It’s easy to forget sometimes that the Presidency isn’t always about Donald Trump, but about the nation he purports to lead. The debate over healthcare ‘reform’ has been a good reminder.

During last year’s election campaign, the old mantra pledging to “repeal and replace Obamacare” was repeated by President Trump and the Republicans so often it became basically meaningless; just another line for the crowds to cheer, perhaps not always understanding the implications.

Now it seems it’s meaningless in practical terms too, at least for now, after the Senate bill to repeal the Affordable Care Act appears to have fallen apart when Senate majority leader Mitch McConnell couldn’t lock down enough backing to bring the rewrite to a vote.

While it might look like the Senate legislation fell apart because of Republican dysfunction, don’t underestimate the power of protest – and it’s significant that activists who organized demonstrations in Washington and in the home districts of Republican congressmen are preparing for further action.

Despite celebration among opponents of the repeal, therefore, this issue has been described as “The Terminator” in that it keeps coming back, and while Republicans control both houses of Congress the idea of ‘repeal’ – even without the immediate ‘replace’ – isn’t yet totally dead.

President Trump, who famously welcomed members of the House GOP caucus to the Rose Garden when they passed their own version of the bill and expressed optimism about it getting through the Senate, tweeted that Republicans should now start over. McConnell said a vote on a delayed repeal would happen “in the coming days” even if it’s unlikely to pass.

Before the bill stalled on Monday, McConnell – knowing he needed the support of every single Senator he could get – had postponed a vote after Sen John McCain needed surgery on a blood clot.

Reports subsequently surfaced that if Sen McCain had been uninsured, his surgery would have cost him about $76,000 – as Vox points out, more than the average American household income – and the whole debate around healthcare has thrown into relief the state of inequality in the nation, particularly since it prioritises tax cuts to the wealthiest Americans alongside deep cuts to the country’s largest insurance programme, Medicaid.

Time reported that proposed cuts in the Republican bill could reverse the recent downward trend in personal bankruptcies.

Unpaid and costly medical bills are a significant contributor in the decision to file for bankruptcy, experts said. And even if the financial distress from being uninsured doesn’t send someone into bankruptcy, high and sometimes unexpected medical costs can still send Americans into a lot of debt.

 It’s been a few years since books like Barbra Ehrenreich’s Nickel and Dimed threw a spotlight on those who were – to borrow a phrase from elsewhere – just about managing. Recent research has shown poverty spreading to the nation’s suburban areas, even as it continues to grow in cities.

 

Adding fear to the mix

The friend I’ve been staying with in Baltimore this week suggested we have breakfast at a lovely local bookstore and coffee shop. As we were sitting down she casually dropped into our conversation that a few months ago it had been the scene of a shooting incident.

Her home is a short distance from where the city exploded in rioting following the death of 25-year-old Freddie Gray two years ago. The pristine, historic neighborhood – where one of the homes has been the home of Frank Underwood on House of Cards – gives way to where those same TV audiences saw police cars burned and drugstores looted.

When I told her I was worried about her, she just replied “Dude, you grew up in Belfast,” and it occurred to me that we’re both resilient cities, having struggled through adversity, making the best of circumstances that we often have little control over. But things are always fragile. The Economist recently described Baltimore as an “exceptionally murderous city” and said that “As America gets safer, Maryland’s biggest city does not.”

And gun violence is sadly repeated all too often, even if it’s not always reported, in cities where parts of the urban areas are already wracked by poverty. The White House recently even said gun violence in Chicago was “driven more by morality than anything else” rejecting the idea that easy access to guns was a contributory factor.

After the National Rifle Association’s recent controversial recruitment video caused a storm, the organization’s latest offering specifically targets women gunowners.

 

We Are Family

But back – at something of a tangent – to the healthcare story.

Anyone who’s ever been to a baseball game will know that all ballparks are great places to hear stories of local volunteers and returning military heroes. Their faces are usually flashed up on the big screen between innings while the crowd put down their beers and applaud. It’s so common it’s almost a kind of pavlovian patriotism that has become just another part of the entertainment.

But I saw two things at different ballparks this week that told me more about the American people than anything on the jumbotron.

At Camden Yards in Baltimore on Saturday night, a woman started to scream in the section behind where my friends and I were sitting. It was a young mother, paralyzed with fear as her baby was choking. As concern spread through the nearby seats – the woman behind me covered her face with her hands and couldn’t watch – a man who was apparently a doctor sprinted to the incident, worked on the child for an agonizing thirty seconds or so, then, to applause he returned to his seat after ensuring the baby was being taken off to be checked out: just someone doing what’s right with no thought about who profits from it.

Then on Monday afternoon in Cincinnati, an extended family of about ten people arrived, all dressed in Reds gear, and they had a disabled teenage boy with them. Throughout the game, they took it in turns to look after him; feeding him, making sure he had enough to drink on a very hot day, talking to him all along; he was clearly well cared for.

America needs to behave like a family again. And perhaps the failure for now of their healthcare bill could be a wake-up call for the Republicans that removing coverage from millions of their voters might not be the most popular strategy.

At the coffee shop I mentioned earlier where the shooting took place, customers can ‘pay it forward’ at the checkout counter by buying a sandwich which someone in need can subsequently claim. There’s a lot riding on political leaders right now to pay it forward, encouraging people to think of themselves as members of the same community. The consequences of further division and polarization are stark.

Also published on Medium.