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Health Care in America Is Exactly Like a “New Dress Shirt”

Thom Tillis’s staffer was cruel but correct in his conversation with a cancer survivor.

Joe Raedle/Getty Images

At the start of the pandemic, Bev Veals, a three-time cancer survivor and Carolina Beach resident, found herself in a very American predicament: Her husband had been furloughed, which put his employer-provided insurance—and her family’s continued access to medical care—in jeopardy. Having already faced medical bankruptcy before, and reaching a point where she said she would likely need to dip into retirement funds to stay insured, Veals called the offices of North Carolina’s elected representatives, including the Washington, D.C., office of Republican Senator Thom Tillis. As is often the case, she spoke to a staffer instead of the senator himself. She explained her situation. When the conversation took an unexpectedly combative turn, she started recording.

“You’re saying that, if you can’t afford it, you don’t get to have it, and that includes health care?” she asked. 

“Yeah, just like if I want to go to the store and buy a new dress shirt. If I can’t afford that dress shirt, I don’t get to get it,” the staffer replied.

“But health care is something that people need, especially if they have cancer,” Veals said.

“Well, you got to find a way to get it,” he responded.

The staff assistant is clearly an asshole. But he was also, in the most callous way possible, completely right.

By design, the United States health care system truly is no different from any other profit-driven business. If you want a service or a good, be it “a new dress shirt” or chemotherapy, you have to be able to afford it; if you can’t afford it, you have to go without a dress shirt or die of a treatable illness. In the eyes of the market, these are functionally the same things. And as in businesses, the profit motive that exists in health care is oftentimes constructed to conform to and reproduce larger societal ills, like systemic racism.

The only possible result is tragedy. It’s 21-year-old Jesimya David Scherer-Radcliff dying because he had to ration his insulin due to skyrocketing prices. It’s a cottage industry being built around people who are forced to publicly beg both friends and strangers to help them pay for their medical bills. It’s 34 million Americans admitting that they know someone who’s passed away because they couldn’t afford care. The problem is not with the people—or the cOnSuMeR—but with the model. There is no way to give people enough consumer choice to remedy these outcomes. You can’t smart shop your way out of medical debt or preventable death. Most people in power get this and think it’s more or less tolerable. On one side, there’s a Democratic Party that’s spent the past decade staving off leftward pushes for a universal system and, on the other, a Republican Party trying to entirely roll back the half-measures its opposition has foisted on the American people. One side is marginally better, but the choice is ultimately between two This Is Fine dogs. Caught in the middle is Veal. And you, probably. 

Tillis’s office says that the staffer has since been reprimanded, and issued a pair of statements—one apologizing for what a spokesperson called the “completely inappropriate” behavior on the part of the staffer and then a follow-up statement attempting damage control on Tillis’s record on health care. 

Two years after the Supreme Court ruled in 2011 that states had the option to determine whether they wanted to expand their Medicaid programs, the Republican-controlled North Carolina General Assembly, of which Tillis was then a member and House speaker, passed a bill that declined expansion and blocked both the governor and the state insurance commissioner from taking unilateral steps toward expansion. 

Some seven years later, North Carolina is currently one of 12 states that has still not moved to use federal funds to expand its public health care network. As a result, the state has the ninth-highest uninsured rate in the nation, with one million residents, or 10 percent of the population, lacking health coverage. To explain his record, Tillis’s office wrote to local news station WRAL, “When he was Speaker of the House, Senator Tillis inherited a Medicaid program that was mismanaged and plagued with overspending and inefficiency. Expanding Medicaid at the time would have been a promise that the state wouldn’t have been able to keep.” 

In the U.S. Senate, Tillis positioned himself as a fierce opponent of the Affordable Care Act, calling it a “cancer” and voting to repeal it. (He has since modestly changed his tune, trying to preserve some provisions of the law.) But as a policymaker, Tillis is a student of the Well, you got to find a way to get it school of thought. He’s just savvy enough to couch his language.  

What the pandemic has provided in chaos, it has likewise provided in clarity. Our national health care system is a joke, one that is repeatedly told by the people still in office today. There are clearly better models that the U.S. could adopt. But every day, those same leaders choose not to, some through outright opposition and others through a meek imagination, and it leaves people like Veals stuck on the phone with assholes telling them to just try harder. It’s maddening and outrageous. It’s American capitalism at its finest.