Dear Mr. Emanuel,

How many favors would you call in and how deep into ruin would you go to save the child who smiles like your mother and really really likes chocolate;or the one who laughs like the uncle you’ve never met; or the kid who wanted to give her hair away to a member of your staff who lost her hair due to chemotherapy? How many favors did your parents call in and how deeply into debt did they go to save your life?(1)

Consider a family of six living in a Chicago suburb with a good public school. Dad is pediatrician, and mom is a social worker. The house is a stretch for them financially. They have four children. The oldest is a rising junior at an expensive private college(2), the middle child is all set to go to an expensive private college with a strong dance program(3) , the youngest boy is a high school sophomore with dyslexia and ADD, and the five year old requires constant physical therapy and many surgeries so she can gain 85% usage of one side of her body.

The middle child is working at a fast food restaurant for extra money.(4) One day he slashes his finger to the bone, skips getting stitches because it’s Prom Weekend, swims in Lake Michigan and lands in the hospital fighting for his life, and luckily survives. Then the real struggle starts. The insurance company realizes that this family is too expensive for their profit margin because they have too many expensive chronic conditions. The insurance company misplaces medical records, reverses social security numbers, flat out rejects hospital bills, lab test bills, specialist visits that it had been paying for before. The company raises the premiums by over 100% and scours their records to see that maybe the father didn’t mention a possible head injury on his insurance application which might lead to potential dementia, or that the mother didn’t mention a childhood sprain. Perfect reasons to rescind insurance retroactively. Suddenly, that stay in the ICU balloons to hundreds of thousands of dollars.

The parents struggle to pay the mortgage and the medical bills, and in the process their credit is trashed. They might even file for bankruptcy. It is perfectly possible that that the eldest child has to drop out of college because there is simply no way he can afford to go to the same school, even with a full scholarship. He might have to forget about the masters, and the Ph.D. and the medical school, because even if he were content to live in heavy debt until the day he died, and even if he managed to win scholarships, the sheer amount of expense from living expenses would be unmanageable.

Since financial aid has been determined for the fall already, and the mother and the father’s prior income determined the financial aid from the government (if they indeed completed a FAFSA despite the high likelihood of not qualifying for aid), the middle child has to try to take on loans, (which he would need a co-signer for, and remember his parents credit rating is trashed), or not attend the school he’s set to go to. The school might take some pity on him and offer some more loans – it probably wasn’t enough. He can forget about majoring in dance and being a dancer – all that lies ahead is penury and more debt with a worn out body and retirement at 35. He can forget about the following: taking most internships during college, an expensive master’s program (5), and low paying jobs that start you out on a ladder, but require you to be subsidized by someone else (I seriously doubt Illinois Public Action offered health insurance). He’d probably go into a more immediately renumerative field if possible, and find that interviews go swimmingly until they ask for a credit check, which isn’t so good because he took out loans on a credit card to pay for living expenses while going to college.

His younger brother can forget about going to a private college – he isn’t going to get an adequate scholarship anywhere with his grades and test scores. He’ll be lucky if they can float community college part time and at home; if by some reason the mounting medical debt hasn’t driven the parents to lose their home. Forget traveling abroad, and asking parents to “shik gelt”, while playing the racquetball circuit or while working 80 hours a week in a glamour industry. The youngest daughter doesn’t know it, but she gets less therapy and less surgery and which results in her being more disabled.

Mr. Emanuel, I’m writing to you because I am angry. I am angry because certain conservative Democratic members of Congress, many of whom you recruited, are doing their level best to make this health care reform a non-entity. I am angry that you seem to think the goal of all of this is to “keep the insurance companies honest” and encourage “competition”–- the health care system in this country does not operate in some classical Adam Smith mythical free market. I can no more diagnose myself than a seventeen year old could negotiate the terms of their hospital stay while slipping in and out of consciousness or a cardiologist should diagnose their own heart attack and haggle with the ER while the event is occurring. The goal is to reform health care. A passage of a health care bill means nothing to me, if the status quo, in which I can’t actually get access to the health care I need, remains.

You seem to think that people like me who aren’t millionaires that can write thousand dollar checks at fundraisers should sit down, shut up, and not exert any pressure on people we helped elect because it makes your multi-millionaire friends who could pay the Sultan of Brunei out-of-pocket rates rich. Progressive groups should not sit down and shut up any more than civil rights protesters in the ‘60s should have sat down and shut up because the United States happened to be embroiled in the Vietnam War, or women’s rights groups should have shut up during World War I, or gay rights groups should shut up because there’s a recession. You seem to think they should just whisper in a tiny corner while everyone else is shouting at the top of their lungs from a loud speaker and they should not even dare even to raise their voice. Pardon me sir, I’m not going to sit down and shut up.

Footnotes

(1)This isn’t just a rhetorical question.

(2)Even a kid on full scholarship still needs room and board and other incidentals. Amherst’s 2009-2010 tuition is $48, 400; cost of attendance 53,140-55090; (other costs could be up to 6690) “The college’s actual cost of educating a student at Amherst exceeds the annual fee by more than 50 percent. However, income from our endowment and gifts helps subsidize that amount significantly, even for students who do not receive financial aid.”
https://www.amherst.edu/admission/financial_aid/tuition The policy of not requiring student loans for the 2009-2010 school year does not mention whether that applies to students who were already admitted two years prior. https://www.amherst.edu/admission/financial_aid

(3)Sarah Lawrence is the most expensive university in the United States.
http://www.nytimes.com/2008/11/05/world/americas/05iht-college.1.17543393.html
Total cost of going to Sarah Lawrence in 2009-2010 is 52,683.
http://www.slc.edu/offices-services/student-accounts/tuition/Undergraduate_Tuition_and_Costs.html
(4) At the current Illinois minimum wage a student would have to work the equivalent of 40 hours a week for 23 weeks to earn enough money before taxes to even pay for room at Sarah Lawrence. http://www.dol.gov/esa/minwage/america.htm#Illinois

(5) ) http://www.communication.northwestern.edu/programs/ms_communication/tuition.php “The Master of Science in Communication Program does not award financial aid or scholarships…”