A Koch-backed think-tank called the Washington Policy Center pays former columnist Elizabeth Hovde to discredit Democratic health care policy around the state. Lots of newspapers run her stuff, including most recently the Spokesman-Review. 

While nobody loves dunking on lackluster liberal health care policy more than I do, her attacks on WA Cares, the state’s new long-term health care benefit, feel particularly galling given her personal history with the issue. 

Back in 2011, she suffered a terrible ski accident that put her in a coma and kept her hospitalized for more than a month, according to her own account in the Oregonian. Like many people who find themselves on the hook for unexpected medical bills, the crowd-funding efforts began shortly thereafter. A fund was established “to help the family defray medical expenses,” according to the Columbian, and her ex-husband's students organized a charity 5K race to help raise even more money. She worked as a columnist at both of those papers for a decade, and both outlets promoted the donation fund and the race, which was nice of them. 

The crowd-fund raised “more than $8,000 in just the first three weeks,” according to a blog post from Hovde's editor at the Oregonian. In an email to The Stranger, Hovde claimed the people who took part in the 5K race were “mostly my personal connections," and she estimated about “100 participants” all told. A follow-up story in the Oregonian reported that the race “attracted 231 participants, 73 of whom ran in the 5K, and raised $3,800 to help the Hovdes cover medical and related expenses.” 

So the family raised at least $11,800 in 2011, thanks partly to the help of two newspapers amplifying the call. “The relatively small fundraiser,” as Hovde described it, couldn’t make up for “several months of lost income,” but the money did help her and her husband pay for bills and medical expenses while he maintained his job and while she found her bearings, she said. 

Though the ubiquity of crowd-funds to cover health care costs should on its own serve as enough of an indictment of the health insurance industry, I don’t bring up the charity efforts to diminish them, nor do I mean to make light of the struggle that so many families endure to pay for health care. I bring it up to highlight how much personal and professional support Hovde enjoyed during this difficult time, and to point out that many, many people aren’t as fortunate as she was. 

A lot of people recovering from serious injuries—or who otherwise need long-term care—do not have partners with incomes, do not work at newspapers with wide reaches, and cannot easily communicate with English speakers. 

For those people, lawmakers developed WA Cares. The long-term health care benefit provides workers $36,500 to spend on stuff that medical insurance doesn’t normally pay for, so long as the worker is more than 18 years old and has paid into the system for a certain number of years. Here are a few likely scenarios for spending the money, straight from the government website:

In my view, Hovde leaning on her personal connections to help pay her long-term health care bills and then deciding to spend her career trying to stop the government from doing the same thing for less-fortunate Washingtonians represents the height of hypocrisy. It’s health care for me, but not for thee. 

Hovde disagrees, of course, but not very well. 

In our brief email exchange, which she published over on her think-tank’s blog for transparently silly reasons, she essentially argued that she couldn’t be hypocritical because WA Cares actually burdens workers rather than benefiting them. For her, ending WA Cares and "strengthening" rather than "expanding" Medicaid would bring us one step closer to the health care nirvana of a completely privatized, unregulated health insurance market. Furthermore, my accusation seemed particularly wrong-headed to her because she wouldn’t have even qualified for WA Cares in the first place. So, hah! 

Those arguments fail to engage with the central premise of my claim–namely, that her privilege blinds her to the fact that many others lack her luck and must rely on government services or else simply suffer and die–and so of course she has a hard time accepting the “scarlet H” I'm affixing to her lapel for spending her time trying to dismantle those government services. But before I address that core issue, I’ll quickly dispatch her claims on her own terms. 

First, she attacks the long-term health care benefit as a “regressive” payroll tax that forces low-income workers to “hand over a portion of their income to benefit other people with higher incomes and who may not need assistance.” Now, I would love to pay for state-run benefits with a progressive income tax, but opposition from Republicans like her and spinelessness from our state Supreme Court means we have to fund most stuff with regressive taxes. If Hovde would like to join the movement for a fairer tax code, then welcome aboard. 

Setting aside her disingenuous concern for regressive taxation, the reality is that she actually doesn’t know whether the program will ultimately pad higher-income fraudsters at the expense of low-income workers, because the benefit won't come online until 2026. Judging from what we do know, however, her scenario seems unlikely.

