Cognitive Dissonance and Health Care

Crossposted from Democratic Convention Watch

I have wondered aloud for years why people vote against their own self-interest. People tell me various answers but none that have ever made enough sense to me. So here's this:

Cancer patient Kathy Watson voted Republican in 2008 and believes the government has no right telling Americans to get health insurance. Nonetheless, she says she'd be dead if it weren't for President Barack Obama's health care law. Source.

You might think that Kathy would, in 2012, be thinking of voting Democratic and changing her mind about the individual mandate. But no. She's a small businesswoman, and doesn't want the government involved in telling business what to do (especially where the individual mandate is concerned) but that she should be able to buy health insurance even with her pre-existing condition. She doesn't realize that insurance is a business, too, and her cancer-riddled body does not fit within their money-making model. Without the government telling the insurers they must cover her, they will not, at least not at any affordable premium cost.

There you have it, a woman who would be dead now if not for ACA, and she STILL supports the people who worked to derail it.

The overall article in which Kathy's story appears is about the people across America who will likely die if the Supremes gut the ACA. They are cancer patients, AIDS patients, cardiac patients, the elderly relying on medications for chronic conditions, and this is not to mention the people who become sick or injured afterwards.

And that doesn't even touch the problems that doctors will face. Consider:

Imagine you’re a physician, and you have a full schedule of patients to see the day after the Supreme Court has thrown out the entire Affordable Care Act. Imagine you never liked “Obamacare” in the first place, so you are feeling pretty good about the Supreme Court decision.

Your first patient, an elderly retiree named Mrs. Jones, comes in for her annual Medicare wellness visit—one of the new Medicare preventive benefits offered at no cost to the patient. But this new preventive service benefit was created by the ACA, so presumably with the ACA overturned, Medicare no longer is allowed to pay for wellness visits. Do you tell Mrs. Jones that Medicare might not cover the visit? Provide the visit anyway, hoping that somehow Medicare will find a way around the Supreme Court ruling and pay for it? Offer it at no charge, or try to collect the 20% you would collect for a normal (non-preventive) office visit?

 Your second patient, Mr. Jones, another senior, comes in for a follow-up visit for an ongoing chronic condition. You decide to renew his expensive brand-name prescription drug, knowing that he is eligible for a 50% discount because he has fallen into the Medicare Part D “doughnut hole.” Oh wait … the Medicare Part D drug discount was part of the now-defunct ACA. So does that mean he now has to pay full price? Do you prescribe the drug anyway, knowing he can’t afford to pay the regular retail price? Prescribe a lower cost no-name brand drug that he doesn’t tolerate as well?

I read articles like these and wonder: the Supremes have access to the same sources I do, so do they read any of these articles? I have read, tagged, and made notes, on my printed copy of the Affordable Care Act. While I cannot recite it from memory, I know a lot about the law, its structure, and its interconnections. I know that none of the Supremes have read it, that was discussed at the hearing. 

If I were a Supreme, and was making a decision that affected the lives and deaths of millions of people, I know I would take the time to read the legislation. To rule without even knowing what the legislation says is to rule blindly. I would do everything I could to not only listen to the people who testified in front of me, but also to research, and have my staff research, everything I could about the impacts related to my decision. While I would certainly cede to the rule of law, I would want to know everything I could about the base data. To do anything less is a complete disservice to all Americans and the rule of law on which this country was founded.

Why do I care more about Americans and their health than the Supremes do? 


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