Lessons in leadership and work from the AHCA mess, plus a letter to my congressman

Well, last week was interesting, wasn't it?

I want to start with some thoughts on Obamacare, and the reason I want to do that is so you don't think I'm a cheerleader.

The Affordable Care Act ("Obamacare") is not perfect. It's barely even good. It did a couple of good things, like making sure anybody who wanted health care could get it, and made sure that if you had a preexisting condition, you could get a policy.

It's also way too expensive for most of us in the middle class (I say most of us, because I think some people who think they're paying too much would be paying way more on the open market, if they could get insurance at all). It's harder to figure out what's going to be covered under my plan — I can pick a doctor in my network, but it takes a lot of work to figure out which tests (if any) are carried out by labs in my network.

The deductible plans under Obamacare are ludicrous. Ten years ago, insurance cost me about $160 a month. If I went to the doctor, I paid $10 and insurance covered the rest. If I went to the eye doctor, I paid $20 and insurance covered the rest. If I got glasses, insurance covered roughly the cost of basic lenses and I was responsible for the frames and any lens upgrade I might want.

Now, it costs about three times as much for insurance (granted I'm older and I have a second person on my insurance and there's been inflation). But the kicker is, the first $5,000 of in-network care comes out of my pocket, outside of one physical. The insurance company negotiates down the cost of care, but doesn't kick in anything except a physical until I've spent over $10,000 (the cost of insurance plus the deductible).

Obamacare, in other words, is not amazing. But it's what we have, so that's where we have to start from.

Here's the thing: In all the years since we've known Obamacare isn't amazing, nobody's bothered to start writing something amazing.

And then Donald Trump was elected president, with one of his major campaign promises being to repeal Obamacare.

If anybody had been doing one iota of real work on health care over the last seven years, we would have had some idea of the basics of a new plan that could have helped us move forward.

There are plenty of career politicians in both houses of Congress — people who would certainly have been around to reap the benefits of their work whenever it came to fruition.

Not that that's why you do it. Remember, you're entitled to work hard, and that's basically it.

Instead, what we wound up with was a quickly-hacked-together piece of legislation that some people were affectionately calling repeal and go fuck yourself.

This is not what you get if you spend seven years putting together a good foundation and then refine some of the details. It's what you get when you assume that people fall in line behind you instead of actually asking them what they want.

It takes 218 votes to get a piece of legislation through the House. It has to be a pretty good piece of legislation, then, not something that gets hacked together.

Lesson One, then, is do the work.

Lesson Two is work with your colleagues.


Two more lessons learned came straight from the top.

Lesson Three: Don't give ultimatums. The president told the House to pass the bill or forget about it. Trump's been in office just over two months, and he left everything on the field on health care? That's even an insult to athletes who actually go out there and leave everything on the field.

If you leave everything on the field, you focused on nothing but this game, gave it everything you had, and are so exhausted at the end that you'll have to deal with the emotion of the result later. For now, all you can do is scrape yourself together and try to pull off your shirt so you can get off in the shower.

Not one of those things describes anyone in the legacy of the AHCA.

Lesson Four: Take some responsibility. And even if you don't control the whole process, understand who can actually help you. If instead you're angry at your son-in-law for being off skiing with your daughter and your grandkids, you clearly don't understand that your son-in-law's job is basically to say what he thinks should happen and hold your hand when things don't go your way.

Jared Kushner doesn't write policy and he doesn't vote on it. And frankly, if he didn't think this was a battle worth fighting, that's his business, not yours.


This is the letter I wrote to Congressman Buddy Carter on Sunday after I received his weekly newsletter. I'll update when I get a response. He only accepts email from his constituents, so unless you're in the first Georgia district, you can just read and enjoy (or whatever).

Congressman Carter,

You write in your most recent email to constituents (March 26, 2017) that "Obamacare is a disaster," and you list many reasons why that may be true.

You also blame a "small number of [your] colleagues in the House" for failure to pass the AHCA.

