Seeking synonyms

Dear Tom,

After a week of peculiarly warm temperatures for February, I’m watching the snow fall again today. It’s been a relaxing weekend as I head into a week-long break from teaching. I still have lots of reading and grading to do, but the campus will be quiet with all the students gone. It will also be a week to schedule some appointments that are hard to fit into my regular routine. I’m taking my younger son to a pediatric dentist tomorrow afternoon to get some cavities filled and I finally have time to schedule a haircut.

This talk of appointments gets me to the subject of my letter to you this week. Ever since I attended your Town Hall meeting and heard you talk about your ideas for health care reform, I’ve been planning to tell you about my experience.

At the meeting, you said you want to replace the Affordable Care Act (ACA) with a plan under which people would have Health Savings Accounts (HSAs) and contribute to them with money they get through a tax credit. I have an HSA, so I’d like to tell you about how that’s worked (for good and for ill) from my perspective.

Through my employer, I am enrolled in a high-deductible insurance plan. My husband has the same employer so we have the simplicity of being on the same plan. The deductible for our family is $5200 per year.

That means that whenever we go to the doctor for anything beyond really basic preventative health care (vaccinations for our kids, yearly physicals), we pay whatever price our doctors have negotiated with the insurance company. So last summer when my daughter had a sore wrist and my son had a weird rash and I took them to see a doctor, we had to pay the full (negotiated) price for those visits. I had a torn meniscus in my knee this fall and needed surgery, and that also cost the full (negotiated) price for the surgeon, the anesthesiologist, etc. The MRI to diagnose the torn meniscus, the visits to the orthopedist, and the physical therapy afterwards were all our responsibility.

This is where our health savings plan comes in. My employer contributes $2600 per year to our HSA. We use that $2600 to pay for our doctor’s visits. This should sound pretty good to you. I think you’re intending that families get at least that much as a tax credit. They could use that money for those kinds of bills.

There are, however, a couple of things about this that are not ideal—at least for people with a lower income than my family. First, you will note that $2600 from my employer is only half of our deductible. So if my family of five has medical expenses beyond $2600 but less than the deductible then we must pay for those ourselves. Will you be able to provide a large enough tax credit to get people without a lot of extra cash in the bank closer to their deductibles?

But the $2600 that I get is a lot of money, right? That should be plenty except in a year when there is a major health crisis (or a minor but expensive one like my knee surgery). In which case, our family would hit its deductible and be grateful that we only had to pay $2600 out of pocket. And if we used funds that we had deposited in our HSA, they would be tax-free to boot.

$2600 would be an adequate amount of money for a relatively healthy family of five if we only had to use it to cover qualified medical expenses. But our insurance doesn’t cover dental or vision. So every year we burn through much of our HSA fund on dental exams, orthodontist’s visits, and eye care. Four-fifths of us wear corrective lenses (so far). So the $2600 disappears pretty quickly. And we’re on our own for the next $2600. We typically spend several thousand dollars more than our employer contributes. And because a lot of this goes toward dental and vision, it doesn’t count toward our deductible.

This isn’t dreadful for us. We make decent professional salaries and paying several thousands of dollars per year in health-care costs is not a crisis. I am not really asking you to fix health care for people like me (middle-class professionals with a stable source of employment).

I will point out, however, that we are not so well off that we can do anything we like with our budget regardless of how much we spend on health care. We are gradually fixing up our older home—increasing its value and the property values of homes on our street by making it a more beautiful and pleasing place to live. Every summer, when we can afford it, we like to do some kind of improvement project. This coming summer we were planning on expanding a side porch, creating a new entrance, and transforming our laundry room/pantry in to an entry/mudroom. We hire local contractors to do these renovations and try to buy most of our supplies from a locally-owned lumberyard (a shout-out here to the wonderful folks at Nunda Lumber).

This year, partly because of my knee surgery and those cavities that my son is getting filled, I’m not sure whether we’ll have enough left over in savings to take on this project. Instead of our money going into the kinds of things that would help our local economy, it has gone to health-insurance companies that exist somewhere out in the netherworld of corporate finance. It’s hard to see how the money we put into health care benefits our community.

