UPDATE x2: Obamacare and The Last Airbender

About a decade ago, there was an excellent animated TV series on Nickelodeon called Avatar: The Last Airbender:

Avatar: The Last Airbender takes place in a world that is home to humans and hybrid animals, adjacent to a parallel Spirit World. Human civilization is divided into four nations: the Water Tribes, the Earth Kingdom, the Fire Nation, and the Air Nomads. Each has a distinct society, wherein people known as "benders" have the ability to manipulate and control the element of their nation using the physical motions of martial arts. The show's creators based each bending style on an existing Chinese martial art, leading to clear visual and physical differences in the techniques used by Waterbenders (tai chi), Earthbenders (Hung Ga kung fu), Firebenders (Northern Shaolin kung fu) and Airbenders (Baguazhang).

...At any given time, only one person in the world is capable of bending all four elements: the Avatar, who serves as an international arbiter. When the Avatar dies, the Avatar spirit is reincarnated into the next one of the four nations in the Avatar Cycle: the Fire Nation, Air Nomads, Water Tribe, Earth Kingdom, in order.

It was well-made and very popular with kids and adults alike (it was also later made into a terrible live-action movie by M. Night Shyamalan, but the less said about that the better).

Anyway, there was one episdode called "The Fortuneteller" in which the main characters (The title character Aang, along with his companions Katara and her brother Sokka) travel to a village sitting beneath a semi-active volcano. The town is pretty much run by a woman who claims to be a fortuneteller called "Aunt Wu":

Later, the group notices a crowd of people gathering in the town square and learn that it is the day of their village's annual cloud reading, a ritual in which Aunt Wu predicts the fate of the villagers by studying cloud formations. She reads the clouds, predicting a good harvest, that it will be a good year for twins, and that Mt. Makapu, the volcano which looms large over the village, will not destroy the village that year. Their good fortunes bring the people to cheers.

[Aang] and Sokka make the climb to the rim; upon reaching the top of the mountain, they discover to their horror that the volcano is on the verge of erupting, contrary to Aunt Wu's prediction. They rush back down to the town to warn everyone of the imminent danger, but, because of their unshakable faith in Aunt Wu, not a single person believes them.

...Aang and Sokka quickly organize the village's earthbenders, as well as anyone capable of digging, to make a giant trench around the village to redirect the lava. As the lava surges over the trench, hanging in space over the village, Aang unleashes a massive gust of wind to cool the lava, solidifying it into a giant wall.

Aang employs a powerful airbending move in order to save Makapu Village.

...Meanwhile, Sokka, believing he has been vindicated by the volcano's eruption, happily tells the villagers that Aunt Wu was wrong, but a man, the same one who encountered the platypus bear, says truthfully that Aunt Wu did not claim the volcano would not erupt; she simply stated that it would not destroy the village. Sokka, beaten again, retorts with an aggravated "I hate you" and Katara drags him away.

So, to summarize: The villagers blindly follow a con artist who leads them around by the nose and keeps reassuring them that they're in absolutely no danger from the volcano looming above them. They're saved purely due to Aang, Kitara and Sokka working their asses off to goad them into actually doing something to save their own lives. Yet, even when it's made plainly obvious how utterly full of crap their "leader" (who didn't do jack sh*t to actually help the situation) is...they go right back to praising her and shrugging off the ones who actually saved the village.

I immediately thought of this episode when I read Sarah Kliff's recent Vox story in which she travelled to Clay County, Kentucky to interview some of the people who owe their healthcare coverage purely to the Affordable Care Act, yet voted for Donald Trump (and presumably other Republicans down the line) even though he and the GOP have vowed to repeal the very law which is providing that healthcare coverage.

It's a long, well-written piece, but for the most part, the Trump-voting residents who just voted to rip away their own healthcare (along with that of 23-30 million other people nationally) seem to fall into two main categories. The first are the ones Kliff says she was expecting to see a lot of: People who were simply clueless and confused, not understanding that the only reason they had coverage at all was due to the ACA:

I kept hearing the same theory over and over again: Kentuckians just did not understand that what they signed up for was part of Obamacare. If they had, certainly they would have voted to save the law.

