fresh voices from the front lines of change







I am not a burned down house. Like millions of Americans, I have a “pre-existing condition.” But I am not a “burned down house”, as Mike Huckabee and those who applauded his recent statement seem, to think.

When Republicans attack health care reform, Democrats like to counter by accusing Republicans of wanting to repeal a law that requires insurance companies to cover people with pre-existing conditions. According to Republican Presidential hopeful Mike Huckabee, that’s exactly right. People with pre-existing conditions, he explains are like houses that have already burned down.

“It sounds so good, and it’s such a warm message to say we’re not gonna deny anyone from a preexisting condition,” Huckabee explained at the Value Voters Summit today. “Look, I think that sounds terrific, but I want to ask you something from a common sense perspective. Suppose we applied that principle [to] our property insurance. And you can call your insurance agent and say, “I’d like to buy some insurance for my house.” He’d say, “Tell me about your house.” “Well sir, it burned down yesterday, but I’d like to insure it today.” And he’ll say “I’m sorry, but we can’t insure it after it’s already burned.” Well, no preexisting conditions.”

As pre-existing conditions go, mine is not immediately life-threatening. But as is the case with millions of other Americans, my condition is not difficult to treat – but it can be deadly if untreated.

I’ve written about it before, but I am one of about 25 million Americans who suffer from gastroesphophageal reflux disease (GERD).

With normal digestion, a circular band of muscle located between the esophagus and stomach widens to allow food to enter the stomach and then tightens.

But when this muscle, known as the lower esophageal sphincter, weakens or relaxes inappropriately, acidic digestive juices in the stomach can flow back up, or "reflux," into the esophagus. Unlike the stomach, the esophagus does not have a protective barrier against the acid.

As a result, reflux can cause irritation, inflammation and other damage to the esophagus that is often perceived as heartburn, an uncomfortable, burning sensation behind the breastbone.

It is far more than just heartburn. In my case, I was diagnosed after my husband noticed that as many as two or three nights per week, I was getting up at night and going to the bathroom to vomit. He urged me to see a doctor about it, and I did. (Don’t ask me why it didn’t occur to me to go to a doctor. I guess that’s an example of why married people live longer.) One barium swallow and upper GI endoscopy later, I was diagnosed with GERD due to a hiatal hernia.

Since my diagnosis, I’ve made what changes I can to reduce my symptoms. I’m not obese. I don’t smoke. I don’t drink, and I avoid spicy foods (which I never liked much anyway). I eat smaller meals, and stop when I start to feel full. And I cut out any snacks a few hours before bedtime.

I got my diagnosis, and a prescription for medicine to help because I had health insurance. And my case appears to be progressive. I tried over the counter medicines until they no longer worked, and have had to change prescriptions each time I’ve experienced "breakthrough symptoms" indicating that my medication was no longer doing the job. I can do that, because I have health insurance. Otherwise, my story could have been more like this guy’s.

Baking soda nearly killed an elderly man. He was using it to relieve the stomach pain caused by an ulcer, but went way overboard with the home remedy.

After slipping on a children’s toy, the retired gentleman could not get back up. Paramedics transported him to Cooper Hospital in New Jersey. En route, they noticed that he was short of breath and picking at his side for no apparent reason.

In the emergency room, the patient was completely incoherent. He looked disheveled, underweight, and could not tell them what year it was.

…Once the patient was stable, the doctors questioned his niece. She had found several empty boxes of baking soda at his home and explained that her uncle, who lacked health insurance, had been using it to cope with severe indigestion.

With an understanding of what went wrong, the doctors gave the patient fluids and potassium, which invigorated his kidneys. Slowly, the problem fixed itself.

How I came to have GERD is due to a number of factors, including biological and structural factors. But I tend to think that, at least to some degree, I inherited it from my dad. (The video above suggests that it may be genetic in some people.) He very likely had GERD. As a child, I remember him drinking Alka-Seltzer and taking Tums just about every evening, after dinner. He didn’t get it treated, probably because he didn’t know he had anything more than heartburn. At the time, I don’t remember any talk of GERD let alone diagnoses, or medicines to treat.

My dad never knew his symptoms were related to anything more than heartburn, and probably never mentioned it to his doctors. The problem is that doctors can’t treat what they’re not told about. And left untreated, GERD can lead to esophageal cancer.

Over the long-term, uncontrolled GERD can cause worrisome complications. One is esophagitis, an inflammation and erosion of the esophagus resulting from stomach-acid damage. Another is esophageal stricture, in which scar tissue causes the esophagus to narrow.

In rare instances, a condition known as Barrett’s esophagus, which is marked by changes to cells lining the lower esophagus, can lead to cancer.

Statistics show that men are about twice as likely as women to develop esophagitis and nearly 10 times as likely to get Barrett’s esophagus. And whites are at greater risk for Barrett’s esophagus and esophageal cancer than non-whites.

The reasons why some people with GERD develop esophageal cancer are still being researched, but some studies point to enzymes and others to genetics. But in one year (2008), some 16,000 people were diagnosed with it, and 14,000 of them died of it. In 2006, my dad died of it.

He wasn’t a burned down house, either. He was veteran of two wars – Korea and Vietnam – who save more than 20 years of military service two his country, raised three kids, went to work every day until his retirement, helped his adult children in countless ways, adored his grandchildren, loved and stayed faithful to the woman to whom he was married for more than 50 years, right up to his death. Neither are my mom and sister, both breast cancer survivors – one who wants to be here for her four children, and one who wants to be here for her children and grandchildren. They aren’t burned down houses either.