The crisis in long-term care–where we have 83% of Washington workers entering their golden years very soon and with little or no savings–hits people with low-incomes the hardest, so they'll likely draw on the benefit the most. Of those with low incomes, Black people, Indigenous people, and people of color are hit particularly hard due mostly to various forms of structural racism in housing, banking, and employment that created wealth gaps. And right now, unpaid caregivers–a disproportionate share of whom are women of color–pay 20% of their own income on long-term care expenses. The 58 cents that WA Cares takes out of every $100 is far less than that, and so the benefit could help ease that burden. 

Hovde also claims that Medicaid, SSI, and SSDI exist, and so we should “strengthen” those programs– i.e. shrink the number of people who qualify for them–if we’re really worried about skyrocketing Medicaid bills that will hit the state once the Boomers retire in a series of silver tsunamis. Her point here makes little sense. To get Medicaid to pay for long-term are, a person would need to drain their family’s assets to $2,000, forcing them into poverty just to pay for bills.

However, it is true, as Hovde points out, that people can buy long-term health care on the private market instead of paying the tax. But the industry isn’t big enough for everyone, and costs remain out of reach for a lot of people. 

Finally, she doesn’t like WA Cares' qualifications. In particular, she points to the fact that workers can draw on the benefit only so long as they’ve paid in for 10 years without a break of five or more years, and only so long as they don’t move out of the state. 

Again, if she’s calling for a more generous benefit, then I join her call. But something in me thinks these attacks are disingenuous, too. That said, it's not like zero people will leave without tapping into the benefit. In the most recent five-year period, data from the AARP shows that about 1.3% of Washingtonians over 65 moved out of the state. I agree that paying the tax sucks for the 1.3% of people who decide to retire elsewhere, but Washington still has time to make the benefit portable, which will be easier if other states set up their own programs, as California and others are already contemplating. 

As for the agita over the 10-year vestment period: Yeah, it's just true that people need to pay into the program in order for us to solve the collective problem of long-term health care needs, but she’s conveniently leaving out WA Cares’ early access period, which covers people who’ve paid in three of the last six years. 

If the state had set up the benefit in 2008, for instance, then it could have helped Hovde pay for her own care, including the costs not covered by her medical insurance policy, and also the costs of paying some of the track-and-field stars to watch the kids while she regained her strength during physical therapy.

But, ever the free-marketeer, when I mentioned that she could have qualified for the benefit, she told me she wouldn’t have paid into it because she didn’t think she’d make a good return on her investment. She’s likely wrong there, as well.  

Let’s say she freelanced for the Oregonian for the equivalent of 20 hours per week at $100 per hour–which would be exceedingly generous–for three years. She would have paid $1,740 into WA Cares and would have received $36,500 in benefits via the early access program, which would make for a 2,100% return on her investment. Not too shabby! 

But it’s not her bad financial advice that damns her political project here. It’s her failure to recognize her own privilege, her understanding of the charity afforded to her as simply a nice thing that happened rather than a product of her place in society as a columnist and a white, married person with a place to live. Her apparent blindness to that reality prevents her from seeing the indignities and inefficiencies of her beloved private health insurance industry, an industry most Americans don’t like–unlike Obamacare. 

And it kinda kills me, because it reallllly seems like she’s almost there. Or, at least she was several months after her accident. In an August 2011 column for the Oregonian, she reflected on her experience with the traumatic brain injury community. That experience and her research on the subject led her to a conclusion that all but demands the existence of a public long-term health care benefit, emphasis mine: 

Although the largest group of TBI survivors is young adults in their prime working years, including many of today's returning soldiers, many survivors do not return to work. The ability to work is highly connected to the executive brain functions the survivor has left. This is one of the reasons high costs are associated with brain injuries and why some caregivers of the severely brain injured have a heavy load.

And it has to be one of the reasons for this statistic: Experts say survivors of a severe brain injury are likely to experience prolonged anxiety and depression and are at a high risk for loss of friendships. Despite a lack of head casts and the fact that they usually ‘look’ normal, many of these survivors could use some more security blankets.

Call it a “security blanket,” or simply call it WA Cares. I don’t care. The vast majority of us—70%—will need this benefit. If lawmakers continue to put universal health care on the back-burner, then the least the state can do is catch people who fall through the cracks of the vampiric health insurance industry.