Tuesday, March 7, 2017

From the Heart of Kansas: Delivering Babies to Aborting the ACA

The four Kansas Congressional Districts
Somehow auntie Em and Miss Elmira Gulch never quite did it for me. The last time I had romantic thoughts about Kansas was when Dave Wottle won the 800m race at the Munich Olympics in 1972. My head was in the triple jump. I was young and a dreamer. And what better dream than Dave Wottle winning the 800m from way in back of the pack.  I had no politics.

But my association between Dave Wottle and Kansas just now, turns out to be a false memory. It was Jim Ryun, the great American miler (3:51.1, Silver medalist in the '68 Mexico City Olympics, and world record setter) who hailed from Kansas. Same fond feeling.

Ryun (born in 1947) was from Wichita, Kansas. He first broke the 4 minute mile as a 17 year-old at a meet in Los Angeles, eighth place in a field of American runners who all broke 4 minutes. Before he was done with high school Ryun ran 3:55.3, setting a record that stood for 36 years. Ryun attended the University of Kansas, set a world record at Edwards Field in Berkeley, California and wound up living in California for a decade. But liberal politics did not rub off on him.

It's a lonely sport, middle distance running. So is politics in much of Kansas.  Jim Ryun returned to Kansas to run for and represent the 2nd Congressional District. His district covered most of the eastern part of the state, except for the Kansas City Metropolitan area. [It's the blue swath in the map at the top of this post] The Second District includes the capital, Topeka (metropolitan population of 234,000), and Lawrence (pop. 87,000) home of the University of Kansas. Population density is 350 people per square mile.

The Second District is a deeply red district. Jim Ryun represented the district for a decade from Nov. 1996 to Jan. 2007 and he was rated as the "most conservative" member of Congress in 2006 by the National Journal. He was given a zero percent rating by the environmental group Republicans for Environmental Protection. He was no friend of Medicare, voting against the Bush prescription drug benefit and voting to allow hospitals to deny non-emergency treatment to Medicaid patients unable to afford their co-pay obligations.

The most lonely district in Kansas, however, is the First Congressional District; it stretches nearly 400 miles along the northern border with Nebraska, 213 miles along the western border with Colorado, and another 200 miles along the southern border with Oklahoma. It's an area the size of the state of Illinois. Population density is fewer than 12 persons per square mile. Voters in the First District voted for Trump over Clinton with a 70 percent margin. Bob Dole represented the district from 1963-1969. In the most recent election, the district elected a 56 year-old obstetrician, Roger Marshall. Like Jim Ryun, Marshall is no friend of Medicaid.

Dr. Roger Marshall, health care entrepeneur to Congress
Marshall has jumped from delivering babies (more than 5,000) to aborting the Affordable Care Act (ACA). “Letting the government run anything, including health care, what happens is prices go up and competition goes down,” said Marshall in a recent interview with STAT, the medical news publication. He is a health care entrepreneur. He helped build a small, four-bed surgical clinic into the full service physician owned Great Bend Regional Hospital in central Kansas. "He measures success in how many people can afford to leave the Medicaid program and enter the private insurance market," says Lev Facher in his STAT portrait.

Marshall has joined the GOP Doctor's Caucus in Congress, which has been focused on overturning the ACA for the past several years.  Repealing the ACA, of course, has been a fixation of Republican Georgia doctor, Representative Tom Price, who now heads the Department of Health and Human Services. The key goals of the GOP Doctor's Caucus is to repeal the ACA, to repeal the individual mandate, to end the obligations for "10 essential benefits" under the ACA (including maternity and mental health), and fighting rule changes applicable to Medicare doctor reimbursement that were designed to inch Medicare away from a fee-for-service model to a quality of care model.

Marshall doesn't support the Medicaid expansion that the ACA accomplished: providing medical insurance to everyone earning up to 125% of the federal poverty level. “Just like Jesus said, ‘The poor will always be with us,’” he said to STAT. “There is a group of people that just don’t want health care and aren’t going to take care of themselves.”

Marshall continued:
“Just, like, homeless people. … I think just morally, spiritually, socially, [some people] just don’t want health care,” he said. “The Medicaid population, which is [on] a free credit card, as a group, do probably the least preventive medicine and taking care of themselves and eating healthy and exercising. And I’m not judging, I’m just saying socially that’s where they are. So there’s a group of people that even with unlimited access to health care are only going to use the emergency room when their arm is chopped off or when their pneumonia is so bad they get brought [into] the ER.”
It's a remarkably callous statement for a doctor.

"I will use treatment to help the sick according to my ability and judgment . . . . Into whatsoever houses I enter, I will enter to help the sick," says the Hippocratic oath. So what does a doctor do when he goes to the House of Representatives in order to deny medical care to people who can't afford to pay or to purchase private health insurance? Does he not violate his Hippocratic oath?

"Show me the money and I will provide for you beautiful health care, in a serene setting!" "Oh, you don't have money? Don't look to me as a doctor, as a Congressman, as a citizen or taxpayer to get a free credit card. Go rot in your hovel."  THAT'S the philosophy behind "Repeal and Replace;" that's the philosophy behind GOP care.

From the heart of Kansas comes this entrepreneurial doctor to violate his Hippocratic oath. Sadly, I fear that Jim Ryun, were he still in Congress, would be joining him.

Post Script.  In case you have not been paying attention, the current American mile superstar and gold medalist from the Rio Olympics last summer is Matthew Centrovicz (3:50.53). The American record is held by Alan Webb (3:46.91), set at a lonely field in Belgium in 2007. The current world record (3:43.13), held by Hicham El Guerrouj of Morocco (1999), has stood for nearly 18 years.

As long as Ohio and Kansas can produce such beautiful runners as Ryun and Wottle, surely there must be hope for this world, no matter what their politics.

Follow me on Twitter @RolandNikles

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