Have you heard of Lane Goodwin? He’s an amazing kid in a tragic situation: he was diagnosed with Alveolar Rhabdomyosarcoma stage III in 2010. Since then he’s gone through dozens of weeks of chemo and radiation, at one point the cancer had cleared up, and more recently things relapsed when 13 tumors were found. While going through more treatment Lane has become something of an international celebrity. Around the world, people have been inspired by his indefatigable attitude and just as often by the other supporters; Lane has an incredibly active facebook page and has even appeared on Ellen DeGeneres.
Maybe you already know this, but I’m a grouchy cynic who is skeptical of the idea that public outpourings and charities like this even have a net positive effect on outcomes. All the same, I can’t help but be overwhelmed by the shear number of heartfelt people willing to give their time and even money in support of someone they hardly even know. It’s seriously touching. Here’s what I want you to think about, though:
Let’s say (I have no insight into the finances or healthcare of the Goodwin family – this is hypothetical) that Lane had been diagnosed in 2007 with Alveolar Rhabdomyosarcoma stage III. Whether or not his parents had good health insurance, Lane and his family would have been in an extremely precarious situation. If Lane had hit his yearly cap on medical expenses, the money that many people would donate to Lane would have been the difference between life and death. Rather than deciding to promote Lane’s hopefulness and strength, Ellen DeGeneres would have decided to help raise funds so that Lane might actually survive (or, perversely, if she declined his appearance on her show, she would have declined to help his chances at surviving). Lane’s mother on his website says “We will do whatever we have to in order to save our sons life!!” And you know she means it. But in this situation, in the US in 2007, that might mean frantically raising money and making tough financial decisions about what they would be willing to sacrifice so that Lane could continue to receive care after his yearly cap had been reached. Would they have to tap into his college fund? The money they'd been saving for a new house once they have another kid? Their retirement fund? Which would they be willing to deplete first?
Of course, a number of other similar situations could have transpired: Lane could have reached his lifetime cap, his parents' insurance company could have found a flaw in their application (maybe an infection from a tick bite they forgot to mention) and thereby saved thousands or perhaps millions of dollars by rescinding coverage, or his parents could have lost their jobs and their access to health insurance (maybe they missed a payment during an especially rough month) so that no insurance provider would accept their family now that Lane had been diagnosed.
Every year, kids find themselves in a situation similar to Lane, except that their moms probably aren’t as good at building facebook campaigns and they probably aren’t as photogenic or inspiring. What happened to these kids and their families in 2007? Many were put in the exact situation I describe and those that weren't had to worry constantly about it. However, starting in 2010 when the Patient Protection and Affordable Care Act went into effect, annual limits, lifetime limits, rescinded coverage, and rejection for pre-existing conditions were all eliminated for children; those regulations will apply to all Americans in 2014. Yes PPACA is messy, but PPACA means that no family will ever have to raise funds for their life through charity so that someone they love might survive. This doesn’t mean that Lane’s parent’s have it easy. It doesn’t mean that his healthcare is cheap or free (remember, Republicans and ‘moderate’ Democrats rejected those options – single-payer, the public option, or other truly universal plans) but it does mean that the demands on Lane’s family are now significantly less extreme.
Yesterday, Nate Silver updated his presidential forecast model. His model, the prediction markets, and vegas now agree that there is roughly a 30% chance or better that Mitt Romney will be elected President. I’m pretty freaked out about this prospect and one of the reasons is that I’m concerned about kids like Lane. Romney and the Republicans in the House and Senate have sworn to repeal PPACA and literally none of them have offered a plan to restore these regulations. The Republicans even mounted a campaign against the constitutionality of the individual mandate, which allowed these regulations to exist without exploding healthcare costs. Let me make sure that is crystal clear: if the Republicans had gotten their way, the protections in PPACA would not just have been repealed but would have been virtually impossible to implement in the future – and 4 (all Republican appointed) out of 9 judges ruled in favor of this outcome.
What troubles me even more than the fact that Mitt Romney might win is why he might win. It seems like a huge fraction of Americans (maybe even a majority!) are okay with placing kids like Lane and their families in one the worst situations imaginable: where insurance companies would have to be fought and charity begged for in order to give a family member the chance to live.
I want everyone I know to wake up. I want everyone I know who has ever told me that it doesn’t make any difference who gets elected, that both candidates are the same, or that they just don’t trust Obama as much as Romney, to explain to me personally how those things could be consistent with the situation in which Romney and the Republican party would put Lane and his family.