In 2009, almost one in five Americans did not have health care coverage in any form.[1] By 2015, that number had been cut almost in half. [2] Regardless of your opinion on “socialized medicine”, most rational commentators agree that providing health care to our people is better than not doing so. Providing adequate health care isn’t altruistic. Think about it, none of us lives in a bubble. Most of us interact with others throughout the day, with co-workers if nobody else, or with waiters, cab drivers, gardeners, and retail clerks. Maybe you interact with your yoga instructor. If those people are ill while working, your exposure increases. Infectious disease does not respect societal limits or boundaries. In a medical crisis, the costs for treating an emergency are likely to be either:
- uncollectible and unpaid (and then re-distributed via increased billings and costs to those of us who do have coverage), or
- borne by society as a whole through Medicaid or other social welfare systems (and redistributed to all of us via increased taxation).
Even those who can afford to pay some portions of such emergency care out-of-pocket can be saddled by enormous debt. Medical expenses are a major cause of bankruptcies.[3] [4]
These are only statistics, and they tell only part of the story. I want to tell you other parts, the respective tales of two friends. Both of them are productive and hard-working people, the kind of people you want living next door. One, at the time his crisis began, was employed. One was not. What happens with their situations, however, may not quite be what you might expect
Let’s start with “Bob” (not his real name) who is in his mid-40s, and lives in Southern California. I’ve known “Bob” for about seven or eight years. He works a variety of jobs to make ends meet, and spends a significant amount of his time hustling to get more work. He is a DJ, Karaoke Host, MC, and whatever else he can do to try and make ends meet. He is fit, athletic, intelligent, and, in my humble opinion, a fine human being on all fronts. Like me, “Bob” is pretty progressive politically. He was in favor of universal health care, or, at a minimum, universal health insurance. “Bob” was quiet, respectful, and a polite advocate for social justice. He was also very healthy, or so we thought.
A week before I started writing this piece, “Bob” suffered a massive stroke. His girlfriend found him at home, unresponsive and unable to move or communicate. He spent five days in intensive care, and as I write this, is now in a hospital room, and not doing too well. They have weaned him off the ventilator, but he is unable to swallow or speak. At present, he is being fed through a tube. He is not able to move too much on his own yet, but we just don’t know how much impairment that he will sustain going forward. It could be profound. His recovery won’t take mere weeks, it is most likely to take a very long time. Because he works several jobs, each less than full time, “Bob” had no employer-provided health insurance. His earnings were not high over the past couple of years, despite working pretty close to full time. Despite roughly full-time employment, “Bob” had no health insurance. I doubt that he could afford it.
Now, in the midst of his medical crisis, California’s version of Medicaid (Medi-Cal) is being brought in. The cost for his care to date is already likely to be well over $200,000, and it won’t get any cheaper. “Bob” can’t pay for that kind of care. He may not be able to hold gainful employment again for a very long time. We don’t know the extent of the damage this stroke has done, or how well he might be able to respond to it. We don’t know how much function he will recover. His only options going forward are to hope that Medi-Cal covers his expenses. His friends are trying to raise enough to cover any shortfall. If those don’t cover things, he may need to file for bankruptcy.
Some estimates opine that 60% of all bankruptcies in America are related to or caused by medical expenses.[5] That number is problematic, but other estimates range from 29% to 57%.[6] Whatever number you choose, that’s hundreds of thousands of people thrown into financial distress to pay for their medical care. For “Bob”, the realities of America’s failure to provide universal health insurance are not theoretical or abstract. They are real, they are imminent. They are dreadful and terrifying at a time when neither he nor his family should need to worry about such things. The cost of “Bob’s” care will now fall on society as a whole, on all of us, through one mechanism or another. The harsh reality is that no amount of political wrangling over ideologies will pay “Bob’s” bills. That requires cash.
Now the tale of the other friend, as promised. Frank (his real name, used with permission) is in his late 50’s and lives in Illinois. I’ve known him for the better part of 20 years. He is conservative politically and was not, until recently, a supporter of Obamacare. I’m not sure that he is, even now. Frank has held professional level jobs throughout his career. He was laid off from an upper management position in the Mid-West about two years ago. He hasn’t been able to find a steady job since then. Laws against age discrimination notwithstanding, nobody wants to hire an old man. That is especially true if that person has a bad back, which Frank does. He has severe spinal stenosis. One surgery was performed some years ago, with mixed results. His COBRA coverage ran out, and Frank turned to the Health Insurance Exchange. Unfortunately, His medical situation deteriorated. Further surgery was needed to prevent paralysis and cure his debilitating pain. Frank was barely able to walk, and couldn’t sit or stand for more than brief periods without extreme pain. The second surgery, I am happy to report, appears to have helped a lot. Frank has much improved, with less pain and better function and feeling in his legs. We are both optimistic.