If a small number of your colleagues were against the AHCA, it would have passed -- at least 218 of them must have been against it.

The problem with dwelling on the faults of Obamacare is that you create no solutions.

Obamacare was always imperfect, and nobody -- Democrat or Republican -- has tried to fix it or work out any of the kinks in the past seven years.

The proposed version of the AHCA failed because the president rushed together a new bill and tried to bully it through the House with a "pass it tomorrow or forget about it" dictate, rather than spending the time working with a majority of the House to write good legislation.

It's going to take some time to write good legislation. If it means gut Obamacare and start over, then do that -- don't just pick apart what you and your colleagues don't like and hope it works out.

Look, I am a healthy 40-year-old man with a healthy wife and so far no children. That makes me fairly immune from whatever comes down the pike over the next few years; even if we're blessed with a child or two, we're in pretty good shape.

My parents are not getting any younger, and their premiums are way too expensive under Obamacare, but they would not have been eligible for coverage under the previous system because a bad back or a previous rotator cuff surgery would have been flagged as a preexisting condition.

We're not sure what would have changed for them under AHCA because nobody bothered to tell us what's in it, other than, "it's better."

I want you to understand something, before you read the rest of this letter. I'm a writer by nature, and do a fair bit of writing by trade. I have a vocabulary roughly three times that of the average college graduate. I say that because the words I'm going to use are very strong, and you should know that I'm picking them purposefully. Ready?

Get it the fuck together.

Your constituents know Obamacare isn't working. We're subject to it, unlike you and your colleagues who have federal health care.

You're not struggling. We are.

You don't have to tell us "Obamacare is a disaster." In fact, we'd really like it if you found your own descriptor. We've heard that one before. Chernobyl was a disaster. By that metric, Obamacare is at best annoying.

While you're coming up with words, try some that mean something. Here is what you said about AHCA in your email: "The legislation contains the critical reforms necessary to deliver relief and a patient-centered health care system with the choice and control needed to empower patients. "

In case you need someone to translate your fancy speech for you, that says, "AHCA contains changes that will give patients power."

Give me some details, please.

You don't fix a broken system by calling it a disaster and then hoping you can speak vaguely enough for long enough that people will cheer for the new one.

Do some fucking work.

I know it's difficult. Remember that you are a public servant. You represent us, but you work for us. It's not the job of your constituents to make you feel great about yourself. It's the job of your constituents to ask you to do great things, even if it takes sacrifice and hard work.

Even God never promised us the fruits of our labor, only the labor itself.

Now, take a deep breath, then decide to take some responsibility for working together with 217 (or more) of your colleagues, to write some legislation that's good for your constituents instead of your reelection campaign.

Yours,
Joshua Shear
Savannah, Georgia

I promised to update this if and when Rep. Carter responded, and I did get an email from him on April 7. I'm just going to paste the letter in and let you infer my reaction.

Thank you for contacting me about the urgent need to rescue America’s failing health care system.

As a lifelong health care professional, I have seen first-hand the devastating impact Obamacare has on health care in America, especially in South Georgia where I served patients for more than 30 years. This misguided law has driven up costs, taken away choices, and inserted Washington bureaucrats in to one of the most personal aspects of our lives: our health. It contained $1 trillion in new taxes, kicked 4.7 million Americans off their health care, and created a new class of uninsured with 19.2 million Americans who could not afford the coverage offered them.

I supported the American Health Care Act, which was our plan to rescue patients and families from the Obamacare train wreck. While imperfect, it put aside the failed policies of the past and built on the best ideas from around the country. The nonpartisan Congressional Budget Office confirmed it would lower costs and empower patients to make their health care decisions. I was disappointed this bill was not brought to the floor for a vote.

Please know that this is not the end. I will not stop working until we empower all patients with access to quality, affordable, patient-centered health care.

Thank you, again, for contacting me and for the benefit of your input. It is an honor to represent you in the United States Congress.

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