I Wrote a Long Letter and Got Back a Post Card

I wrote the following letter, by hand, to Senator Robert Portman in which I attempted to articulate my concerns about healthcare policy and the importance of affordability.

I wrote to Senator Portman because I was fairly certain that our other senator, Mr. Brown is much closer to my position and because I believe it is important to engage in respectful debate.

It was not my intent to share this letter, but I was disturbed by the way the Senate bill emerged not as the product of the traditional legislative process of hearings and amendments, but by escaping from closed-door negotiations among a handful of members of the majority party.

That the finished product largely apes the House bill while delaying some of its more painful features until after the mid-terms are over speaks more to a commitment to job security than to the welfare of the governed.

I will say that I did receive a response to this letter which I will include at the end.  It was a particularly creepy response in that I hand-wrote the letter and got back an e-mail to an account I rarely use and the address of which was not included in the letter.

(Updated to reflect Mom's editorial comments.  Letter mailed 5/27/17.)

Dear Senator Portman:

I'm a new American, circa 2014, and a new voter.  I've lived in this country for more than 30 years, but it was only after a lot of hard work and saving that I was able to afford the attorney and other fees that would let me apply for citizenship.

I came here from Canada both because of the opportunities and because I had grown up watching Americans challenge themselves, rally to meet those challenges and then exceed their expectations all while my country seemed mired in questions of language and sovereignty and process.  We never seemed to be able to get anything done whereas Americans always seemed to be doing everything.

I came here ready and able to work hard and challenge myself.  I wanted to be a contributor, part of the team.

Unfortunately, my timing was not good.

I came in the mid-Eighties while the country was changing from a making country to a taking country.  I came at a time when people stopped wanting to be engineers and scientists and wanted to be lawyers and MBAs instead.  I came at a time when the future was changing from being limitless to being either a one or a zero.

One or zero; on or off; yes or no.

It was not long after I got here to attend graduate school that I saw a news item about an elected official proposing a Constitutional amendment to make English the country's official language.  It was like I had never left Canada.

But I stayed.

I stayed because I really wanted to teach, because I loved the work I was doing and because it felt like a grand adventure.  

Hard work, determination and a bit of luck and the possibilities are limitless:  isn't that the ideal?  Isn't that the headline in the national press kit?

Whoever developed that message deserves a raise because it's short, pithy and, to use a modern expression, "sticky."  It gets under the skin and becomes malignant.  If you weren't successful today, then you didn't do enough, weren't fast enough, weren't good enough and tomorrow you have do more, do it faster and do it better.

What is less apparent is that while one is busy focusing on one's adverbs, the goal line keeps moving.

I am not your core constituent.  I identify as a liberal democrat, but having said that, we do share some common ground:  I believe in hard work, I would rather pay my own way than get a handout and I am suspicious of regulation from whatever the institution.

Where we differ, I suspect, is on the concept of a common good.  

I do not believe this is a liberal concept, but rather one that is central to the concept of democracy.

If there is one thing that binds the country together, then there is more than one thing.  If we believe that a common defense is a shared value then we have to accept that there be some mechanism to pay for it.

That's an easy one.

As you go on down the list of things that are, or could be, shared, or common, values it gets trickier.

I understand that.

But I think that's why you have constitutions:  to remind you what we all think is important and what is worth fighting for.

I am sharing all of this because I want you to know that while much is expected from each of us, there are some things that are too big for an individual to handle on their own.  In just the same way that I cannot, alone, defend the country against all of its enemies, so too I cannot be counted upon to solve healthcare and provide for the protection of myself and my family--much as I would like to.

There is too much money in healthcare for any individual to change the system.  Why would it change for me, or for anyone else?  But, if there is research to suggest that our health outcomes per dollar spent are not comparable to other industrialized powers then should that alone not be reason for a stronger solutions-focus?  And by "solutions" I do not just mean reductions/elimination of public spending.  

The President has acknowledged that healthcare is a complex issue but addressing it has to be more nuanced than the binary public versus private insurance meme that permeates our conversation.

