Today marks the second anniversary of the passage of the Affordable Care Act. Not everyone is throwing a party. Detractors, who disparagingly refer to the law as "Obamacare," are hoping that next week's extraordinary three days of hearings on the legislation by the U.S. Supreme Court will serve as prelude to a judicial override that shrinks the entire enterprise down to a historical footnote.
Now you Bay Area folks, in the heart of the heart of Blue Territory -- let's face it, most of you are rooting for the legislation to prevail like you cheered on the Giants versus the Rangers in the World Series. Because the debate over the law has become something much more than an argument over a specific policy. Opposition to the act among Republican politicians is virtually mandatory, and its fate feels like, at least, a proxy for the success or failure of the entire Obama presidency. Furthermore, opponents' extreme interpretations of the law's provisions and their eventual effects are indicative of not just the gaping partisan divide, but an almost metaphysical chasm between two distinct sets of Americans.
Which all serves as our introduction to interviews that KQED's Sarah Varney conducted when she traveled outside the Blue Bubble to Madera County, "a largely conservative and agricultural area where one in every three people lacks coverage," as she reports on our State of Health blog. "While many people say they want the Supreme Court to throw out the federal health law, I found that many there are struggling to reconcile their political views with the basic need for health insurance."
As web extra -- since many of you may only hear conservatives explicating their opinions when your in-laws are over for Thanksgiving and someone mentions global warming and then it's "Hey why don't we all settle down and turn the football game on, it's THANKSGIVING for God's sake!" -- we're posting three extended if edited transcripts from Sarah's conversations with the folks in Madera County, as they explain their feelings about the health care bill. All three live in Oakhurst, a southern gateway to Yosemite north of Fresno; and all three are both uninsured and opposed to the law to one degree or another. Here they are...
Paul Ruffino, age 55
I’ve been involved in the hospitality business for 35 years at a corporate level and have always had full insurance benefits, major medical, vision, dental, the Cadillac of all packages. This last year I left my job and it was the first time I left without having another one because I was trying to decide what I wanted to do in my old age. I went on COBRA and that ran out. Now here I am at a more independent job, less of a corporate environment, that doesn’t have those insurance benefits. So I am looking.
I’m uninsured! It’s the first time in my life and it’s probably when I need it the most. I ‘m looking at AFLAC, but its very expensive. I was an athlete in college and I'm riddled with pre-existing conditions. So I’m out and about finding policies that wont accept things that I have… in my ankles, knees and my hurt back.
I’m an old-school libertarian. I get frustrated sometimes when I see government putting their fingers all over it and then I sort of wonder if they have to. I wonder if we can leave it up to individuals and companies and the doctors to sort it out. Because you start getting involved in profit motivation then you effect everybody’s health.
What I find in government is lack of accountability. In corporate America, lack of accountability will get you fired. And all I’ve ever seen now is passing the buck, regardless of who comes in. The Democrats, Republicans, there’s no delineation anymore. That’s why I’m on the Ron Paul bandwagon.
I was a Democrat until Reagan, then Republican, then back and forth with being an independent. Now I'm libertarian.
On being uninsured and his feelings about the law
It’s not either/or for me. They hide these things. I started to do research on Obamacare and all these things and there’s so much other pork they put in there. I distrust government.
Do I make the government responsible for my choices? I didn’t leave my world and then turn around and say 'oh my god this is happening to me.' I knew beforehand. I have to be responsible for my own decisions.
Would I like to be better? There’s a greedy part of me that says I would. I believe there are people and Americans who need health care a lot more than I do because ultimately the bottom line is I can afford it.
My concern is for people who can’t afford it. And that’s where I have to ask: Does there come a time when government has to get involved and at what levels? But when you are distrustful of the system it makes it difficult. I ping pong on this all the time.
It comes back down to accountability. Our parents used to be responsible for us. Now parents blame everybody else. I think a lot of it has to do with education. We spend a lot of time educating people about sex, abstinence. The problem is we don’t educate people about insurance. It's never talked about until people are in their 30s, 40s. So I think there’s a little bit of a wake-up call, saying this needs to get talked about soon. Knowing insurance and knowing your responsiblities are as important as telling kids about safe sex.
I have eight children – seven daughters and one son – and my children knew about insurance by the time they graduated from high school. The system we have is sufficient if we have the information. Absolutely. It works. It really does work.
I do think companies have to be held accountable. They shouldn't be allowed to cherrypick. Banks don’t let it happen in the private sector. If a company buys mortgage papers, they can’t buy all A paper. They have to buy the B,C, D paper in order to maintain their licenses. You could say if you want to operate in this community as a licensed health insurance, you must have a certain spread in your portfolio.
The cost is kind of crazy. Is it irrationally crazy? No. To fix it, you have to get people to participate.
I don’t anticipate change. I don’t see it getting better...
Joe Stern, age 66
I own Joe Stern Water Conditioning. I only have two employees so the rates are pretty high. I offered it but they’ve elected not to take it. For myself, I’m on Medicare and I have a Medicare supplement through Kaiser. Before Medicare I had Kaiser, and I just paid for it.
When I went on Medicare, I was paying $670 a month as a single person. And I consider that pretty high. And that was without dental or glasses. So I just paid my dental out of pocket.