And I am considerably better-off than many people in our district. Families with lower incomes than mine would have to cut back on more essential things than home improvement to meet those high deductibles.

So HSAs, in my experience, are not a bad thing. But they also don’t feel like a solution.

The other thing about your plan that worries me is the elimination of the individual mandate that requires people to carry health insurance. Without it, a lot of relatively healthy people will go without insurance. Why get insurance and then still have to pay out of pocket until you reach a high deductible? If you were in their shoes, mightn’t you be tempted to forego insurance altogether? And without everyone signing up for health care, insurance companies would lose profits. Then they’d have to raise their premiums and deductibles.

Despite how easy your press releases make this sound, I don’t think there are any “common-sense solutions” that everyone can agree on. This is going to be hard.

HSAs are one tool that might be part of a responsible health-care plan. The individual mandate is another tool that I think you may find indispensable.

I suspect that, as a conservative, you don’t like the language of “mandates”—it sounds like government overreach. Here’s where you can be creative, though, Tom.  I’ve noticed that some of your colleagues are starting to use the language of “repair” instead of “repeal” for the ACA. That was a clever way to shift positions while sort-of-sounding like they’re talking about the same thing. Perhaps you could do the same thing with the individual mandate. Could you find a synonym for “mandate” that sounds more pleasant to conservative ears? What about “individual requisite”? That sounds vague and bureaucratic enough for government work.  “Individual obligation” might have nice moral overtones. You have bright people on your staff and in your caucus. I bet they could come up with something.

Although you did send me those three form emails, I’d still love to get a personal note from someone in your office acknowledging these letters and my blog. I’m very curious what you think of them if you ever have time to read them.

As ever,

Susan

Contact!

Dear Tom,

This is the week I’ve been waiting for. I received three letters from you and got to attend a town hall meeting in my neighborhood. It was a good week for contact with my representative.

In an ideal world, these contacts would have gone something like this:

The letters I received from your office would have said, “Wow, Susan! You’ve written to me almost weekly since November. I appreciate how you’re trying to frame issues in terms of common ground that we share. I’m reading and paying attention to what you’re saying.”

The town hall meeting I attended would have featured a lot of calm constituents taking turns asking questions and hearing your answers. There would have been time and space for each person to ask the questions or make the statements they wanted to, and you would have been able to explain what political initiatives you were working on and why.

We don’t live in an ideal world.

So what actually happened this week

I received three form letters from you—stock responses on popular topics. These are responses your office can send out to whoever writes a letter or makes a phone call. If a constituent writes with concerns about health care, she gets the stock health-care letter. If a constituent calls about immigration, he gets the stock immigration letter. I get it. You’ve got hundreds of thousands of constituents. I don’t know how many letters or phone calls you receive every day. Hundreds? Samara, Kyle, Natalie, Tom, and Brenden (and others in your office) don’t have time to craft individualized responses.

I had the fantasy that maybe because I put considerable time into this correspondence and more than a hundred people are reading what I write to you that I was a special case. Maybe I would get a more personalized reply. Nope.

The town hall meeting was also not ideal. I arrived to find hundreds of people standing in a muddy parking lot—some carrying signs protesting various policies you support. You had done three other town hall meetings that day and arrived late. There wasn’t room for everyone inside the building you’d reserved so you had to answer questions via a borrowed megaphone. Some people at the event were loud and rowdy, interrupting you and making it hard both for people to ask questions and for you to give responses.

I stayed around for half an hour after you arrived before I had to go meet my family for supper. I knew quite a few people at the meeting who had come prepared with carefully and gently worded questions. They didn’t have a chance to speak while I was there, and it wasn’t looking likely to happen later. It was pretty chaotic and disappointing.

So this week did not exactly satisfy my desire for productive and meaningful political engagement.  But it wasn’t a complete train wreck either.

First, you did write me back! That’s something. I’m happy to see that your office is catching up with the standard back-and-forth that representatives have with their constituents. I was getting worried, since I had been writing to you for several months and hadn’t even received one of these form letters. So now you’ve done that.

Second, I was impressed with your calm and measured engagement with some pretty angry people at the town hall meeting. Some of your congressional colleagues are refusing to hold town hall meetings or are holding them by phone so that they can control the situation. You put yourself in the middle of a muddy parking lot with people who were shouting at you and you kept your cool.