I am not a burned down house. I’m a husband and father who wants to be here for my family, to kiss "owies," dry tears, help with homework, attend graduations and weddings, and someday spoil my grandchildren.

I am not a burned down house. Neither are the millions Americans with pre-existing conditions, whose stories are just like mine and family’s.

According to the American Heart Association, more than 81,000,000 Americans suffer from one or more forms of cardiovascular disease. According to the American Cancer Society, more than 11,000,000 people in America currently suffer from some form of cancer. According to the American Diabetes Association, 23.6 million Americans currently suffer from diabetes, and the Center for Disease Control has estimated as many as half of all Americans will suffer from the disease by the year 2050, thanks to our deplorable dietary habits. According to the National Parkinson’s Foundation, between 50,000 and 60,000 new cases of Parkinson’s Disease are diagnosed in America each year. According to the National Multiple Sclerosis Society, some 400,000 Americans currently suffer from MS.

That’s a pretty substantial portion of the population, with more being diagnosed with cardiovascular diseases, cancer, diabetes, Parkinson’s and MS every day.

All of them, every single one of them, are like a house that has already burned down, according to Mike Huckabee and the sick bastards who cheered his comments. All of them, every single one of them, are not worthy of health insurance because they had the misfortune of getting sick before they got insurance. All of them, every single one of them, therefore, are not worthy of health care in any real form, unless, of course, they are wealthy and able to afford the staggering cost of ill health in America.

All of them, in short, every single one of them, can basically just go die in Mike Huckabee’s world. They are not worthy of coverage, treatment or consideration. The five diseases I listed account for well over a third of the American population, and if Mike Huckabee or someone who agrees with him somehow becomes president someday, those millions of people should just dig their own graves and lie down in them.

Last year, I spent about seven posts exploring the morality of health care reform. And here Mike Huckabee sums the morality of the opposition to health care reform in just a few sentences. Those of us, those 81 million of us with pre-existing conditions, are not worthy of coverage, treatment, or consideration. It would be better, cheaper, and quicker to take us "out behind the barn" and shoot us.

What becomes of us if people who agree with Mike Huckabee take over congress? What happens to Americans who will benefit from the parts of health care reform that just went into effect?

As of today, insurance companies can no longer deny insurance to children with pre-existing conditions-the young people who are ill and need insurance the most. As many as 5 million children fall in this category.

As of today, insurance companies can no longer drop people from coverage when they get sick because they made clerical mistakes on their applications.

As of today, insurance companies will no longer be allowed to drop children from their parents’ health insurance plans after they reach 21 or graduate from college, unless they are offered coverage at work. About 1.6 million young adults between 21 and 26 will go onto their parents’ policies.

As of today, insurance companies will be prohibited from placing lifetime caps on health coverage.

As of today, insurance companies will be restricted in their use of annual limits on coverage and will be banned completely in 2014.

As of today, insurance companies are required to cover recommended preventive services with no out-of-pocket cost for patients and with preventive services exempt from deductibles.

As of today, employer-sponsored health plans can no longer establishing any eligibility rules for coverage that discriminate against lower- and middle-income employees.

On the right, the mantra is "repeal and replace," but Matt Yglesias paints a picture of what that will really look like.

To review: As of this week, insurers will be unable to refuse to do business with children. Insurers will also be unable to impose arbitrary lifetime caps on benefits. And insured parents will be able to keep adult children on their plans up to the age of 26. This is a downpayment on the eventual transition to a system in which nobody will be denied coverage on the basis of a pre-existing condition. Which is to say that the system of health insurance for people under the age of 65 will at last do what Medicare has done for seniors for decades-actually guarantee that if you get sick you won’t need to shoulder the entire financial burden yourself.

Existing insurance policies are supposed to do this, but not only do many people lack insurance, many who are insured find that when disaster strikes suddenly, the insurance vanishes. That’s a business model that’s made insurance executives loathed, but it’s inherent to the economic logic of the current system, a logic that the ACA> will upend with its system of subsidies, regulations, and-yes-the dread individual mandate to make everyone buy health care.

The system is, however, under grave threat. It’s unlikely that a new congressional majority will literally repeal the law in one fell stroke. Their plan instead is to fatally wound it. The law is a fairly intricate quilt of popular ideas, and not-so-popular ideas that are necessary to make the popular ones work. By picking away at the unpopular planks in an unprincipled way while pretending not to realize the consequences of these actions, a GOP Congress could ensure that by the time the full ship launches in 2014 it won’t be very seaworthy. Then they can ride the ensuing backlash to victory and be in a position to finish off repeal.

Never mind that a majority of Americans oppose repealing health care reform, and those who wish it went further outnumber those who don’t by 2 to 1. What they replace it with, if anything, is anybody’s guess. But this summer the GOP presented a health care "reform" plan that ignores the uninsured and offers nothing for those with pre-existing conditions. No surprise that it was practically written by the insurance industry. No surprise that, in the world as Huckabee and his supporters think it should be, if I lose my job and/or lose my insurance I’m out of luck. In fact, I’m dead. And I should be.

After all, what do you do for a burned down house? Answer: Nothing. You knock down what’s left, bury the ashes, and walk away. It’s not worth saving.

What do you do for millions of burned down houses? Answer: Nothing. They’re not worth saving.

Correction. We’re not worth saving.

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