I just finished reading Nicholas Kristoff's column in the New York Times. I am
making that disclosure in case you consider the New York Times a liberal
East Coast rag and think of the Times' readers as hopeless liberal fops.
Read on only if you choose.
In his column, Mr. Kristoff writes about his
college roommate who is dying of prostate cancer in Seattle. A couple of
Oregon farm boys who arrived together as freshman at Harvard in 1979, Mr.
Kristoff and his friend have led very different lives. Mr. Kristoff is a
New York Times columnist, of course, and presumably does not live without
health insurance or close to the margin in other essential ways. By
contrast, we learn that his former roommate, obviously a very talented man who earned a degree from Harvard, has made some choices that have come back to haunt him
in fundamental ways. He quit a career several years ago and had been working
seasonally without health insurance for some time. With no health
insurance, Mr. Kristoff's friend, like approximately 48 million other
Americans, did not go to a doctor regularly or as health problems arose.
Only when he become so ill that a visit to an emergency room was required
did his friend get treated and then diagnosed. At that point, the
diagnosis of prostate cancer was more dire than it need have been, and may have
come too late to save the life of Mr. Kristoff's friend.
This story really struck a chord in me as I
considered the consequences of the decisions I have made or might make.
It also made me wonder why this outcome is one that nearly half the
country seems to think should occur more often, not less. To be sure, the
choices Mr. Kristoff's friend made are not choices I would make. For
starters, I am far too risk averse to actually consider quitting a job with
health insurance, even if I hated the job desperately (and I have hated jobs
desperately in the past). By contrast to Mr. Kristoff's friend, I think
every day is the day people will realize I am a complete fraud and I will be
fired, and this compels me to try even harder to be good at what I do.
And, even if my irrational self-view is not a close approximation of
reality, I live with the legacy of my mother, a child of the depression who
grew up in a single parent household for a time, and whose anxiety about money
and security permeated every aspect of my life growing up. To this day, I
worry about having enough money on which to live, and irrationally fret over
spending money when emergencies like home repairs or unplanned trips to
funerals arise. In reality, I have been earning a good living as a lawyer
for 20 years, and I am lucky in the moment to be financially far away enough
from my own college days when I wondered if I would have $5 to withdraw from
the ATM at the University of Florida student union.
But, still, you never know, do you? Fortunes do
turn. Debilitating, career-ending illnesses can occur. This is true
even if you are a virtuous, hard-working person who does all the right things
and never makes a mistake. So, why is moving to some level of a basic
healthcare safety net such an infuriating proposition. It's not like
we're not already paying terribly for healthcare, whether it's for our own or
for some portion of somebody else's. Surely, some progress is better than
none at this point. Why are opponents of health care reform, including
Mitt Romney and his supporters, so furious in their opposition. What is
so wrong with making it more possible and likely that fewer people will die or
suffer needlessly because they have no health insurance? Why is that so
anathema to 21st century life and society in the greatest country on earth?
The typical responses in support of Romney's
campaign platform are about personal responsibility and not having a nanny
state of government. While those make for patriotic soundbites during a
campaign, both are disingenuous and completely unresponsive to the legitimate
and real problems with healthcare access in this country.
Problem one: the cost of health insurance.
Unlike Mr. Kristoff's college friend, I have a job working for the
Federal government, which provides me with health insurance coverage.
When I joined my agency in 2008, I selected my health plan from available
options and my contribution to paying for that coverage is deducted from my
paycheck on a pro rata basis over the course of a year. In other words,
with taxes and other deductions, my health insurance payments are unnoticeable
to me. Note also that I said contribution to, not payment for, coverage.
Like many, I am lucky in that I am not forced to pay the full cost of the
coverage. My employer chips in a significant portion of the payment for
my coverage. As a result of this very important benefit, I see a general
practice physician regularly and have access to specialists when the need
arises. I don't wait until I'm on the way to the emergency room before I
see a doctor about a health problem.
In contrast to my current situation, if you are
self-employed or have a job that does not provide health insurance coverage (or
provides very limited coverage), it is prohibitively expensive to buy your own
health insurance. An equal obstacle is the fact that, if you can afford
the coverage, the policy exclusions for pre-existing conditions often make the
benefit of the insurance rather limited. I mean, if you have a condition
or are sick already, what good is health insurance you can't use anyway.
One of the intended changes of Obamacare is that everyone will be able to
afford some health insurance coverage (and yes, it is a mandate) and they won't
be locked out of coverage for a pre-existing condition.
Some scream about the personal policy mandate
aspect of Obamacare. They admonish taking personal responsibility and
complain about the overreach of the Federal government, but how detached from
reality are those arguments. We have seat belt laws so you can't stupidly
place your infant child in the front seat of your car unbelted and risk him or
her flying through the windshield in an accident. Surely, parents should be
responsible enough not to do such a thing. But, obviously, enough weren't
along the way and now we have these laws.
It's also popular among some to believe that you
"make it on your own." You earn every dollar and support
yourself with no assistance from anyone or any government agency or program.
The correlation seems to be that anyone who does advocate for some
government assistance or program is lazy, not hard-working and lacking in moral
fiber. In order to take that view, it seems to me that you have to be
remarkably free of the ability to engage in self reflection. It also
completely ignores the fact that, for many hard-working people in this country,
including members of the armed forces, police and fire professionals and
others, government benefits and programs are part of the contract, under which
these men and women by their turn make sacrifices and put their lives at risk
in order to do their jobs and provide those very important benefits to you and
me.
