Open Letter to Rep Tom Garrett, re: health care

I'll try to be brief. Your early days in Congress, you responded to constituent taunts about seven years of 'repeal and replace' rhetoric by pointing us to some sketchy talking points published by the Speaker's office. You now embrace the Freedom Caucus approach to health care, and have spoken publicly on their behalf. I'd like to impress on you a third way, the same way I expressed to Tom Perriello during the crafting and enactment of the ACA. Let me first state that I don't believe that the ACA has any insufficiencies that can't be attributed to GOP sabotage.

I've stated on Twitter to you and Rep Brat of Virginia's 7th district my objections to the anti-federalist erosion of the regulatory authority of the several states; the diversion of financial capital from investment to predation; and the frank refusal to legitimize and make provision for medical necessity as a public obligation of hospitality to others.  All appear to be features of the Freedom Caucus approach. One that keeps coming up, for decades now, is the erosion of the sovereign capacity of the People as exercised by juries.

Prior to the ACA, medical emergencies large and small could be presented to certain hospital emergency rooms (and still can) with an assurance of appropriate treatment. This assurance is subsidized by providers, insurers, and governments, and ultimately by individuals in cost of services, premiums, and taxes.

I think we can agree that this last resort safety net of the emergency room is the least efficient place to effectuate a public guarantee of care. Despite crowd reaction to hypotheticals addressed in the 2012 Republican debates, turning people away is not an option. If you believe it is an option, just come out and say it. I assure you, the people of the Fifth district will take umbrage. The alternative is a system of care that promotes wellness, promotes relationships with providers, has multi-tiered service capacities appropriate to needs, and stops giving thousand dollar care to fifty dollar concerns.

What does all this, preserves the sovereignty of states and citizens, promotes responsible use of personal savings, and incentivizes cost containment and innovation? Look to Nelson County for some answers. I'm certain other localities in our Fifth district, in Virginia, and nationwide have similar exemplary public health providers. Embrace that service model. As far as where subsidies come from -- fellow patients, fellow policy holders, or fellow residents, such is a matter of political values and interests. We all want others to pay disproportionately. I don't much care how that allocation is made. I'll do my share. I do care when the result of those deliberations constrains juries, state and local governments, financial stability and justice, individuals in need of medical attention short of crisis, and competing models of care. I believe the Freedom Caucus formula threatens these and more fundamental American values.

I did try to be brief. Sorry. I'll close briefly by stating that subscription-style wellness services appear to me to be a service model by which state and local governments in partnership with the medical community can provide means-adjusted subsidized care and walk-in urgent care. Medical catastrophe remains a concern. Whose, I don't know, but wellness emphasis should lessen the instance of catastrophe and facilitate more efficient response. Think wellness. Legislate wellness. I've shared my views. I'm sure you will continue to share yours and hope several large venue town halls will be one means of sharing. The only personal response I'd request is your prepared constituent response to ACA related queries, by email or snail mail, as suits your operation.