​One of the things by which I’m most struck in the Trump era – and which may have helped cause the Trump era – is a remarkably abhorrent culture of selfishness. I’d happily blame Ayn Rand, but I’m guessing that many contemporary students’ version of reading The Fountainhead involves reading Wikipedia and SparkNotes. (That said, we all know Paul Ryan has been masturbating to Ayn Rand since his teens. Apologies for the unpleasant image.) But whatever the cause, it’s dismaying at both a personal and a societal level.
 
​Senator Kirsten Gillibrand said recently, “If we’ are not helping people, we should go the fuck home.” She was right. Indeed, the operative word in public service is service. Sadly, this sentiment isn’t shared by enough of her colleagues.

Watching Senator John McCain – who is fighting cancer and receiving taxpayer-subsidized health care – fly to Washington D.C. to proceed with Republican efforts to dismantle the Affordable Care Act is a perfect example: “I got mine, so I don’t care about you.” We see white men in Congress crowded around a table agreeing to undermine insurers’ coverage of women’s health. (Okay, if I’d been in abstinence-only education and had as little sex as they look like they’ve had, I might think a stork dropped me off too). We see doctors in the Senate who have taken the Hippocratic Oath to “do no harm” working to advance legislation knowing that it will result in tens of millions fewer with insurance, but with so much “freedom” to go without care because of prohibitively high costs. We see wealthy senators without a care in the world voting to strip care from the nation’s most vulnerable populations, while claiming to embrace Jesus Christ, who, like, TOTALLY was all about just helping the rich and the healthy.
 
Of course, if we’re human, we’re fallible, and if we’re fallible, we can fall ill. The good fortune we may have had shouldn’t serve as a license to deprive basic needs from others less fortunate. And it’s almost like the Bible had a lot to say about that… What can I say, the religious right seems to be a lot better on memorization than reading comprehension.
 
Twitter is at times a fun, and at other times a disturbing place, where I have made friends with some and been told by others that my autoimmune conditions are my fault and that I’m a drain on the health care system. (Me, personally? I had no idea I was that powerful!). I’ve seen people freely say that their own ability to get health insurance should mean other people are on their own caring for their needs. And I’ve been left baffled by their transparent disregard for fellow citizens (don’t get me started on many people’s views on non-citizens…).

When did basic kindness and decency come to be viewed as prohibitively costly, as opposed to a moral imperative?
 
I’ve been asked more times than I can count whether I’ve had an abortion since I write a lot on Planned Parenthood (not that it’s anyone’s business, but I haven’t), whether I’m in the LGBT community since I’ve long advocated for LGBT rights (not that it’s anyone’s business, but I’ve explored with women but for all intents and purposes am basically straight, much to my chagrin at times), or whether I’m on Medicaid since I’m fiercely committed to its expansion (up until this month, I’d only ever had private insurance). I’ve been asked if my life is at stake with the repeal efforts and while it most definitely is, my passion for this issue preceded the decline of my health.
 
I care because I’m human and I care about people. But this isn’t me patting myself on the back, though I think I was brought up right. This is me saying that other people should care too. Indeed, it shouldn’t require a majority female Congress to have basic health care protections for women. And while greater LGBT representation in our government would be ideal, that shouldn’t be a necessary condition for opposing infringements on their basic rights, with the most recent attack being the barring of transgender individuals from the United States military.
 
I may be overly idealistic, but I’ve always believed that those who are self-serving rather than believers in loving thy neighbor shouldn’t opt for careers in public service. And for the love of god, if you hate government, don’t work in it. Instead, be businessmen on Wall Street, where they reward being a soulless schmuck if it means improving the business and one’s financial earnings.
 
Senator Ben Sasse recently wrote a book on the “vanishing adult,” viewing young adults as lacking the personal responsibility and independence observed in prior decades, rather existing in a perpetual adolescence. What he fails to truly confront is that this generation was graduating from college amid the greatest economic recession since the Great Depression, and has a Congress working to demolish safety-net programs on which millions rely but on which members of Congress have not themselves depended.
 
The reality is that it’s very difficult, if not impossible, to take personal responsibility when conservatives’ self-serving economic policy plunges the nation into deep recession. It’s difficult to take personal responsibility when white, heterosexual men make it easier to discriminate on the basis of sexual orientation and identity, or to maintain job security and maternity benefits when deciding to have a child. It’s difficult to take personal responsibility when Republican determination to micromanage women’s bodies means that women with unwanted pregnancies in some parts of the country may need to either obtain dangerous, illegal abortions or else have children for whom they cannot properly care and for whom a Republican-led government will not care either. It’s difficult to take personal responsibility when wealthy, healthy men never relying on safety-net programs work to gut Medicaid funding, thus leaving one with the “freedom” to choose between untreated illness and bankruptcy.
 
Selfishness under the label of “personal responsibility” is still selfishness. And while this selfishness under the guise of limited government (government so small it fits in bedrooms and bathrooms!) has been the Republican mantra for quite some time, we see it at full force now with unified Republican government as well as Republican-dominated governorships and state legislatures.
 
