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The Smile: Trading lives for premium rebates and tax reductions

June 22, 2017
by Ron Manderscheid, PhD, Executive Director, NACBHDD and NARMH
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On Thursday, the Senate released its healthcare bill. This bill was crafted in deepest secret—no input, no hearings, no nothing. Yet, the shroud hiding the underlying calculus has disappeared like the smiling Cheshire cat of yore. All that remains is the smile.

This is not the smile of kindness, but rather the sly, smirky smile of deceit—the smile of someone who feels that they have successfully deluded and tricked their opponents.

What is the trick? It is one of the oldest in the playbook: bait and switch. The Senate crafted a bill in the name of repealing, replacing and allegedly improving "Obamacare." The actual purpose was to make hundreds of billions of dollars available for premium rebates for the healthy and tax reductions for the wealthy.

This is an egregious violation of the simplest social-justice principles, as I have argued many times in the past. It simply is unacceptable to rob those who are poor, disabled or older of their access to essential health insurance—to rob them of their constitutional right to life—in order to reduce insurance premiums for those who are young and healthy, and taxes for those who already have access to excessive wealth. The youngest child among us would recognize this as a morally unacceptable course.

However, rather than simply focusing on the loss of health insurance for literally millions of Americans, let’s also look ahead to decry some more distal and reprehensible social consequences. Here are just a few of these untoward effects:

  • Flooding of our hospital emergency rooms, perhaps to the point of being overwhelmed, with hundreds of thousands of new cases, yet without adequate funding for charity care.
  • Spiking mortality rates, with a national loss in longevity, due to the removal of essential prevention and treatment services for groups at high risk of catastrophic illnesses.
  • Unprecedented growth in the numbers of persons who are homeless and mentally ill due to lack of essential care.
  • Continued escalation to ever more dizzying epidemic levels in the number of opioid overdoses and deaths.
  • Continued unprecedented growth in our jail and prison populations who suffer from mental health, substance use and developmental conditions.
  • Rapid decline of our national health and behavioral healthcare systems due to abrupt withdrawal of trillions of dollars.
  • And this list goes on and on.

Clearly, this future is not only untoward; it simply is unacceptable to reasonable people. Unfortunately, however, I suspect that many of our senators don’t actually understand that their actions will lead to these disastrous effects. They are far too concerned with premium rebates and tax reductions.

That is your cue. Your time for greatness has arrived.

We need a national outcry right now—today—in response to this crass deception. Think of someone you know who will be harmed—even killed—by these actions: Your neighbor who is barely making ends meet; your friend who is advancing in years; your colleague who has a disabling condition. All are at very high risk under the Senate plan.

Even if you have never lobbied for a single thing in your life, now is your time to shine. You can take up your personal torch today for compassion, decency, and equity.



Ron Manderscheid

Exec. Dir., NACBHDD and NARMH

Ron Manderscheid


Ron Manderscheid, Ph.D., serves as the Executive Director of the National Association of County...

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