Kentucky had been deliberate in trying to hide Obamacare’s role in its coverage expansion. The state built a marketplace called Kynect where consumers could shop for the law’s private plans, in part to obscure the fact that it had anything to do with the unpopular federal law.

“We wanted to get as far away from the word Obamacare as we could,” Steve Beshear, the former Kentucky governor who oversaw the effort, says. “Polls at the time in Kentucky showed that Obamacare was disapproved of by maybe 60 percent of the people.”

I heard from Obamacare enrollment counselors who had seen this confusion play out firsthand, too. “When we’re approaching people about getting signed up on health care, one of the first questions they have is, ‘Is this Obamacare?’” says Michael Wynn, one of Oller’s co-workers. “So we would tell them, ‘No, this is not Obamacare. This is a state-run plan.’”

I've written about the perils of ACA supporters going out of their way to hide the ACA from beneficiaries of the law; branding is important, and this was exasperating to me, for the very reasons laid out above.

However, according to Kliff, the reality is, in some ways, far worse:

This was a story I heard a lot, but it was not the one that fit the Obamacare enrollees I met. All but one knew full well that the coverage was part of Obamacare. They voted for Trump because they were concerned about other issues — and just couldn’t fathom the idea that this new coverage would be taken away from them.

“I guess I thought that, you know, he would not do this, he would not take health insurance away knowing it would affect so many peoples lives,” says Debbie Mills, an Obamacare enrollee who supported Trump. “I mean, what are you to do then if you cannot pay for insurance?”

Mills and her husband run a furniture store. They used to buy their own health insurance in the early 2000s, but the premiums became unaffordable, surpassing $1,200. They had gone without coverage for two years, paying cash for doctor visits, until the Affordable Care Act began.

“It’s made it affordable,” Mills says of Healthcare.gov. This year, she received generous tax credits and paid a $115 monthly premium for a plan that covered herself, her husband, and her 19-year-old son.

Earlier this year, Mills’s husband was diagnosed with non-alcoholic cirrhosis of the liver. He is now on the waiting list for a liver transplant. Obamacare’s promise of health coverage, she says, has become absolutely vital in their lives.

...We spoke a good deal longer about the Affordable Care Act, and the possibility of repeal. Mills said she had gone into the voting booth confident that Republicans wouldn’t dismantle the law, despite their promises. How could they, when people like her had become so reliant on it?

As always, this Brexit-era Tweet encapsulates everything:

'I never thought leopards would eat MY face,' sobs woman who voted for the Leopards Eating People's Faces Party.

— Adrian Bott (@Cavalorn) October 16, 2015

And it's not just Clay County. People voted for the Face-Eating Leopards in Miami, Florida...

Dalia Carmeli, who drives a trolley in downtown Miami, voted for Donald J. Trump on Election Day. A week later, she stopped in to see the enrollment counselor who will help her sign up for another year of health insurance under the Affordable Care Act.

“I hope it still stays the same,” said Ms. Carmeli, 64, who has Crohn’s disease and relies on her insurance to cover frequent doctor’s appointments and an array of medications.

...and Huntsville, Tennessee....

But now some in coal country are worried that instead of helping, Trump’s first actions will deprive miners — and their widows and children — of the compensation they can receive if they are disabled by respiratory problems linked to breathing coal mine dust.

That’s because buried in the Affordable Care Act are three sentences that made it much easier to access these benefits. If Trump repeals Obamacare — as he vowed to do before the election — and does not keep that section on the books, the miners will be back to where they were in 2009, when it was exceedingly difficult to be awarded compensation for “black lung” disease.

On November 29th, Greg Sargent of the Washington Post noted:

I have obtained new numbers from the Gallup-Healthways Well-Being Index that suggest that a lot of poor and working-class whites — who voted for Trump in disproportionate numbers — have benefited from Obamacare, meaning they likely stand to lose out from its repeal (and even its replacement with something that covers far fewer people). Gallup-Healthways numbers from earlier this fall showed that overall, the national uninsured rate has plummeted to a new low of 10 percent, a drop of over six percentage points since the law went into effect — which alone is a major achievement.

But that drop, it turns out, is even more pronounced among poor whites. Gallup-Healthways tells me that among whites without a college degree who have household incomes of under $36,000, the uninsured rate has dropped from 25 percent in 2013 to 15 percent now — a drop of 10 percentage points. It’s often noted that the law has disproportionately expanded coverage among African Americans and Latinos. That is correct, but it has also disproportionately expanded coverage among poor white people.

