The American Health Care Act that passed the House provides for the sorting of people with preexisting conditions into “high-risk pools.” Historically these have not worked, providing extremely limited benefits at a very high cost. And the AHCA allots a comically small $8 billion to help fund such pools, meaning that vulnerable people who need coverage are likely to be left stranded. 

With apologies to Shirley Jackson.

The morning of the drawing dawned bright and clear, with the fresh warmth of a full summer day.

The flowers blossomed profusely and the grass was lushly green, like a fresh 20-dollar bill. Old Mr. Paulson had once held a 20-dollar bill before he had discovered something wrong with his heart and been placed here with the others with Conditions; it had smelled like a kale chip.

There was activity all around. When the Van pulled into the town square everyone felt a surge of excitement, as if the air held an electric charge.

The children assembled first, of course, the ones who were mobile enough. They shoved and laughed and started gathering stones. Annie Cenotaph suggested that they play doctor and they gravely formed a line in front of her and she turned them away one by one on the grounds of a scraped knee or a scabbed elbow and everyone giggled so loudly that Mrs. Cenotaph had to come out of her house and tell them to hush.

They did not speak directly of the thing that was going to take place, but little Katie Hinkle had made a pretend IV out of some grass and attached it to her arm, bouncing with excitement. She contributed two small stones to the pile and then sat down for a long time to catch her breath.

The crowd assembled slowly. It had been many years since a drawing had taken place and everyone spoke in hushed, reverent tones. Even the teenagers stood quietly in the back, trying not to wheeze too noticeably at the pollen.

The pool was conducted by Mr. Ryan, who had inherited the function of determining who was to be singled out for the Conferring of Benefits from his father or grandfather or great-grandfather or some even more remote ancestor. He arrived soon enough, carrying the black box from which the pool was traditionally conducted, and then everyone assembled around him in the middle of the town square, between the library and the bank and the CVS 30-second clinic. He began the tedious work of listing the names of heads of households and families and filling the box with the paper slips that had replaced the plastic cards of years prior, nodding politely at the women and joking with the few men. The town, except for the graveyard, was smaller than it had been, and the drawings seemed to be fewer and farther between than they had been, too. Very few people were still there who had been present for the last one.

Tess Hutchinson, visibly pregnant, came running late through the crowd from her double shift at work. She pushed through the crowd to take her position behind her husband a few moments before the drawing was due to begin. But there was no sign of him. “Kevin?” she called. “Kevin?”

“Given your condition, he’s opting to enter the market as an individual,” her neighbor Kathy Delacroix explained. “Said his odds were better. I thought you knew.”

The origins of the tradition had been lost in time, but the idea that it was somehow American and Market-Based and that Limits Had To Be Put On These Things had managed to seep down through the years. Mr. Ryan finished his fussing, produced the traditional celebratory Bud Light, cracked it open, then squared his shoulders and turned to the crowd. “Anyone missing?”

“Several,” came the murmur from the crowd. Dunbar and Banner and Hupp were all bedridden and could not be stirred. Provisions were made for others to draw on their behalf. Then Mr. Ryan said they had better start so it would be over by dinner time.

“Remember,” Mr. Ryan intoned, “don’t unfold it until everyone has taken theirs.” He called them up by name. One by one, a member from each family went up to the black wooden box and withdrew a slip. Atkins. (“Obesity,” the crowd murmured.) Baker. (“Pregnancy,” came the whisper.) Marvin. (“Heart defect.”) Paulson.

“You know,” Tess whispered, “I hear in Canada they don’t do it like this.”

“Shh,” Mr. Ryan said, sharply.

“Tess, this is America,” Kathy said, wiping her sweating palms on her apron. “We reward industry and toil and people who make responsible choices, like being born with money or without a chronic health condition.”

A big dirigible full of rich people with gleaming white teeth whooshed by overhead, tossing spare kidneys from the window, interrupting the lazy murmur of Mr. Ryan’s voice calling the names.

“Being born like that is not a choice,” Tess said. Kathy elbowed her in the ribs, then winced. Her bursitis was excruciatingly painful and she had been unable to afford treatment, even though she had put together what she thought was a very compelling GoFundMe campaign for it.

“High-risk pool,” Mrs. Cenotaph said, “high-reward pool. That’s what they always say.”

“It’s patriotic.”

“We all take the same chance.”

They all waited patiently, and then Mr. Ryan said, “Now, fellows!” and there was a great rustling.

“Who’s got it?” voices asked. “Who’s got it?” Little Katie Hinkle tugged at her mother’s sleeve in excitement, but their paper had nothing on it but the usual black spot.

Finally a murmuring began, “It’s Hank Mill! Mill’s got it!” and Mill stepped to the front of the group with a beaming smile.

Mr. Ryan handed him an insurance card and he climbed into the waiting van to go get his prostate looked at.

The stones were for everyone else, if they got sick of hoping.