Dalton Delan: An alternative future under the ‘Pay Your Share Act’ health care reform

Sitting atop my high horse as 2022 draws to a close, I’m amazed at how far we’ve come. Back in early March, nobody would have predicted the perfect storm that revolutionized our health care system. Yet here we are, with the PYSA signed into law — that’s the Washingtonian acronym for “Pay Your Share Act” for those few who also say “ACA” rather than “Obamacare” — and health costs are calibrated not by what you can pay, but what you should.

It started with resentment by overburdened nurses and doctors in ICUs treating a plague of the unvaccinated. Once free vaccines were no longer a treasure hunt, it seemed unfair — borderline criminal — that people were still intubated and dying unnecessarily. It was one thing to do so in the privacy of their echo chamber of antisocial media; it was quite another to expect civilized society to kill itself working to save them from a COVID comeuppance.

Lobbying by the American Medical Association and American Nurses Association resulted in swift action by a Congress emboldened by the temporary absence of Sen. Joe Manchin from the floor as rescuers worked to free him from a coal mine collapse that had trapped him in nonvoting hell for critical days. With the Vice President emerging from shadow to cast a deciding vote, the commiserator in chief signed the PYSA into law.

As usual, petty grudges and vote-swaying add-ons had been tucked in, and when shove came to push for a vote, virtually no-one had read the fine print of the bill’s 6,000-odd pages. When you added it up, the new math of the PYSA had an inescapable gravitational pull. With nearly three of four Americans overweight or obese, the “fat tax,” as it came to be known, was notoriously cruel: for every pound over target weight, patients paid a dollar more for their copay. Once everyone was forced to wear a fitness-tracking device, with every step under the 10,000-a-day goal, the unfit surrendered another penny in copay. Nastiest of all was the sugar index, with all its diabetic inclusions and exclusions: your Starbucks card and Dunkin facial recognition security-cam video recorded the use of whole milk and sugar, not to mention the addition of glazing to donuts and breakfast biscuits with bacon, and more than four instances a month resulted in an automatic copay doubling.

The foodies had their struggles, but the burden of sexual proclivities fell inordinately hard on the young, unwed and adulterous. The use of dating apps for one-night stands was a particular no-no, with resultant STDs punished accordingly. Although the STD rate in the Villages in Florida was not the scandal the press made it out to be, the AARP nevertheless got into the act and sought to render toothless this puritanical provision.

Especially controversial has been the “Color Rule” cribbed from old legislation of the glorious Confederacy: the insured in red states automatically pay twice as much in premiums as those in blue states, the assumption being that the former would disproportionately remain unmasked and unvaccinated, while drawing on more government support. When he learned of this provision, relayed to him via the first tiny tunnel to reach his air-pocket, Manchin was heard to yell so loudly that it caused another cave-in that kept him from voting.

As we await a Supreme Court ruling that is expected to gut the PYSA, it is instructive to remember the stinging dissent of Justice Sotomayor when the Texas SB8 abortion law was upheld and Roe v. Wade overturned: “As a proud graduate of a Garden State university once presided over by that paragon of prejudice Woodrow Wilson, I cannot conceive of a fouler stench of partisanship than this ruling by a six-pack of clowns-in-gowns, a troika of whom having been appointed by a guy who thinks ketchup on fries comprises the five food groups.” Given the House was just flipped by the midterms, it’s academic.

For another few weeks, we abide in the new normal. Money being tight, I am measuring my BMI, strapping my Fitbit to the dog’s leg to amass a simulacrum of steps and ordering coffee black-no-sugar. To the unvaccinated, I cry, “Bring out your dead!”