That was courageous. I may not agree with all of your policy ideas, but I was impressed with you yesterday. I hope you keep doing these town hall meetings (maybe pick some larger venues and get microphones) and modeling willingness to engage with people who disagree with you. Well done, Tom.

Also, I left early and didn’t get to see how the event played out. When I checked Facebook later in the evening, I saw a group photo with you and a bunch of the people I knew at the event. It looks like they did get to interact with you in a more peaceful way. I gave up too soon and regret I didn’t stick around a little longer.

So on the whole, I’m hopeful. Your office is getting back into its routine. And when constituents were more patient and persistent than I was, they got to engage with you.

I’m not giving up. I’ll keep writing and keep showing up to try to meet you whenever I can—even if it’s the middle of a muddy parking lot in a messy, imperfect world.

With hope,

Susan

My week and your week

Dear Tom,

It’s been a while since I’ve given you an update about what’s going on in my life, so I’ll take a few moments to tell you about my week.

In my family, we celebrated the birthday of my middle child. He wanted a red velvet cake, but I didn’t like the idea of all that red food coloring, so I made this one instead. It turned out great; I highly recommend it. It would work great for Valentine’s Day too.

At work, we’ve been busy approving the details of our new general-education curriculum to go into next year’s academic catalog. That’s meant some extra meetings and some of my usual meetings going extra-long as we work to get this done.

One of the classes I’ve been teaching this semester is on the novels of Charlotte, Emily, and Anne Brontë. After the very passionate and somewhat gothic Jane Eyre and Wuthering Heights, we turned to the quieter, gentler Agnes Grey this week. I love to see how my students are developing their critical-thinking skills, noticing patterns in these books and analyzing the details. We’ve also talked a lot about the Victorian period in English history and how these novels demonstrate very different assumptions about class, gender, economics, and religion than we make in 21st century America. I’ve been watching the PBS mini-series on Queen Victoria too. Along with the great acting and costumes, it’s a fascinating study of strategic political positioning. You might like it.

Finally, I’ve been calling your office every day (although I missed Friday as one of my meetings went until after 5 pm and I missed the hours when your offices were open). I’ve spoken to Samara, Kyle, and Brenden (twice). Samara sounds a little weary. Kyle is very upbeat. But my favorite person to talk to is Brenden, who said he is an intern in your office. He sounds young. And earnest. As someone who works at a college, I really like young, earnest people.

What have you been up to this week?

I see that you’ve been in Rochester celebrating the 21st Century Cures Act which you helped pass late in November last year. It’s a bill that got a lot of bi-partisan support and was enthusiastically signed by President Obama. It will help people with serious illnesses get access to experimental drugs faster so it’s a significant win for people with serious illnesses. It’s also a big win for pharmaceutical companies. I’m always nervous about legislation that is a result of lobbying by huge corporations, but I can see that this bill will help some people who feel pretty hopeless.

I can see why you want to talk about legislation from several months ago. Much of the work of Congress is behind-the-scenes right now. I assume that you’re working on tax reform, an infrastructure bill, and health-care reform. But those are things that will and should take time.

You haven’t said anything in public about your votes for environmental deregulation as part of the Congressional Review Act. Those votes would probably be pretty controversial within your district—some of your constituents would be very supportive of deregulation and some would not (I wrote to you about this on January 29).  You voted to overturn rules that would regulate what coal companies can dump into streams, how much methane can be released into the atmosphere by oil and gas companies, and what kinds of financial disclosures oil and mining companies need to make about their payments to overseas governments.

I’ve been admiring some of your Republican colleagues in the Senate lately and noticing how a couple of them are willing to vote independently of their party. Susan Collins of Maine is a great example of this. And it’s put her in a position of considerable power. Both parties angle for her vote because neither is confident that it will get it. But I realized something, too. Because you only have a two-year term, it’s harder for you to be as bold or as principled as a senator with a six-year term. Perhaps you have to play it safer.

Remember my promise to you in December, Tom? If you move to the center and sometimes resist your party to do what is best for your constituents, I’ll support your re-election (especially in the primary where you might feel the greatest risk).

