Jim Vetsch shifted uncomfortably as Dr. Paul Gordon leaned in and asked him about Obamacare.
The two men — one a retired power plant operator, the other a medical school professor — were standing in Vetsch’s kitchen at the Horse Creek Bed and Breakfast in eastern Montana where Gordon had stopped for the night.
Vetsch wasn’t happy about the country’s direction, he told Gordon at last. And he definitely didn’t like the Affordable Care Act — it was too expensive, and the government shouldn’t be providing health insurance.
“It’s a crutch,” Vetsch declared.
Gordon tried to press Vetsch, asking what should happen to people who couldn’t afford health coverage. Vetsch didn’t answer directly. “I’ve worked all my life,” he stated, noting he’d always had jobs with benefits.
Gordon had heard a lot of that in recent months. On sabbatical from the University of Arizona, he had set off in the spring on a cross-country bicycling trip and “listening tour” from Washington, D.C., to Seattle, talking along the way to Americans about the controversial health law that President Obama signed six years ago.
Much of what Gordon uncovered was as unsettling as the current presidential campaign. Americans raged at the government, at the healthcare system, at fellow citizens who’d gained coverage through Obamacare.
The outpouring of resentment and apparent lack of empathy disturbed Gordon at first. “Not a lot of generosity of spirit,” he noted glumly over the phone early in his trip.
But as he made his way west, Gordon’s feelings evolved. His depression gave way to a new sense of resolve. As a doctor, he could and should do something about the anger he was hearing.
“I saw this could make me a better teacher, a better clinician, a better human being,” he said.
Gordon, 61, a compact man with sharp features, black half-rim glasses and a gray beard that gave him a distinctly academic look, conceived his ride as a scholarly exercise that would generate academic papers about perceptions of the health law while fulfilling his 40-year dream of biking across the country.
Eager to learn what his unusual project might reveal about a bitter national healthcare debate I’d been covering for nearly eight years, I met up with him in eastern Montana to bike along and listen for a day.
We started in Forsyth, an aging railroad town in the wide Yellowstone Valley where long coal trains rumble past at all hours. Gordon was moving into the arduous final third of his 3,255-mile journey, which would go up through the Rockies and the Cascades before ending on the West Coast.
We planned to ride west along the Yellowstone River paralleling the route Lewis and Clark had taken, then south into the foothills of the Big Horn Mountains where Custer was famously ambushed.
All around us, mammoth ranches stretched across valleys dotted with sage brush and lazy cattle sheltering under stands of cottonwood trees.
On either side, pine-studded ridge lines offered shelter to elk, mountain lions and wolves.
Gordon and his team — which at times had included his wife, his adult children, a couple he’d befriended in Arizona and a medical student, Laurel Gray, who made the trip a research project — had endured far harder rides: long slogs across the Dakotas where towns were separated by 60 miles or more, and cold days of freezing rain in the Midwest.
But what had proved most challenging for Gordon were the conversations.
In Pennsylvania, a restaurant owner complained about her rising insurance bills and told Gordon she was sick of her insurance payments covering other people’s medical care.
In a small cafe in western Minnesota, a 64-year-old woman accused the law of spawning widespread abuse. “Obamacare encourages people to take advantage of the system,” she told Gordon.
Outside a convenience store in eastern South Dakota, another woman said — somewhat ashamedly — that everyone in town thought Obamacare and Obama were terrible. “He just gives all the taxpayers’ money away to poor people,” she said.
“I thought, ‘Oh, my God, how did we get here?’” a dispirited Gordon told me as he struggled to decipher the anger.
“I am having these beautiful days riding through the country, and then at the end of the day, I sit down to talk to people and hear this terrible stuff.… It’s overwhelming how little care people seem to have for others.”
Equally jarring, Gordon found that few of the people he met seemed mean-spirited.
“These were people who would help you on the side of the road,” Gordon said. “They are good people. But what was coming out of their mouths was so ugly.”
Gordon, who has spent 30 years as a family physician caring for patients, had been prepared to hear frustrations. He expected complaints about rising premiums and deductibles that were making growing numbers of Americans skip medical care.
He also knew many people he met wouldn’t share his liberal political views.
Gordon had resolved he wouldn’t argue or try to sway opinions. He wanted to record what Americans were thinking.
But as his conversations uncovered basic misunderstandings about healthcare and health insurance, Gordon tried to push people to think about how they would fix the system.
Rarely did he get much of an answer.
“There just weren’t solutions,” Gordon told me at one point, venting his frustration with the misinformation and the cable news sound bites he was hearing. “All we had were complaints.”
Over time, however, Gordon began to see that those complaints represented an opportunity.
Doctors, he concluded, could step in and begin to correct some of the misinformation and help Americans better understand their healthcare system.
“I actually feel inspired,” he said at one point.
As we rode up out of the Yellowstone Valley, climbing gently but steadily along a meandering stream called Sarpy Creek, Gordon expanded on what he had come to appreciate.
The U.S. healthcare system is numbingly complex. It’s difficult for patients to understand why it costs so much, even how health insurance works.
At the same time, Americans’ anger about how much they are paying is justified. “These are legitimate concerns, the kind of concerns my patients could have when they come into the office,” Gordon said.
If these patients worried about a medical issue – a sore throat, an aching leg – he would consider it a professional duty to investigate and to seek a remedy.
Physicians have been reluctant to talk to patients about the healthcare system, however, perhaps leery of being drawn into the partisan political debate.
That is a mistake, Gordon concluded.
“I’m not saying, ‘Be political.’ … I’m not going to tell someone to vote for this candidate or that.”
But, he reasoned, physicians could do far more to guide their patients through the system and explain how it works. Armed with better information, perhaps Americans would base their opinions about health policy on more than the kind of emotional responses he heard across the country.
“We, as doctors, need to help people understand,” he said.
As we neared the end of our 50-mile ride that day, the hills got steeper and the temperature soared to more than 100 degrees. Conversations quieted.
By midafternoon, we made it to a turnoff about halfway up the valley. There, Vetsch picked us up, saving five miles of pedaling down a dirt road to his inn.
He greeted us warmly, helping put the bikes on a trailer before driving us to his ranch house on a slight rise overlooking the valley.
Vetsch offered tall glasses of iced tea as we gathered in his kitchen, surrounded by photos of his family. After the awkward conversation about Obamacare, we all helped chop vegetables as Vetsch cooked chicken breasts.
I caught a ride back to Forsyth after dinner with a local hunting guide Vestch knew.
Later, as Gordon reflected on the conversation, he said it would have once frustrated him. By Montana, it was another reminder of how much explaining Gordon and other doctors needed to do.
A few weeks later, after he arrived in Seattle, Gordon told me he was feeling good about the journey and the more than 100 conversations he’d had across the country.
“I’m tired,” he admitted. But he was thinking about another potential project – a ride across Canada to talk with Canadians about their healthcare system.