Inspired by his piece, both Paul Krugman and I each took a shot at trying to figure out just how many Trump voters would likely lose coverage due to their own actions, and came up with a range of anywhere between 4-9 million people.

Well, guess what? According to the Wall St. Journal today:

When he campaigned for president, Donald Trump made repealing and replacing the Affordable Care Act a signature issue. Polling suggests that such a move would have the biggest impacts on communities that gave Mr. Trump some of his highest levels of support, potentially complicating the politics of a repeal effort.

More than 20 million Americans now depend on the ACA, also known as Obamacare, for health insurance. Data from Gallup indicate that a lot of those people live in counties that favored Mr. Trump.

The Gallup data, analyzed with the county typology from the American Communities Project, show that eight county types have seen increases in health insurance coverage greater than the national average. Six of those types — representing about 77 million people or 33 million votes, a quarter of the total cast — sided with Mr. Trump, some by very large margins.

In other words: No sh*t, Sherlock.

And yet, it's still entirely possible that the ACA won't in fact be repealed even now (or at least not in as devastating a manner as the Republican plans flying around so far would indicate. But if that's the case, the only reason will be because the DEMOCRATS BUST THEIR ASSES TO PREVENT THE REPUBLICANS FROM DOING SO.

If the ACA (or at least large portions of it) are salvaged, and millions of people's lives and health are saved as a result, it will be purely due to Democrats saving these people's asses from their own actions. Like Aang, Kitara and Sokka, the Dems will have saved the people of Clay County, Kentucky from themselves...

...and those they saved will respond by continuing to vote for Republicans until the day they die, because hey, they were "proven right!!" They didn't lose their healthcare coverage after all!! Donald Trump and the Republicans didn't take it away from them! See how "overblown" all those fears were???

Sokka, beaten again, retorts with an aggravated "I hate you" and Katara drags him away.


UPDATE: I just realized after I posted this that it's awfully similar to a different post I wrote just over a year ago regarding the election of Matt Bevin as Governor of...Kentucky:

I'm not talking about those who didn't know that "Kynect = Obamacare" or who didn't know that Bevin campaigned on taking their healthcare coverage away; I mean yes, that's pretty pathetic and depressing in and of itself given that this was such a high profile part of the election.

In fact, I'm not even talking about the Bevin voters of a higher income; I may still think their priorities are completely out of whack, but if losing Medicaid expansion and kynect wouldn't (directly) impact them, I guess I can at least understand them voting their interests otherwise.

I'm talking about those who knew that they were risking losing healthcare coverage and still voted for Bevin anyway...because of utter nothingburgers like "liberal race peddlers", whatever the hell that is.

How do you argue with these people? How do you get the slightest bit of logic to penetrate their brains when they truly believe the equivalent of "cutting into a body will release the spirit, reducing the body to something worse than death"? How do you convince someone to support you when they honestly believe that doing so would turn them and their children into "soulless demons" and would rather die than allow that to happen?

I even included another parallel to an old TV series...although in that case it was Babylon 5.


GETTYSBURG, Pa.—As her hair was styled at the Grace Kelly hair salon in this quaint tourist town, a middle-aged mother told me that she wants Obamacare gone, even though her 24-year-old son is still on her plan, thanks to an Obamacare provision that allows young adults to stay on their parents’ health insurance until the age of 26. (The woman asked that we not use her name because she’s worried about her privacy.)

In its place, she’d like to see a new law in which people pay for their insurance as a percentage of their income, so that everyone has some “skin in the game.” When I asked her if the Obamacare subsidies, which reimburse people making less than about $48,000 for a portion of their health-insurance premiums based on their income level, come close enough to this kind of system, she balked. “I do not like the Obamacare subsidies,” she said.

As Adrianna McIntyre noted this morning:

"Good health reform would do this thing."
"You know, Obamacare does that thing."
"Obamacare is bad."

— Adrianna McIntyre (@onceuponA) December 20, 2016

It's not even "Obamacare is bad." It is literally "I do not like the part of Obamacare I just proposed should exist."

— Adrianna McIntyre (@onceuponA) December 20, 2016