Last month, Aaron D. Viny, MD, a Damon Runyon-William Raveis Charitable Fund Fellow at Memorial Sloan Kettering Cancer Center participated in the March for Science in New York City. Below he explains his unique motivation for marching, and why he read every word of President Trump’s Affordable Healthcare Act.
Last month my wife and I took our 21-month-old daughter to the March for Science. Irrespective of the tidal wave of political changes that have happened in the last 6 months, as parents, we found ourselves inspired by a Sarah Silverman stand-up comedy routine we saw several years ago.
“Don’t tell girls they can be anything they want when they grow up, because it would never have occurred to them that they couldn’t. It’s like saying, ‘Hey when you get in the shower I’m NOT going to read your diary.’ ‘Wait, are you going to read my diary?’ ‘No! I said I’m not going to read your diary. Now go take a shower!”
In that spirit we want to expose her to STEM subjects just as we want to expose her to the music and literature and art that inspires my wife’s career. Now, I swear that I wasn’t pushing this on her, but it just so happens that her favorite book is called Women in Science: 50 Fearless Pioneers that Changed the World. She knows them by name the same way I knew every member of the 1992 USA Dream Team. I can’t even attempt to humble-brag here, as she knows that Jane Cooke-Wright is an Oncologist just like daddy. I know. It is a little nauseating. My heart melts every time.
This is all to say that my career as a scientist is important to me, and I want to be sure my daughter understands what I do. Frankly, she’s a product of science herself, so maybe that explains the instinctive bedtime book choices. See, her dad was diagnosed with leukemia when he was in college and needed the chemotherapy regimen designed by Bayard Clarkson and the bone marrow transplant pioneered by E. Donnall Thomas. He needed the doctors and nurses at the Cleveland Clinic, and he needed the reproductive endocrinologists who, with the frozen sperm that was banked on the very first day of chemotherapy, made a kiddo with the girl he fell in love with and married. The kid’s got science in her genes…and probably epigenome too (plug for my Runyon project here).
Last month the House of Representatives passed President Trump’s Affordable Healthcare Act. I read the bill. All of it. I will start by saying that nowhere in the bill is rape described as a pre-existing condition contrary to certain reports. More precisely however, there is actually no definition at all for pre-existing conditions. That said, there is specific verbiage to state that a person cannot enroll on Medicaid while pregnant (Sec. 112) and abortion coverage in optional (Sec. 202). So the challenge with this legislation is the scarcity of details in critical policy while certain specifics of limiting access are explicit. Medicaid gets deep cuts, Planned Parenthood gets defunded—this is explicit.
Outside of these clear policy changes (which I oppose), much of the media reporting is in interpretation and hypotheticals, though the lack of definition seems like the invitation for misuse. What is clear is that the actuarial metrics behind health insurance would be completely changed. The inception of the health insurance industry began with the Texas teacher’s union where individual actuarial risk was diluted by pooling every member of the union together, such that high users of healthcare and low users of healthcare evened each other out. While the verbiage of the bill still states that pre-existing conditions are covered (Sec. 137), there is no mandate (Sec. 204) and no common pool. Moreover, a waiver system to “ensure fair health insurance premiums” would permit insurers to employ health insurance underwriting to charge higher premiums for pre-existing conditions in order to directly offset any added actuarial risk that insurer will hold (Sec. 136). The legislation clearly sweetens the pot for insurance providers and decreases the resources for those who depend on government sponsored health coverage. Thus an insurer with a waiver would be legally compliant by only offering a 35-year-old father, scientist, oncologist, and leukemia survivor a plan with an increase in premium of $72,980 (source: Americanprogress.org). Compound that to the 15.5 million others who are cancer survivors and access to healthcare will be undoubtedly reduced—something I would face both personally and professionally.
I have to say that these policy positions denigrate my identifying characteristics: pursuit of new scientific breakthroughs, care for cancer patients, and leukemia survivorship. I still don’t know the best way to make my voice heard, just as I still don’t know how to engage my conservative family members when their vote feels like a personal attack. A blog post and a plea for anyone reading this to call their Senator and Representative seemed like a reasonable place to start. At only 21 months, my daughter is still finding her voice, so let’s make sure ours are heard all the more loudly so that our nation’s leaders give science half the respect she knows it deserves.