When the Republican budget won’t even provide for the bootstraps by which we can pull ourselves up, it is difficult to see their party as doing anything other than engaging in naked partisanship and selfishness to a degree that is now dangerously normalized, if not embraced.
 
Claiming to love America while showing utter disregard for helping tens of millions of Americans is no way to govern, or even to exist in the diverse, pluralistic society that defines America.

​The evening of January 19, 2017, I marched down Central Park West outside of Trump Tower, in protest of the inauguration while holding a sign that read, “GOP Health Plan: Grab ‘Em by the Premium.” Then I got a text message from my doctor, who told me that based on my recent test results, I needed to go to the emergency room, where I would surely be admitted rather than going to DC for the women’s march.
 
Health policy is an issue to which I have long been invested, both as a scholar and as a patient. And while I have long advocated expanding health coverage, this month is the first time I have ever been on government-provided insurance.
 
This is not to say that I haven’t been immensely concerned amid the Republicans’ ongoing efforts to repeal the Affordable Care Act. From an early age, I have struggled with a number of health problems, whether chronic ear infections to chronic kidney inflections stemming from a kidney disorder that almost required surgery. While in college, my anemia worsened and required iron infusions, but the underlying cause of the anemia wouldn’t be discovered for a few years. While I was in graduate school, in addition to being diagnosed with a couple of stomach conditions, I was diagnosed with a rare parathyroid disorder that caused electrolyte imbalances requiring several hospitalizations. In 2012, I experienced a violent assault, after which I required extensive treatment for depression and PTSD. As a postdoctoral fellow, my electrolyte abnormalities began to cause what were thankfully only minor cardiac complications.
 
Long story short, while I was able to thrive in graduate school and beyond, I have a lot of preexisting conditions, which prior to Obamacare’s passage would have led me imperiled had I not been on my mother’s insurance through college.  
 
Up until recently, I had been lucky on the insurance front. As a doctoral student at Columbia University, I had outstanding insurance to cover treatment by some of the best doctors in the country. I had to make some unfortunate changes to my career path on account of limited health care options in certain regions of the country, but otherwise have always made it work.
 
But amid academia’s shift toward hiring visiting or adjunct faculty, and with a laundry list of preexisting conditions, I have known that should Obamacare be repealed and my position not be renewed, I would be unable to obtain health insurance due to either outright denial (as happened to me in the past between college and graduate school) or by insurance companies making coverage prohibitively expensive. Indeed, I watched President Trump’s inauguration from my hospital room at New York Presbyterian Hospital at Columbia University, tears rolling down my cheeks as I considered the fate of the nation and more selfishly, my health care. Up until recently, this concern was merely hypothetical.
 
With my lecturer position not renewed, my health insurance expired on May 31st. Low-deductible marketplace plans in Connecticut were prohibitively expensive while I was job hunting, and COBRA insurance even more so. I decided to take my chances being uninsured, in hopes that it would be a short-lived state of affairs. Each time I noticed more symptoms from my chronic conditions, I felt the anxiety of wondering whether I was getting sick again. Each time I went for a run, I thought about what would happen if I got injured.
 
After 7 weeks of being uninsured, I called the Access Health CT number to see if there was any subsidy assistance available in light of my unemployment. Ten minutes later, thanks to Connecticut’s Medicaid expansion and the helpful woman with whom I spoke, I was able to enroll in Medicaid for the first time in my life. And I cried with relief. This was certainly not a benefit that would have been available to me had I been living in one of the 18 states that has not opted to expand Medicaid through the Affordable Care Act. 
 
Though I have long been well-acquainted with the immense benefits that Medicaid offers millions – with 1 in 5 Americans on Medicaid or CHIP and with Medicaid patients vastly more likely than the uninsured to have a usual source of medical care  – I had never expected that I would be a recipient of that aid. I had aided people in getting connected with social services. I had championed its expansion and called my legislators to thank them for voting in favor of programs I was not on. Today, my Medicaid card came in the mail.
 
The reality is that health, as well as the employment through which many rely on health coverage, can be tenuous. While some are born into fortunate circumstances or have unusually high degrees of job and financial security, a $500 surprise (e.g., an unexpected medical bill) would for the majority of Americans require going into debt. And it goes without saying that absent insurance, medical expenses often aggregate to thousands, if not tens of thousands or more.
 
While I have long advocated Medicaid’s expansion and continued support, I had never envisioned myself as a recipient of its great benefits. Despite a moment of shame at my current state of seeking employment, I’m filled with gratitude to not be without insurance given my medical history. And the reality is that there’s a hubris to assuming that misfortune will never befall us, and the majority of Americans believe that the government has a responsible for ensuring health coverage for all Americans, regardless of our level of good fortune at a given point of time.
 
This has never been a battle over personal responsibility. People cannot accept the responsibility of full-time employment when they are faced with the “choice” of bankruptcy versus untreated illness. And those whose own health care is subsidized by the taxpayers whose care they undermine have no business voting – without so much as a congressional hearing – to decimate care for millions under the guise of “public service.”
 
Deepening health and economic inequality is no path to American greatness. America can and should do better.