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The Kings and I

My Facebook friend and the liberal dilemma.

Like a lot of writers, I have a Facebook page where I post articles that I’ve published. Over the past year or two, I’ve accumulated a few hundred followers--that is, Facebook friends--and, based upon the comments they leave, they tend to see the world the same way that I do. They’re left of center, by and large, and they believe fervently in health care reform. If they have something negative to say, it’s typically that President Obama and his allies in Congress aren’t being ambitious enough.

But, a little over a month ago, I noticed that one of my Facebook friends had rather different ideas about health care reform--and the people in Washington who were promoting it. Her name is Terri Davenport King, and she posted her first comment on February 7, Super Bowl Sunday, right after Obama appeared on CBS to lay out his plan for pushing health care legislation in the wake of the Massachusetts special election. I had written a blog item praising Obama and explaining his strategy. Soon, Terri had written a response: “The man is takin this country down, and fast!!! I’ve never seen anything like it in 49 yrs. Scary.” About two weeks later, I wrote an item speculating about whether Obama or his congressional allies might try to revive the public option. Terri’s response was up within minutes: “*Screams* it’s like night of the living dead!!!” When I wrote about Obama’s bipartisan summit, Terri responded, “I do NOT want government run healthcare! I am so very upset,” and “*sigh* I am done w/Obama for the day. I just despise him so much.”

It wasn’t just Obama whom Terri couldn’t abide. When I wrote about Senator Evan Bayh’s willingness to consider using the budget reconciliation process to pass health care reform, Terri responded, “I’m fed up with them all... they ALL are pieces of crap.” At one point, one of my other Facebook friends--a liberal--started challenging Terri on some of her arguments. The two went back and forth for nearly an hour and a half, exchanging 19 messages in total. “Government needs to butt out,” Terri said in closing. “[G]et out of our healthcare system.”

What made these comments so striking is that Terri isn’t just some random Facebook friend. She was the subject of an article I wrote for The New Republic’s website in late 2006. Her son has serious congenital problems that have required millions of dollars worth of medical care--and that, at one point, threatened her and her husband with financial ruin. I had recounted her story in order to showcase the cruel inadequacies of our health care system and make the case for the kind of health care reform that I support and that, in the last year, the Democrats have embraced. Since that article first appeared, Terri and I have kept in touch, exchanging holiday greetings and talking about her family’s subsequent experiences with the medical care system. But it was only last month that I realized she held views almost entirely opposite to mine--and I couldn’t help but wonder why.

It is, of course, the same question that has preoccupied liberals for a generation: Why do so many middle-class people bristle at policies from which they would seem to benefit? And why, at the voting booth, do they seem to vote against their economic self-interest? Terri’s story is almost a perfect example. After her son Matthew was born, doctors diagnosed him with pulmonary artesia, a deformity that restricts blood flow between the heart and lungs. Treatment included an arterial transplant, performed at Stanford University Medical Center, and months of hospitalization.

Terri’s husband, Michael, is a police officer in Las Vegas, and he had what the Kings thought was good insurance coverage through his department. But, Terri later explained to me, it also came with an annual limit of $250,000 for expenses associated with a heart transplant and a lifetime limit of $2 million overall. When the insurance company claimed Matthew had exceeded the $250,000 threshold, the Kings protested, arguing that the limit should not apply since their baby had had an artery transplanted (as opposed to a heart). They prevailed, but there was still the matter of the $2 million lifetime cap, which Matthew nearly met before he was even two years old. That’s when I heard about Terri’s story and wrote about it. Local media outlets did the same, and, not long after, the Kings’ insurance plan was renegotiated with a substantially higher cap.

