To be fair it would be reasonable for Mr. Trump to publicly discuss the ramifications of the Trumpcare provisions that would specifically impact individuals with pre-existing conditions similar to his own. This would demonstrate understanding of the complexities of these potentially life altering conditions even though Mr. Trump would not himself be impacted by any changes in the law. This is not because Presidents can’t have pre-existing conditions. This is due to his geriatric status. As an almost 71 year old he is eligible for Medicare. Nevertheless even though he is not at risk a 64 year old would be so at least the demonstration of understanding would prove useful.
So, the first pre-existing condition is age. The next most obvious condition is obesity. Some consider this a self-inflicted condition which often results in the development of diabetes. In fact Mr. Mulvaney has suggested self-inflicted conditions deserve increased scrutiny when medical coverage is decided. The next obvious condition would be what we all observe, Mr. Trump’s impulsiveness and difficulty maintaining attention. If diagnosable a disorder with these characteristics would have lifelong negative consequences. Most experts would not place these in the self-inflicted category yet the willingness to seek and maintain appropriate treatment might be. So in Mr. Trump we have an impulsive, obese old man who has difficulty maintaining attention who might also be at risk for diabetes and any number of co-occuring disorders the result of unwillingness to seek or follow through with appropriate care.
The issue of personal responsibility is an important one. Obesity may or may not be self-inflicted. Some studies reflect a strong genetic pre-disposition. In fact most clinicians would likely agree that at some level everything happens at the genetic level. But then everything within our influence happens at the behavioral level. The conundrum for caregivers is in discerning the influence of these factors and then devising an effective strategy. Even though the proper treatment is known the strategy necessary for patient compliance may be more problematic. Genetics affects everything. So does the environment. In some environments patients with challenging and complicated diagnoses thrive. In others their conditions rapidly worsen. The keys to good care are access to sufficient resources and a supporting and nurturing environment in which treatment has the best chance to succeed.
Trumpcare has suggested that an individual with the profile of Mr. Trump could, by the decision of the state in which he was residing, be placed into a “High Risk Pool”. These individuals would then be subjected to significant rate increases to the degree where many would be priced out of insurance. That part is clear. The part that is not clear is who decides and by what standards? The deciders would be members of what Sarah Palin famously called, “Death Panels”. But who are these people? How do they get the information about the patients to be thrown into the pool? Does privacy have any role? What kind of person would seek membership on a Death Panel? What would they be paid and would that give them incentive to throw more people into the pool?
There is a popular concept out there right now in psychology, economics and sociology called, “Grit”. Those with Grit have what it takes to rise up and out of adverse circumstances whether it be a child in Southside Chicago or a laid off factory worker in Ohio. These individuals have the internal mechanism to problem solve them right out of the ditch. Workshops are happening at this moment around the country teaching bosses and teachers and counselors how to instill Grit. There is a competing philosophy, not a refutation but rather a suggestion that Grit is good but it only works in the presence of another factor. This factor is, “Slack”. Slack is the idea that a challenged individual best succeeds from within an environment that permits failure, offers encouragement and promotes second and third chances. Bankruptcy is not a death sentence for a career but rather information that when heeded paves the way to future success. Slack is the catalyst for Grit.
In the healthcare debate I would then propose a new slogan. SLACK TODAY FOR US. Put it on a hat. STFU.
