Written by Thu Tran, MD,FACOG
March 19, 2017
We recently held a book club to discuss JD Vance’s “Hillbilly Elegy,” one of Amazon’s all time best sellers. JD Vance grew up in rural Ohio in a dysfunctional family. He eventually left his rural town, joined the marines, later went to Ohio State University before going to Yale Law school. After graduating from law school, Vance worked for a business firm in SanFrancisco. During the presidential campaign, JD Vance explained why rural people were coming out to support Mr. Trump. They felt they were the forgotten segment of society and were angry at “the establishment.” He admitted he did not vote for Trump even when he considered himself a conservative voter.
During the review of JD Vance’s book, we posed many questions about JD Vance himself and how he has, like many of us in the group, gone from “rags to riches,” while others in the same social circumstances could not escape their poverty. Many of us including me were immigrants or who had parents who were immigrants coming to the U.S. with very little money or education. Yet, we did it, achieving the American dream by thriving in schools, going to professional schools, and now living in prestigious neighborhoods, in areas that conservative professor Charles Murray would call the “Super Zips.” Many of us now have an easier life than 99% of our American fellows.
It’s peculiar to many of us in the group, however, that JD Vance is very conservative. Unlike him, I have become more “progressive” as the years go by, although I was raised in a very conservative environment. JD Vance and I went through the same transformation but have parted our ways politically. Many of us were puzzled over how JD Vance has criticized many “Hillbilly” fellows who he considered “consumerists” and who take advantage of the system, unlike he and his grandmother who were hard working and proud hillbillies and found success.
The reason some poor people like JD Vance or me would succeed in the face of adversity while others succumb to their impoverished circumstance is quite complicated. A nurturing environment, strong family ties and good role models as parents, I believe, helped me and my siblings escape poverty. JD Vance had his grandmother who nurtured him to success. Not everyone, however, is lucky enough to have such role models. Until all of us start out on equal or “fair” footing, I do not like to fault people for not being as successful as I am in life, as our “equal” beginnings could be very unequal and, therefore, our paths to success can be misjudged in superficial and misleading ways.
What has gone through JD Vance’s mind in the last few weeks when the proposed American Health Care Act (AHCA), the Republican proposal to replace the Affordable Care Act, was dissected meticulously by multiple experts? What does he think about the drastic cuts in multiple social programs proposed by Mr. Trump’s federal budget? A few important things should stand out for JD Vance and the hillbilly people he cares about:
—AHCA will be devastating to programs to address opioid addicts like JD Vance’s mother. It will remove the government requirement for states to provide mental health and care for addicts. Reduction in Medicaid funding would further curtail care for opioid addicts. Don’t we all know mental health treatment is essential to drug addicts?
Opioid addiction is widespread beyond rural communities. A recent United Nation report shows that Americans consume more than 99% of the world’s supply of hydrocodone, a popular opioid.
—Women’s healthcare in rural areas will be severely restricted as many Planned Parenthood clinics will be closed because of federal cuts in aid. The AHCA proposal includes no funding from Medicaid for Planned Parenthood. In rural areas, Planned Parenthood is often the only place women receive healthcare services such as mammography, cancer screenings, sexually transmitted disease screening and pregnancy counseling prevention, and contraception options. The Congressional Budget Office (CBO) warned how cutting funds to Planned Parenthood will lead to an increase in medicaid pregnancies. In JD Vance’s Hillbilly Elegy, one of the big problems of the poor is the numerous children they bring into the world without being able to care for them. Cycles of poverty haunt families with many children.
—Multiple cuts for many social programs meant to help the poor and rural poor: Mr. Trump’s federal budget will slash programs such as Meals on Wheals, after school care, public education, multiple anti-poverty projects from Housing and Urban Development. Even abolishing the National Endowment for the Arts, as Mr. Trump’s budget will do, will shut down many local radio and TV stations in rural areas.
Did you know the yearly annual funding for the National Endowment for the Arts costs $148 million, while the annual cost to keep the First Family safe can be as much as $183 million, with about $53 million alone to protect Melania and Baron Trump if they continue to stay at Trump Tower in NewYork City? What does JD Vance think about this fact?
JD Vance recently wrote a NewYork Time Op Ed to explain why he left his lucrative job in SanFrancisco to go back to Ohio. For him, it was like coming home to do something useful for his community. In his case, he will run a foundation to battle Opioid addiction. He complained how many people in rural areas become successful and never come back to help their communities.
I am glad JD Vance will come back to Ohio, although I don’t think he will live in his impoverished childhood neighborhood. He will be living in Columbus, Ohio, where my family settled after arriving to America from Vietnam. JD Vance has moved up in life. The weekend we were reviewing his book, we heard how he had dinner with Vice President Pence the night before. As I jokingly told my friends, a few rides in the limos can make people forget they used to ride the bus to work. I hope JD Vance will not forget his hardship which I believe has built his strong and compassionate character.
I am also glad Vance will be living close enough to his rural friends and relatives so that he can visit them often to see how their lives would be transformed under the federal steep cuts. No more meals on wheels for the elderly poor, no more after school programs for the young students, no more public broadcast programs where we learn the human side of our existence.
How many JD Vance hillbillies will be among the 24 millions estimated by CBO to lose their insurance under AHCA’s proposal? Isn’t it ironic that they will be hit the hardest, those who were so angry they chose to put anybody but “the establishment” in power, in hoping that their life would be better?
I don’t expect JD Vance hillbillies to know the complicated and intricate details of social policies and programs. Even Mr. Trump acknowledged he did not realize until recently that healthcare issues are very complicated. Utah Congressman Jason Chaffetz, for example, recently made a public comment on how poor people will need to choose between buying a new iPhone or health insurance.
Choosing health insurance instead of an iPhone? As John Oliver the comedian pointed out in his last week show, if health insurance cost the same as a cellphone, we would not have spent years debating on this issue! If Chaffetz, whom I assume is more educated and knowledgeable compared to an average citizen, could make such ignorant and, frankly, insensitive remark, I would not expect rural people to be thoroughly knowledgeable on issues that are vital to them and their family, policies that could be helpful for their children and grandchildren to someday, like JD Vance, escape the rural hills of Kentucky and Ohio and dine with the Vice President of the United States.
As a Christian with conservative values, maybe JD Vance would find Nicholas Kristof’s article “And Jesus Said unto Paul of Ryan…” thought provoking, as I did:
As a devout Christian, JD Vance probably is also familiar with many Bible passages that hopefully he will share with or remind many of his wealthy friends, now that he is in the company of the most elite members of society.
James 2:14-17
What good is it, my brothers and sisters, if someone claims to have faith but has no deeds? Can such faith save them? 15 Suppose a brother or a sister is without clothes and daily food. 16 If one of you says to them, “Go in peace; keep warm and well fed,” but does nothing about their physical needs, what good is it? 17 In the same way, faith by itself, if it is not accompanied by action, is dead.
Congressional Budget Office (CBO) Rates Republican Healthcare Plan:
AHCA Effect on Opioid Crisis:
AHCA and Older People:
AHCA and its Effect on Poor People, by Nobel Laureate in Economic Paul Krugman:
Another Blog on AHCA Effect on Rural People:
Winners and Losers of Proposed Federal Budget:
http://www.vox.com/2017/3/16/14943816/trumps-budget-health-winners-losers
https://www.nytimes.com/interactive/2017/03/15/us/politics/trump-budget-proposal.html?_r=0
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