But the experience left a deep impression on Terri. Back when Matthew had been in the hospital and it looked like the insurance company was going to cut off further payment for heartrelated treatment, nurses and social workers had suggested that Terri contemplate divorcing Mike, so that she’d be eligible for Medicaid. Terri never forgot that--and, months later, when CNN asked her to tell her story, she cited that as proof the health care system was broken:

I would have never thought in a million years that, in this country, that families that do all the right things can be completely ruined. There needs to be something available for the middle class people because health care is so unaffordable. There needs to be something for those of us that fall through those cracks, because we fell through every single crack.  

Of course, this is exactly the sort of thing President Obama says when he talks about the Democrats’ health care plan. And, as it happens, one of the first changes his health care bill will make is to eliminate lifetime caps on benefits.

So what soured Terri on Obama and the health care plan? One issue, clearly, is concern that the plan will affect her family’s care. The Obama plan includes a tax on expensive health care benefits. Terri thinks that her plan, which comes through the police department, might qualify--and that, as a result, the benefits will be pared back. “You know one thing we are deathly afraid of??” she posted at one point. “This freaking 40% excise tax on employers that offer great health insurance... like we have...(and we fought for a higher lifetime cap and got!!) We have already heard from our employer about this tax. Why would they continue to offer insurance if they will be punished.”

I would argue that Terri doesn’t need to be so concerned. The excise tax has higher thresholds for some high-risk professions and wouldn’t start until 2018, so the plan’s administrators would have ample time to rearrange the benefits in a way that reduced costs without sacrificing Matthew’s care. (Reform also includes safeguards--not just a prohibition on lifetime limits, but also a cap on personal out-of-pocket costs and an appeals system for treatment denials--although one open question in the final congressional negotiations is how widely those safeguards will apply.)

But, even if I could convince Terri not to worry, her opposition to health care reform plainly goes deeper than any policy issue: It’s the product of a sincerely held distrust she harbors toward government in general and Democratic politicians in particular--a distrust so deep that she doesn’t believe that provisions of the bill will actually do what their sponsors say they will:

insurance companies should not cut people off when they need it the most.. and there should be no limit... and no pre existing clauses[.]... BUT.. it still needs to be affordable... they can SAY they won’t cut you off and SAY there is no limit and SAY no pre existing.. but they can price it right out of reach. I simply don’t trust a thing our government says. They all lie.

Terri’s skepticism finds plenty of reinforcement in the one institution she does have faith in. “I trust ONLY Fox News,” she posted during a back-and-forth with one of my liberal Facebook friends. But Fox probably wouldn’t resonate if she didn’t have those feelings in the first place. And it wasn’t until I reread that same exchange that I stumbled across a possible foundation for her feelings--the sense that government is out to protect somebody else, not her:

Yes, we need insurance reform. No doubt. Good people like my husband and I should not ever be told to sell off ALL our assets while our baby is on a ventilator in the hospital. ... My baby deserves the same access to medical care as the babies of illegal aliens that went home with Medicaid cards... and my husband is a Gulf War Vet and a police officer. But we are middle class... we get screwed. Healthcare workers CONSTANTLY told us... too bad you were not poor or illegal... then you would be covered. Government steers you to poverty.

For all of our philosophical disagreements, I can understand why Terri feels that way. If you can’t get insurance and you are poor, there’s a decent chance you’ll qualify for Medicaid. But, if you can’t get insurance and you are middle class, there’s a decent chance you’re just out of luck. Is it any wonder so many middle-class people end up resentful?

Still, not all government programs inspire such reactions. You don’t see people angry about Medicare and Social Security, because--unlike Medicaid--they are programs for everybody, rather than just a narrow set of particularly needy people. Obama and his allies know that; the whole point of their health care reform project is to expand the government’s umbrella of protection, so that it covers the middle class as well as the poor. But they’ve struggled to complete this project in no small part because many of its intended beneficiaries, like Terri, don’t believe the effort is genuine. The distrust of government among some middle-class Americans runs so deep that the only way to ameliorate it may be to enact programs that clearly put government on their side--and hope that, over time, the middle class takes notice.

Jonathan Cohn is a senior editor of The New Republic.