpcare:

“The AMA supported health system reform legislation in 2010 because it was a significant improvement on the status quo at the time; and although it was imperfect, we continue to embrace its primary goal — making high-quality, affordable health coverage accessible to all Americans,” AMA President Andrew W. Gurman, M.D. said. “As drafted, the AHCA would result in millions of Americans losing coverage and benefits. By replacing income-based premium subsidies with age-based tax credits, the AHCA will also make coverage more expensive — if not out of reach — for poor and sick Americans. For these reasons, the AMA cannot support the AHCA as it is currently written.”

Other groups have joined the AMA in its stance, including the American Hospital Association and the American Academy of Family of Physicians.

I’m Worried

Canadian healthcare is far from perfect. Obamacare wasn’t perfect either. And I’m only learning about this new plan, and I’m willing to see how it pans out.

But I’m worried, even just after hearing Chaffetz’s CNN interview, that disabled people who can’t work and other groups living in poverty are going to suffer under this new bill. Please be prepared to fight for them.

They need your voice.

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Happy Canada Day…and Yay for the SCOTUS Ruling on the Affordable Care Act!

This is my fourth Canada Day post. But I’m posting a bit early because I meant to write a post over the weekend congratulating America on the Supreme Court of the United of the United States ruling on the Affordable Care Act last week, and haven’t got to it yet…and I figured that the two posts would fit well together, because all of my Canada Day posts have been about how Canada’s universal health care system is one of the reasons that I’m most proud to be Canadian.

Content Note: Healthcare, same-sex marriage

White maple leaf on a red background with "Happy Canada Day!" in red script across it. Keyword:

Image Description: White maple leaf on a red background with “Happy Canada Day!” in red script across it.

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Long-time readers will know that I’ve been a clear supporter of the Affordable Care Act from the outset. I feel quite strongly that everyone should have access to good health care regardless of their ability to pay for it. Which is why I love the liberal judges on SCOTUS so much for squeaking this ruling through, because now it’s. Not. Going. Anywhere.

CNN said about the ruling:

“The ruling holds that the Affordable Care Act authorized federal tax credits for eligible Americans living not only in states with their own exchanges but also in the 34 states with federal marketplaces. It staved off a major political showdown and a mad scramble in states that would have needed to act to prevent millions from losing health care coverage.”

I realize that Canada’s system of universal health care looks less like what’s in place under the Affordable Care Act than it does the single payer system with which America toyed, but I think that any health care system with a mandate that as many people as possible should have access to medical care is one in which people can take pride.

Laws like the Affordable Care Act and Canadian Medicare move quality, high-cost medical treatment from the realm of the very privileged to that of people who can’t afford good insurance and certainly can’t afford to pay medical costs out of pocket.

Heck, I could barely have afforded the first ambulance ride to the first ER visit, let alone the ER visit itself, if I’d lived in a country without universal health care. Even with my family helping as much as they could, how could I have afforded the 14-hour brain surgery with one of the best AVM surgeons in North America, let alone the rehabilitation that came afterward?

Because I live in Canada, cost to me (and ultimately to my family, as I had next to no money when I discovered that I’d need brain surgery) wasn’t a factor in my decision to have my AVM treated, or in determining how long I could stay in inpatient rehabilitation after my stroke, or in deciding what kind of follow-up treatment was appropriate and when. That’s a tremendous gift to people who are facing a health crisis, and to their families, who already have so many things to worry about (and, for families who live in rural Canada, may already have to incur substantial costs associated with travel/lodging/food while dealing with loss of income). I’m proud that I live in country where people feel that providing this sort of care to citizens should be a priority, and proud to be neighbour to a country that is moving in the same direction. High five, America, and  Happy Canada Day to all!

Oh, there was another very important SCOTUS ruling last week definitely needs a mention. I was online when word came out that SCOTUS had made gay marriage just “marriage” in all 50 states, meaning that now people can marry who they like (there are still some restrictions on disabled people, but I’ll get into that another day), and the rainbows went over social media in a wave. It was really something to see.

Again, congratulations, America!

I’m proud to say that Canada has been doing this for 10 years.

You’ll love it! 🙂