I have a pre-existing condition. I do things “the right way”.

When I was a medical student, I started to notice blood in the toilet. I was a medical student, so I panicked. I called my father, who at the time was still a practicing surgeon, and he told me it was likely hemorrhoids. Given the alternatives, I breathed a sigh of relief.

The blood didn’t go away, though. Soon, I started to have diarrhea, cramps, and the urge to go to the bathroom all the time. That summer, I worked at Children’s Hospital of Philadelphia on a research project, and I had to go to the bathroom so many times, I thought they were going to fire me. It got so bad, my Dad (who is a minimalist), finally sent me to the gastroenterologist. The short version of the story is they determined I had ulcerative colitis.

I’ve written about this before, so I’m not going to get into the details of the disease. The only reason I bring any of this up is so you understand that I was diagnosed when I was 22 years old and a full-time student.

None of it was my fault.

Today, I eat a well-balanced diet. My weight is good. I exercise 5 times or so a week. I don’t smoke or do drugs. I don’t drink more than socially. I do everything I’m supposed to do. I still have ulcerative colitis, and I will until I die, likely. I’m doing the things I need to do to keep my body healthy. I lead a good life.


I try very hard to see the good in others. When I write, when I debate others, I do my best to assume that the intentions of those with whom I disagree are righteous. Even when we see the world differently, I make every effort not to think that others are “bad” or want to see people suffer. I’m not one who writes that people who want to reform the insurance system want “to kill people”. I don’t think that people who want to reform welfare “hate the poor”. I’m not perfect, so sometimes I screw up. When I do, I apologize.

Yesterday, a Congressman went on TV and said (emphasis mine):

“My understanding is that it will allow insurance companies to require people who have higher health care costs to contribute more to the insurance pool. That helps offset all these costs, thereby reducing the cost to those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy. And right now those are the people—who’ve done things the right way—that are seeing their costs skyrocketing.”

I cannot adequately describe how much this enraged me. This is one of those things that you hear people say “the other side believes”, but discount. I don’t want to believe that people think this. I don’t want to believe that people think that some others deserve to be sick. I don’t want to believe that people equate being ill with a moral failing.

I didn’t do anything to get ulcerative colitis. I did nothing wrong. I lead a good life. I didn’t fail.


My brother, amazingly enough, has Crohn’s disease; the Carroll GI protoplasm ain’t the best. When I was a resident, and he was a law student, we would talk often about how we would both have to work for very large companies or organizations in order to get health care. It was a fact of life. We both knew that on the individual market, no insurance company would touch us. Ever. Because of our pre-existing conditions, we’d be screwed for the rest of our lives.

He didn’t do anything wrong either, by the way. He was diagnosed in high school, and he was a really good boy, too.

I could start quoting statistics here, but what’s the point? A huge number of Americans have pre-existing conditions. They couldn’t get insurance on the individual market before the ACA because it was in insurance companies’ best interest not to issue them policies. It made good business sense. That didn’t mean it was right.

There is certainly a case to be made that people have some responsibility for their health. But the lines aren’t clear at all. It’s easy to point at smokers and say they’re doing something harmful and are raising costs for all of us. That’s why we can charge smokers more under the ACA. After that… it gets dicey.

Do you start regulating what people eat? What they drink? If you eat dessert, and I don’t, why should I have to pay for your healthcare? Should we charge people more if they drive cars (number one killer of children!)? I like to ski. That has risks. So does rock climbing. Or playing contact sports. Should we make them stop, or charge them more? What about people who scuba dive?

Should we start penalizing people who have different organs in their body than we do?


I expect that this Congressman will soon be issuing a statement saying he was “taken out of context”. Something along the lines of “he misspoke”. But maybe not. Maybe he does believe what he said, that people who did things the right way are the ones who are healthy. If that’s the case, then I have just one question for him.

What did the baby born prematurely, the one with congenital heart disease, or the toddler with sickle cell disease, or the child with autism, or the little girl with leukemia, or the boy with asthma, or the adolescent with juvenile arthritis, or the young woman with lupus, or the young man with testicular cancer, or the new mother with breast cancer, or the new father with inflammatory bowel disease, or the woman with familial heart disease, or the man with early onset Parkinson’s disease, or the retiring woman with Alzheimer’s disease, or the elderly man with lymphoma – what did they do wrong?

Did they lead bad lives?

I guess I had two questions. Take your time answering. I’ll wait.


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