You no doubt know the numbers better than I, but there are a lot of people--my family included--who depend on the exchanges to make healthcare accessible.  I'm in my mid-fifties now but I still am not afraid to work and I still want to pay my own way.

I just can't.

Time and genetics have had their way with me and so I have had some health issues that puts unregulated private insurance out of reach.  Without healthcare and the access to more reasonably priced medications I would not be a contributing member of society and no longer be able to pursue the American Dream.

That's a choice that should not be forced upon any of our citizens, especially if it is within the nation's power to fix it.

I understand that there are powerful incentives to leave things as they are, or to make it the next guy's problem.  I understand that it is really expensive to get and keep an elected office.  I understand also  that America is about more than who has the deepest pockets and the loudest voices; it's about doing the right thing instead of the easy thing.  It's about staying when it's easier to leave, passing even though the net is open and "taking one for the team."

I'm about to lose my customer service job in part because I subscribed to the company's stated guarantee more than their monthly sales quotas.  It was my job to resolve the customer's concern about a product of service and I could not reconcile protecting their good will for the company with leading them to make a new purchase.  That's on me and so I cannot challenge them when they come to tell me it's time to go.  I did what was right for the customer.

Having come of age in Canada and socialized medicine and then been exposed to America's private insurance model, I have an obvious preference, but I know an "American" answer lies in some sort of a compromise.  My hope is that you are allowed the room to look for a honest compromise that celebrates life and the quality thereof over money and the quantity thereof.

Thank you for your kind attention.

The response:

Dear Graham,

Thank you for taking the time to write me with your concerns regarding reforms to our nation’s health care system. It is good to hear from you.

As you know, members of the House of Representatives recently passed a bill to repeal and replace the Affordable Care Act, otherwise known as Obamacare. This bill, the American Health Care Act (AHCA), replaces Obamacare with a market-driven health insurance system and makes significant changes to the Medicaid program. Since the AHCA has passed in the House, it now comes to the Senate for debate. 

I have already made clear that I do not support the House bill as it is currently constructed. My concerns that the AHCA does not do enough to protect Ohio's Medicaid expansion population, especially those who are receiving treatment for heroin and prescription drug abuse, remain unchanged. We have an opioid epidemic in this country, and I will continue to work with my colleagues on solutions that will ensure those who are caught in the grips of this epidemic can continue to get the treatment they need.

This said, we must not lose sight of the fact that, for many Ohioans, the status quo is unacceptable. Individuals and families continue to face higher health care costs and fewer choices for health care providers. Insurance companies, saddled with costly and cumbersome regulations, continue to pull their health plans from the individual market across the State. Small businesses continue to pay more money for insurance premiums that could have otherwise been used to hire more employees or provide better pay for those they already employ. Congress must provide solutions to these problems, and I look forward to working with my colleagues to do so. 

After seven years of increasing costs and decreasing choices under the Affordable Care Act, it is clear that the current course of our health care system is unsustainable. Ohio families who are struggling to pay for health care need relief soon. Our nation’s health care system is broken, and while changing such a large and complicated system is no easy task, I believe that such change is necessary to ensure affordable access to high quality care for Ohioans and Americans across the country for years to come. 

  Sincerely,
Rob Portman
U.S. Senator

 I understand that nobody wants to go back to the summer of discontent that preceded the passage of the ACA, but there has to be a better way than one side imposing their political philosophy on the other:  that's not governance, that's bullying.

I wrote a letter because I wanted to live my belief in engagement and compromise solution.  I got back a letter full of boiler plate language.

I heard a lot about American exceptionalism and the remarkable healthcare system that is the envy of the world.  Why then do we appear hell-bent on making active choices to put it out reach to so many of our citizens?

For me, there is no more important context to this issue than the inevitable march of time and the decay and failure of our health and prospects.  We will all need healthcare; some sooner than later, some more than others.  We have a common interest in getting this right for everyone and yet will "fix it" so only a tiny subset of us can pay the cost of their own care.

To borrow from another transplant to these shores, "America:  what a country!"