I’ve got another busy week ahead of me. I hope you do too. And I hope to see more detail about what you’re actually doing. And a little more courage.

See you at your town hall meeting on Saturday!

Susan

What are you afraid of?

Dear Tom,

I’ve been thinking about fear this week. I’ve been puzzling over two facts. First, that our fears are one of the things that motivate our efforts for political change. And second, that people fear very different things.

This prompted me to think about what I fear. I drafted a partial list (these are not ranked):

  1. The sudden tragic death of my husband or one of my children. My brother died in his sleep in his late-thirties leaving a wife and four children. The sudden death of a spouse is something I fear. The death of a child is, of course, the stuff of nightmares.
  2. The college that I work for closing because of financial collapse. I fear losing the only job I’ve had in my professional career and having to try to sell a house in a community in which the major economic contributor has just gone under. I’m in administrative meetings where we talk about how tight the budget is. If, hypothetically, the governor of our state is successful in directing massive amounts of state financial aid toward public universities rather than private ones and a quarter of our entering freshman class chooses to go to a state university, I doubt my college would survive.
  3. Cancer. My mom died of undetected colon cancer. I know lots of people who have cancer. It scares me.
  4. The future of my children. Will their lives continue on healthy and productive pathways? Will they keep their faith in God and remain connected to the church?  Will they go to college or find something productive to do with their lives and be able to support themselves financially? Or, will something happen along the way (sexual assault, mental illness, a foolish choice) that will send their lives careening off a proverbial cliff? I’ve seen it happen.
  5. Heights. I’m really, really, scared of heights. I don’t like going to the tops of tall buildings, standing at the edge of cliffs overlooking waterfalls, or driving over big bridges. I don’t like these experiences at all.

I could expand this list. But I noticed when I thought about it that one thing I’m not afraid of is a terrorist attack. I don’t think much about terrorism at all. My family spends a few months in London, England, every couple of years and when we are there, I think a little more about terrorism. As I ride the escalator deep into the underground transportation system of a major world capital, I do think, now and then: “okay, it’s a possibility, something could happen.”

But in my day-to-day life in rural New York state, I don’t worry about national security.  I’m pretty confident this is a problem that is not likely to touch my life.

But some of my neighbors in rural western New York do worry about terrorism. They are really worried that immigrants and refugees coming to the United States are going to launch attacks–or, at least, try. They tell me they don’t understand why I’m not more concerned.

At some level, I understand what they are saying. We had a large-scale terrorist attack on the United States in 2001. There have been other killings since by terrorists. I did a little research on this and it looks like 94 people have been killed in the US since 2001 in terrorist violence. Those were 94 precious lives. Every death was the realization of some mother’s nightmare.

But because fears are so visceral and often irrational—take, for example, my fear of heights or that my husband will die suddenly—it is difficult to have a calm discussion about these things and how to respond appropriately.

Many people were excited and relieved by President Trump’s travel ban on people from Iraq, Syria, Sudan, Iran, Somalia, Libya, and Yemen because they saw it as addressing their fears. Many other people were outraged and annoyed because they, like me, are not afraid. Or they’ve decided that the risk of terrorism is less important than living in a country that helps families flee from war, or helps smart graduate students study in great universities, or lets people experience American freedom to start businesses and make a better life for themselves.

So what are you afraid of, Tom? Are you afraid that allowing refuges from Libya, Somalia, and the Sudan to resettle in Buffalo is risking a terrorist attack in the 23rd district or elsewhere? Are you afraid that people from these countries are going to carry out another large-scale attack like the one in 2001? Or, are you afraid that if you don’t support a president who has a lot of popular support, you’ll lose your election two years from now?

I’ve kept my promise to call your office every weekday in February. On Wednesday, I had a conversation with Tom, a case worker in the Corning Office. On Thursday, I spoke with Natalie in the DC office and on Friday with Samara in DC. Thank them, for me, for their graciousness in listening. It must be annoying to have to listen to constituents who do not agree with what your boss is doing. They were very polite.

I see that you’re going to be visiting my neighborhood on February 18 for a town-hall meeting. I asked you to do that in a previous letter, and now you are. Thank you! I’m looking forward to meeting you then.

Until next week,

Susan