As for your own bootstraps, please. You've
never been able to rely on friends or family to care for a sick child while you
went to work, or to feed your pet while you took a trip, or to give you a ride
when your car broke down? Really, you've never gotten a leg up or an
introduction from a friend who had connections that helped you get a job?
Honestly, you've never just been lucky enough to be in the right place at
the right time? Or, as in my case, you've never had a spouse or friend or
family member talk you out of a really stupid decision with potentially
disastrous consequences? Would you prefer that we not have a federal
interstate system of roads and would you rather inspect that bridge you're
about to cross with your family? By that same line of reasoning, would
you rather not have Federal food inspectors and take personal responsibility
for ensuring that the hamburger you just cooked for your family doesn't have
dangerous levels of eColi, which could result in a life-threatening illness?
Sure, bad things still happen, but they happen a lot less with these
aspects of a nanny state. The government can't solve every problem, but
that doesn't mean it needs to be active in fomenting new problems or preventing solutions to existing problems.
Problem two: the cost of healthcare. Even if a person has a health
insurance, that doesn't mean that financial ruin through illness is completely
off the table. In today's column, Mr. Kristoff's friend reports that his
hospital bill at Swedish Medical Center in Seattle exceeds $500,000 at this
point. Because of his income level, he qualifies for charity and will not
be required to pay that bill. But, the cost of his treatment will be paid
by the rest of the insured patients of that facility. Under the current system, if that cost can't
be disbursed among the health insurance-covered patients over time, Swedish
Medical Center can't stay in business indefinitely. But, even if a person
has health insurance, it's often not enough. I used to represent banks,
which would be served with court orders to freeze bank accounts in order to pay
delinquent medical bills. My client, the bank, really was between the
rock of the court and the hard place of an angry customer. Those
customers often called to yell at - or cry to - me about the lack of access to
their money. There was little I could do to help these customers because the
bank was my client, not them. In talking to them, however, I did learn
that many found themselves in that state even though they had health insurance.
But, a catastrophic illness or injury had far exceeded the limits of their
coverage. It's sometimes not possible to avoid
financially ruinous health events even if you have a job and manage to have health insurance.
I had a good reminder of this reality earlier this
year. As noted, I have good health insurance, so it didn't end
badly for me, but I also was lucky in lots of other ways. I awoke on New
Year's Day with a burning headache. It was strange in feeling and
radiated down my neck. I am married to a doctor, as it turns out, and
when I described what I was feeling to him, my first stroke of luck was that he
ordered me into the car and off to the emergency room. We live in the
suburbs of Baltimore and my next piece of luck was having a community hospital
nearby that is affiliated with one of the world's greatest medical centers,
Johns Hopkins University. Upon arrival at the emergency room, the
attending physician immediately recognized the signs of a brain hemorrhage.
A quick CT scan was performed and I was shipped downtown to the main
hospital campus where I spent 11 days in neurological care for a ruptured vein between the tissue of my brain and my skull. I was lucky
again in that the bleed occurred where it did; I did not die or suffer a
traumatic injury to the surface of the brain and its functions. I was
lucky once again to be in the care of the some of the world's most talented
neurosurgeons.
My final stroke of luck brings me back to my
employer-provided health coverage. As you might imagine, the cost for
such world-class healthcare is not cheap. My 11-day odyssey, including
the ambulance ride, totaled just under $80,000. My out of pocket cost was
about $4,000. Still, even if I had not had my insurance, none of the
professionals at Johns Hopkins would have done anything different for me. I just would have been recovering from this
injury facing an $80,000 bill. In point
of fact, the medical campus of Hopkins sits at the northeast edge of downtown
Baltimore in a very poor, inner city neighborhood. Many people have been
treated at Johns Hopkins over the years and rung up similarly sized medical
bills without my level of insurance. With a low-paying job, or with no or
limited health insurance, their emergency becomes an ultimate event of
bankruptcy.
In the
end. I believe in personal
responsibility. I do not blame others
for my misfortunes and I do not believe I (or anyone) am entitled to any
handout. I was the child of parents who
never made more than $40,000 a year, but I wanted to be a lawyer. So, I went to law school with loans and
borrowed every dollar to earn two law degrees.
That was a bet that mostly has paid off.
Today, I own property and pay taxes and am a member of the bar in my
home state. I am married and we are
raising a child with the goal of producing another productive, law-abiding
citizen of this country. But personal
responsibility shouldn't morph into class warfare and a derision of everyone
who might not be as successful or lucky or fortunate as you. That speaks more of arrogance and bigotry than of an embodiment of the American spirit.
In the end, healthcare reform won't fix the problem
of the cost of healthcare, but it seems cruel to me to hold fast to the
notion that paying for and ensuring an adequate level of healthcare is
completely a function of personal responsibility. I am not nostalgic for a time when a few
people had it great and it sucked for the rest of us.
I'd also like my country to be a place where there
are more opportunities but I also want fewer obstacles - for everyone, not just me. We do have a clear choice in this election.
It's between a version of America that never really existed (except for
rich, straight white men) and the continuing movement towards a country that
works together so that everyone has a fair shot at living a productive and
healthy life.
I feel better anyway.
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