All Commentary
Tuesday, October 3, 2017

Why the Kimmel Case for ACA Fails

It's true that no parent should have to decide if they can afford healthcare for their sick child, but the Graham-Cassidy bill wouldn't have made them.

On May 12th, late-night personality Jimmy Kimmel gave a now-famous monologue about his newborn son’s health complications, concluding with a politicized message against Trump’s budget and healthcare reforms. Although the Republican AHCA was defeated in the Senate months ago, Kimmel has since revived his sentiments in an effort to kill the latest, now-dead Graham-Cassidy healthcare reform. Kimmel’s now-famous test that “no parents should ever have to decide if they can afford to save their child’s life,” has given him a much-needed ratings boost, and also dealt a significant blow to efforts to save our flopping healthcare system.

Ironically, Kimmel has failed his own test and contradicted his call for national unity by politicizing his son’s condition and misrepresenting the Republican budgetary and healthcare reforms.

Kids Are Not Dying in the Street

Despite Kimmel’s assertion, there has not been a case of a child in the US dying because his parents were too poor to afford treatment since 1986 when a law was passed barring hospitals and emergency rooms from turning any patients away. None of this would change under the Trump administration.

There were no throngs of dying Americans on the streets in 2006, and there will be none under Trump. Kimmel should know, after his son received treatment at the Children’s Hospital of LA (which runs largely off of donations), that American commitment to helping those in need transcends political party and platform. Americans donate a greater percentage to charity than any other country, far outpacing the “generous” socialist societies of Europe. Unlike taxation and socialized medicine, this profoundly American altruism does not come from a government mandate but from the heart and will continue to ensure that the infirm, regardless of income, receive the care they need.

When it comes to what could change under Trump, Kimmel’s plea appeared equally uninformed. Trump’s requested cut in NIH funding, which Kimmel censured, would not have affected anyone’s access to medical care but rather shrink government-subsidized biomedical research. Having worked for years in cancer research, I can attest to the fact that pharmaceutical companies, rather than the NIH, fund a vast majority of the research that leads to breakthrough medical innovations and cures. A far greater impediment to progress than tight government funding is the regulatory burden that has befallen insurance and pharmaceutical companies under the Obama administration, which Trump aims to roll back.

Reforms in health insurance coverage under the Republican AHCA, or Graham-Cassidy bill, would likewise not have impeded sick children from receiving essential care. Kids are born covered by their parents’ insurance plan, and parents currently on government assistance would still retain their Medicaid under Trump. While Obama greatly expanded Medicaid benefits, Republicans have proposed to slow down this growth, maintaining current Medicaid recipients but eventually judging prospective enrollees based on pre-Obama standards. There were no throngs of dying Americans on the streets in 2006, and there will be none under Trump, as Kimmel, NYC Mayor Bill De Blasio, and even Hillary Clinton have suggested.

State-run programs for children who fall through the cracks, such as Children’s Health Insurance Program (CHIP), would likewise not be directly affected by federal health care reforms. Critics argue that the Republican bill would have given states more freedom to cut funding to CHIP or Medicaid, which simply means making local legislatures, which are more attuned to the needs and challenges of their respective communities, responsible for maintaining their health safety nets. When the ACA guaranteed Medicaid for everyone within 133% of the national poverty line, it failed to recognize that that income can translate to vastly different qualities of life in different parts of the country. Local and state governments know the economies, health coverage gaps, and mentalities of their constituencies, and are far easier to hold accountable for their shortcomings. Reverting to the original federalist system our nation was founded upon would go a long way towards alleviating an ever more polarized political climate by allowing communities to manage their own safety nets and live by their own values.

The Risks Inherent

Kimmel’s reckless and manipulative emotional rhetoric does not stand up to the litmus test of reality. There is risk inherent in everything, including living. Thus, health insurance exists to protect against the unfortunate and often unpredictable human tragedies of genetic defects and illness. But, although the insurance model mitigates random risk, it is not meant to eliminate the consequences of personal choices. Recent research has suggested that the greatest determinant of health outcomes is lifestyle. This may explain why 5% of patients, who suffer from multiple preventable chronic conditions, account for over 50% of healthcare spending, leaving the rest of us to foot their bill. One way to disincentivize poor choices (such as smoking, drinking, or failing to exercise) is to allow for personalized insurance premiums. The AHCA does exactly that: by repealing “essential” universal health benefits and allowing for greater variation in premium cost for patients with costly, preventable conditions, the AHCA gives the power over healthcare costs back to the people. Moreover, by charging extra for lapses in coverage, it discourages social loafing by those who wait to purchase insurance until they fall sick. These reforms are not, as the critics have cried, a punishment for mothers or cancer patients — they are a core tenet of the insurance model, without which, none of us would be able to afford healthcare at all. Risky drivers pay more for car insurance, mountain climbers pay more for life insurance, and patients who make expensive choices should pay more for health insurance.

It is irresponsible of politicians and talk-show hosts alike to make heavy-handed assumptions and accusations without having all the facts at hand, especially in a sector like healthcare where lives hang in the balance. Returning the zeitgeist of American healthcare to a prior state which emphasized personal responsibility and choice over government intervention should not be confused with the defective straw-man argument of leaving infants out to die. Nevertheless, the Graham-Cassidy bill has failed thanks to the efforts of Kimmel, et al, who have tirelessly poisoned the public perception of a much-needed reform.

Kimmel’s reckless and manipulative emotional rhetoric, which seemed to suggest that Trump is coming after our children’s healthcare, does not stand up to the litmus test of reality. Obama, by passing the ACA, expanded medical benefits and subsidies to an unsustainable level, greatly contributing to a ballooning 20 trillion dollar debt and imperiling the future of American medicine. Those earnestly concerned for our children’s prospects are looking for ways to spend more efficiently and provide a lasting healthcare safety net, not shedding crocodile tears in hopes of gaining political points or viewership. Ultimately, Kimmel was half-right: the fate of our children does rest upon our ability to fix healthcare.