I thought it was pretty brutal but I was still against Obamacare by far. Because I saw how they did it in the middle of the night. It was just not how you do a radical change like that. You do it slowly so you don’t make mistakes. You study it. But you don’t say we’re going to find out what’s in it after we pass it, like Nancy Pelosi said. That was unbelievable.
I’m totally against the mandate. You can’t make someone buy anything. So I think that’s terrible. The only reason they’re doing it is cause they can’t pay for it any other way and it’s just a horrible bill in every way. There’s nothing good about it. It doesn’t even insure more people like they promised. And by the way, I just read an article in the Wall Street Journal that the cost has doubled from what they predicted.
Our Congress is not qualified to make a law like that. When have they ever done any big change that came out good economically?
What do you think about Medicare?
(Laughs) Well, yes, but it looks like we’ve got trouble coming up…
I think we should always have a safety net for people, and I always thought we did. Why did we need this big cumbersome program that no one really likes except the most liberal people? Or people who just like Obama no matter what…
I think we have a safety net in the United States. When they were trying to get the health care bill passed, Obamacare, they said we’ve got 60 million uninsured. A lot of that may not be true. A lot of the uninsured don’t want insurance, like young people. They don’t think they need it. And a lot of people are qualified, for Medi-Cal for instance, and they just haven’t gone out and gotten it.
I don’t know of anyone that was left on the street to bleed to death. Unless they were some drunk. I don’t know anyone who was really left out.
Is it important that everyone have health insurance?
No. It’s important that everybody who wants it should get it competitively.
I think you get competition by… you don’t have the state lines when it comes to coverage, put it out to bid, use economies of scale to get it competitive.
But mandates? No. I’m a capitalist. I’m a free-market guy. I’m not for government control. Or anything government does.
I’m glad I’m on Medicare, okay? I paid into it since I was a kid. And I’m glad I’m on it, it’s a good plan. Social security is a good plan, but where was that money? It wasn’t invested properly. Government that governs best governs the least.
I don’t think it was good that Obamacare eliminates pre-existing conditions. If you’re unhealthy, you should pay a little more. It's only fair. Otherwise the healthy people are paying for the unhealthy and that’s more like the socialistic thing which I’m not really in favor of.
Maybe a little bit. I am a compassionate person. At least I’m trying to be. I don’t want anyone suffering, and I love people.
But still I just don’t think that works very well. It costs way too much. A lot of people just milk the system. If everything were free, then every time you go to a hospital, an aspirin would go up to $17. People would be going there all the time. People would be hanging out at the emergency room. That’s how I see it. Welfare Cadillac. That’s what I’m worried about.
We need to really qualify the needy people who do get government assistance. They need to make sure they qualify… not all addicted to drugs, buying drugs, not been on welfare for generations, driving Cadillacs... then I’m all for it. But it wouldn’t be no 60 million people.
I try not to follow things too closely… I was guilty of watching Fox news and hanging on to every word for awhile. Nah, why should I just be miserable?
ObamaCare is absolutely horrible, horrible, horrible. It should be struck down immediately and I hope the Supreme Court does it. It's just terrible. The way they did it, in the middle of the night, promised it would be on CSPAN, he lied… Reid, Pelosi, pathetic… Romney has a good chance of beating Obama But as a Republican in California, I don’t get a say in the presidential election. Around campaign time, I write letters…
Do you know many people who are uninsured? My daughter is on Medi-Cal; she’s getting ready to gradate; we didn’t have to pass ObamaCare for her…
I’m a self employed artist-businesswoman… I make purses and luggage and I sell them at street fairs and art and wine festivals. I’ve been divorced for 17 years.
When I was married I had insurance through my husband. Since we got divorced, I was self employed, I just couldn’t afford it. I couldn't afford the premiums. I was flying by the seat of my pants every inch of the way.
I’ve only been the doctor or hospital on an emergency basis so I just have to take care of myself. I haven’t been getting regular pap smears, mammograms. I won’t qualify for Medicare for awhile…
I registered as a Republican, but I’m really going to vote the candidate.
You can’t make people who don’t have money buy health insurance, because they can’t afford it. It will just break them. It’s the most ridiculous thing I’ve ever heard.
What about the subsidies that people will get to help people buy it?
Really? No, never heard of that.
If people knew more, would that shift their position on the law?
I think it’s really daunting. For my job, I make money three-quarters of the year and when I don’t do shows, I have no income. People who have families, I don’t know how they could fit one more thing in.
I thought about applying for Medi-Cal, but I have a ROTH IRA, and I think you have to exhaust that.
Moving toward a government subsidy is not a bad idea; it's worked in other countries, but I don’t know if it’s going to work here because our country is too big and we’re in debt. I don’t know what the answer is. I’m just hanging on by the seat of my pants and hoping I stay healthy.
What would you like the Supreme Court to do?
In theory, it sounds like a good idea that they uphold it. I’m sure that if the Supreme Court sees that its going to work and it can be implemented, I think that’s probably the right thing to do. And it’s not going to take place immediately. I don’t know if it will ever impact me.
To me, insurance right now is just too daunting. It’s as much as I pay for rent, if I had to insure myself. If it were subsidies, if it were made, you know, manageable, I would want that. And I don’t know how people who can afford it can sit there and say that we shouldn’t have that. Because there are a lot more of us, than them. So…