I actually thought this would come to a head much sooner than 100 days, this tension between the trust and loyalty President Trump requires of his staff and supporters and the actual lived experience of his staff and supporters. I did think it would happen, when it did happen, in the area of Affordable Care Act repeal, replace, or modify because all kinds of people have substantial, if partial, knowledge of how health insurance does and doesn't work in the United States, based on lived experience.
I have done a great deal of public speaking on the ACA in Missouri and I have yet to speak at an event — large or small — where someone listening has not advanced themselves, a loved one, or as a friend of someone with a pre-existing health condition that has, in essence, rendered them uninsurable, COBRA and high risk pools notwithstanding. It is interesting how vocal those who resist insurance mandates for individuals can be equally vocal in support of insurance company mandates requiring guaranteed issue without pre-existing condition exclusions.
Yet, the entire 100 day dance around the ACA has circled this tension between a communitarian view of insurance equity and an individually underwritten view of insurance equity, without explicitly naming it I find it fascinating that the same public that cries along with Jimmy Kimmel at the serious heart disease of his new born son also appears relatively undisturbed that, before the ACA's passage, many insurance policies excluded maternity coverage entirely. Yes, Medicaid funds over 50 percent of births in a number of states but anyone too rich for Medicaid and also driven to an individual market health insurance product excluding maternity coverage entirely, might not be lucky enough to choose to have a baby at all.
You may say that newborns represent the ultimate blameless among us and the difference is something that may be hardwired in as we turn a hard heart to those who would merely like to re-produce without bankruptcy as distinguished from those who already have reproduced and plead on behalf of a quite ill newborn. It's the old rescue preference for those at risk that we can see in another guise, perhaps.
But now we've gone one step further with the President insisting protections against pre-existing condition exclusions are in the latest MacArthur Amendment to the American Health Care Act of 2017 proposal when they are not. What will you trust or who will you trust, your senses or your President? It does, after all, require some thought and analysis to consider why high risk pools were a failure before the ACA and to consider whether the MacArthur Amendment would do anything to change that. It turns out it is difficult to graduate from high risk status and pools of high risk individuals are inherently unattractive in a commercial health insurance system where every claim paid is a loss to the insurance company.
Is this the ultimate President Trump loyalty test? Will you trust my representations over your own lived experience?
Morton Deutsch noted that ""trust" involves the notion of motivational relevance as well as the notion of predictability." Even then, there is individual trust, societal trust, and relationship trust. What kind of trust is implicated in the call for supporters of the McArthur Amendment to the AHCA? Is it relationship trust when you suspend your own disbelief in order to embrace an assertion contrary to your own lived experience? Or, is this really just a matter of figuring out what people want to hear and finding a shrewd way to tell them just that? As Marina Korokova has noted: "[Con artists] will tell me the story that I want to hear. They’re not going to tell me the story they told someone else. It’s not like they have, you know, a story book that they read out of. They’re going to profile me and sell me the things I’m not going to question."
Interestingly, many of us can spot a con when it is being perpetuated on someone else ("that is too good to be true") but are vulnerable to the same cons being perpetuated on ourselves. Why? We're special. Things may not seem as they appear because of how special we are. It is about emotions, not logic. The laws of commercial health insurance underwriting must not apply to us, only to those other folks.