Frank and I corresponded just before the debate and defeat of the Republican ‘repeal and replace’ attack on the PPACA. He said, in his email, “We are among those that [sic] will be severely hurt if this bill passes. We are humans. This bill has become political. The effect on people is an afterthought. We are on “Obamacare”. It is not perfect. But without it, I would be paralyzed with pain and no recourse.”
He goes on to state, “We are not getting anything free under Obamacare. We have a huge deductible, we had to change doctors and hospitals, many prescriptions are not covered, BUT I was able to get necessary medical services and should be able to walk again. .. Obamacare is not perfect. Maybe improve it? The new act will cost [sic] me to lose coverage. If it is enacted, I am supposed to pay for it with a very small tax credit. I am unemployed so have no income to be taxed ???? Really?”
There is a tragedy in both these stories that angers me. What no politician has been able to explain to me to date is why these scenarios exist in America. Why can we not provide even the most basic health insurance coverage to our citizens? Set. aside for the moment the questions of healthcare itself. Universal coverage for healthcare leaves the existing model of for-profit medicine alone. To me, there is a difference between universal coverage and universal health care. Dealing with the coverage questions address only how you pay for the care under our present system. We, in the United States, do a pretty mediocre job of handling that transaction.
For example, we are a member of the Organization for Economic Cooperation and Development. Among the 34 countries in that organization, the US ranks number 33 in providing coverage for health care. We did beat out Chile, but that’s it. Thirty-two other countries do a better job than the US at providing health care coverage. That’s embarrassing, and it’s appalling. That it has improved under Obamacare is telling as well. We have a mess on our hands, and we should be ashamed of it. Instead of political wrangling, we ought to be ashamed enough to do something to fix the problem.
Now, before someone jumps up and accuses me of advocating for socialized medicine, take a deep breath and let’s get some definitions straight. “Socialized Medicine” is where the provision of medical care itself works under a socialist economic model. Obamacare isn’t socialized medicine. Obamacare changed some things about how we pay for medical care and set some minimum standards for insurance policies. Obamacare required coverage for more people under those policies. It required the policies to pay for preventive services. It mandated coverage for pre-existing conditions. It did not change who owned your clinic or your hospital. It did not change employed your physician, or who owned the pharmacy you used. It did not change the capitalistic medicine-for-profit model we use here. It did not nationalize the insurance industry, pharmaceutical industry, or the medical industry. So if that was your argument, you’re erecting a strawman fallacy. Get over it, knock it off, and stop distracting from real problems that need real solutions. This isn’t just about ideology, this is really about people’s lives. This is about my friends, and they deserve a great deal more respect than that.
NOTES:
1. OECD (2017), “Social protection”, OECD Health Statistics (database). DOI: http://dx.doi.org/10.1787/data-00544-en (Accessed on 08 April 2017)
2. ibid.
3. http://www.huffingtonpost.com/simple-thrifty-living/top-10-reasons-people-go-_b_6887642.html
4. David U. Himmelstein, Elizabeth Warren, Deborah Thorne and Steffie Woolhandler MarketWatch: Illness And Injury As Contributors To Bankruptcy; Health Affairs published onlineFebruary 2, 2005; doi: 10.1377/hlthaff.w5.63 (Accessed on 08 April 2017 at http://content.healthaffairs.org/content/suppl/2005/01/28/hlthaff.w5.63.DC1)
5. Himmelstein ( op cit) and The Huffington Post, 24 March 2015, at http://www.huffingtonpost.com/simple-thrifty-living/top-10-reasons-people-go-_b_6887642.html (accessed 9 April 2017)
6. LaCapria, Kim; “Money, Cash, Throes”; snopes.com 22 April 2016 at http://www.snopes.com/643000-bankruptcies-in-the-u-s-every-year-due-to-medical-bills/ (accessed 9 April 2017).
dbdolnick 