If the republic were the Titanic and the government’s end-of-year shutdown over health care the iceberg, Congress would be the first-class passengers already in the lifeboats — with their doctors aboard, their gold-tier coverage guaranteed, and the rest of the country left to drown in the frozen waters.
What began as a modest workplace amenity for public servants has metastasized into a taxpayer-funded citadel of privilege — a Capitol Hill concierge service offering the kind of round-the-clock care and personalized access that, in the private sector, is the sort of luxury care only millionaires can afford. All the while, the nation’s public health care system lists beneath it.
When a lawmaker collapses, Washington treats it like a national emergency. In 2012, Senator Mark Kirk suffered a stroke and a Coast Guard helicopter carried him from a community hospital in Illinois to Northwestern Memorial in Chicago, where neurosurgeons operated within hours. Bob Dole, Ted Kennedy, Robert Byrd — all stabilized in the attending physician’s office before transfer to elite medical centers. The same medical crises bankrupt ordinary Americans. The difference is structural: Congress wrote the laws that let them step outside the machinery.
The arrangement began quietly, almost a century ago. In 1928, Congress created the Office of the Attending Physician, a Capitol clinic staffed by U.S. Navy doctors to tend to members too essential to be left waiting in line. It was emergency preparedness, but now it’s the fastest medical treatment in the country: same-day exams, X-rays, blood work, and referrals to Walter Reed National Military Medical Center. For roughly $650 a year, which is less than I pay a month for medical coverage as a single woman, members receive unlimited access.
What began as contingency became custom. In 1959, lawmakers had further insulated themselves by joining the newly created Federal Employees Health Benefits Program. It looked like a simple inclusion, but the government’s share of their premiums — capped at about 75 percent — made it one of the best deals in American medicine. They were covered by statute, federally funded, and protected by a bureaucracy they controlled. During the Cold War, their attending physicians stockpiled morphine and stretchers in the Capitol basement in case of nuclear attack. In peacetime, members were airlifted from crashes by military helicopter, treated at federally funded hospitals, and attended by Navy doctors whose salaries were hidden in the Defense budget.
As the Affordable Care Act inched toward passage in 2010, the disparity in options for members of Congress and their constituents became impossible to ignore. Lawmakers were designing a public insurance marketplace while sitting atop an older, richer one. To deflect outrage, they added a clause requiring members and their staff to buy insurance through the D.C. Health Exchange. On paper, it was reform. In practice, it was theater. They kept their 75-percent federal government contribution and selected gold-tier plans — protection from the very insecurity they publicly fretted over.
Now, as the ACA itself hangs in the balance during the year-end shutdown, the contrast is obscene. Medicaid reimbursements stall, community clinics edge toward closure, and millions prepare to lose their insurance. Inside the Capitol, the Navy clinic hums, the subsidies flow, the care never stops. Republicans denounce “government health care” while relying on a government-run medical staff. Democrats defend the ACA from the comfort of benefits they will never lose. The immunity is bipartisan.
The current Congress has dropped the pretense of public service altogether. As the government neared budget paralysis, lawmakers padded the stopgap bill with gifts for themselves: a long-frozen cost-of-living raise and a quiet move to rejoin the Federal Employees Health Benefits Program — the platinum-tier insurance system they theatrically abandoned under the ACA. It’s legislative sleight of hand at its most American: the house is on fire, and lawmakers are adjusting the lighting.
This latest standoff is more self-preservation, dressed as gridlock. The government has seized up as enhanced ACA subsidies near expiration. Without an extension, premiums will soar next year — double or even triple for many families — the steepest rise since the law took effect. The Congressional Budget Office estimates nearly four million people will lose coverage, on top of the millions more estimated to lose coverage as a result of the Medicaid cuts in the so-called “Big Beautiful Bill” Donald Trump and the GOP passed earlier this year Republicans call the ACA subsidies wasteful; Democrats refuse to reopen the government without them. Between them lies a country running out of time to afford treatment.
The numbers tell the story. The uninsured rate, once about 16 percent before the ACA and now 7.7 percent, is expected to climb again. Medicaid rolls are shrinking as states cut eligibility faster than people can reapply. Nearly 40 percent of Americans say they couldn’t cover a $400 emergency expense, yet a single ER visit can wipe that out. Lawmakers argue from inside a Navy-run clinic, their premiums publicly underwritten, while the people who fund it are left to wonder whether they can afford to be sick.
Congress built a system to guarantee their own survival and legislated one that imperils everyone else. They are flown out by helicopter while their constituents die waiting for treatment. Every republic leaves a record of what it chose to save first. Ours saved the politicians.
