Words of occasional wisdom from Bruce Oakley

Simply not good enough

Posted by boakley59 on October 13, 2009

Half a lifetime ago, I wrote about the day I lied (twice) to a panhandler about being able to give him the money he was begging for. That day, I had just come out of the local pool hall where I had been spending money to drink and play games.

This scruffy, mostly toothless, old fellow, looking like an honors graduate of the School of Hard Knocks, Alcoholics Department, asked if I could spare some change because he was hungry and had just been turned down or found the door shut at a local aid office. He pointed in a direction that seemed wrong for that particular office.

So I said no, I couldn’t give him any money. I headed back home to get cleaned up for work, but the look on his face and his general condition stuck with me, so I slapped a couple of cold cut sandwiches together and looked for him on my way to my office. I found him a block or two away from first sighting and waited for traffic to pass before walking up to him and lying (again) about not being able to give money but telling him he could have the sandwiches. He was overjoyed, thanked me enthusiastically and sat right down on the curb, wolfing down the meager meal as my conscience and I wandered away.

Now, we can argue about whether I was giving in to a shiftless con artist, helping my fellow man or doing just enough to salve my conscience, but the point is this: I looked that man right in the eye, twice, and as much as told him he could die for all I cared. Yes, I eventually hedged my bet that he was making up or responsible for his desperate state and I shared a small bit of my excess, so some might say I should cut myself some slack, but there is no escaping the reluctance and distrust with which I bought a man a couple of hours of life with my table scraps.

Half a lifetime later, I still think my effort was simply not good enough.

I retell this story now because I see frightening echoes of it in our national discussion of health-care reform, and I have come to think that I (and millions of others) have become like that desperate old man.

In all the talk about reform, all of the noise is about the money and who will spend it or lose it or be cheated out of it. As a nation, we are telling our fellow citizens, our neighbors, they can die for all we care, because we would rather protect whatever money we have than trust them to be as sick or as poor as they say they are.

America is telling me that I can die for all it cares, I am telling my friend who lost her job and has a condition that makes it difficult to get health insurance that she can die, and… Well, I won’t go through the list of family, friends and neighbors who live on the edge with the American system of health care.

This is undeniably a matter of life and death, and there is no other way to look at it than that as a nation, we choose death. We spend more money per person than any other nation on health care and yet we die younger and suffer more from preventable or curable conditions than most developed nations. Some boast that we have the best health care in the world and that those ailing in other nations strive mightily to come here for advanced care. But this is a narrow view, because in general our own citizens die at a higher rate than those in other nations from the very diseases that those who can manage it come here to have treated. That is, the so-called “best health care in the world” is the “best that money can buy” and those without money can just die like street dogs. Given the wealth disparity in this nation, that leaves a lot of us to just die, and in greater proportion than those in nations with what some call lesser care.

Those with money and political power are secure in their health care and they work desperately to scare those on the margins that they might lose the little bit they have.

Wrangling over the numbers of uninsured is part of this search for acceptable failure. Estimates of the uninsured have been as high as 45 million, which is 1 in 7 Americans. If you talked to a different person every day for a week, on average one of them would be uninsured at that level. Or consider your family: your parents, your spouse’s parents, you and your spouse, and one child. That’s seven, and on average one of those would be uninsured if 45 million is the correct number. It’s hard to imagine anyone arguing that such a level of insecurity is acceptable, even in a free democratic capitalist state where the citizen makes his own choices and fortune.

Suppose the number of uninsured is only 30 million, as the next round of more cautious estimates suggested. This refinement in the number is usually explained by suggesting that many of those in the higher figure could afford insurance but choose not to spend for it. These choosers are generally considered to be young and healthy, unafraid yet of catastrophic illness. Nevertheless, that level is still 1 in 10, and it’s not difficult to add a few faces to the previous examples to arrive at such a grouping. For instance, one starter on any soccer or football team would on average be uninsured at such a level. Here, too, it’s hard to imagine anyone arguing that this level of risk is acceptable.

Lately, the number of hard-core uninsured, those who absolutely cannot afford it, has been put at 9 million to 10 million. That’s “only” 1 in 30, so maybe we can feel better about that. In my day, that was about the size of a typical grade school class. Perhaps this is the players on all the teams in a local 5-on-5 or 6-on-6 youth soccer league or two youth softball teams and their coaches. It’s not hard to think of a familiar group of that size and then imagine that on average one of those people would be uninsured. Thinking of the classroom group, we provide subsidized breakfast and lunch to poor children. I hear the faint, chilling echo from that street corner half a lifetime ago: “I’m willing to risk a sandwich to help you.”

Let’s face it: In this nation, even in this miserable economic time — no, especially in this miserable economic time — it doesn’t matter whether the number of uninsured is 1 in 7, 1 in 30 or 1 in 60. We are all of us simply not good enough if we allow that many of us to be at risk merely so that the rest of us can keep our money.

Some will argue that uninsured does not necessarily mean unable to get health care. The money one might spend on health insurance might better be spent directly on health care, such as visits to the doctor, immunizations and other simple preventive care. That’s all well and good, so far as it goes. The problem is that it doesn’t go very far.

My own case pretty well covers the gamut in our system, so let me tell you how I have come to see a resemblance to that beggar on the street when I look in the mirror.

I have a chronic disease diagnosed in 1998, after I failed to recover from an infection and spent six weeks passing blood and dropping from 140 pounds down to 120. I spent two weeks in intensive care, a month on a home IV feeding tube, a month working from home and another month working half days before I could work full time. I didn’t have another episode or take a sick day for another five years, but I ended up in the hospital for a week again in 2003, with a new IV hyperactivating a stealth infection we didn’t know I had, producing a cyst that eventually a surgeon was able to burst by finger pressure so I didn’t have to have surgery.

Then again four years without a sick day or another episode until some nagging discomfort in 2007 that worsened until I could not sit for extended periods, finally costing me my job after five months off the job without recovery. Two months later still, I had to have surgery to drain and disinfect the involved region.

Up until that surgery was scheduled, my employer’s disability insurer denied my claim on the grounds that I should have been able to find some kind of cushion that would allow me to sit to do my job. Apparently, nine years of living and working with my disease and five months of prescriptions that did not solve the problem weren’t sufficient proof that I understood my condition. You see, nothing in the medical documentation of that five months of treatment explicitly stated, “Patient is unable to sit or work,” even though that was precisely the reason I went to the doctor, precisely the condition being treated. Once the record explicitly showed the patient must be sliced open to have the problem scraped away, disability benefits were awarded on appeal.

Three months later, I was feeling stronger and wanting to go back to work, so I called the insurer to report that I thought I was better and wanted to try working. The agent without hesitation said, “That ends your claim then.” I immediately added, “But I haven’t gotten clearance from my doctor yet to go back to work,” but he stopped benefits right that day. I never did get clearance from my doctor and in fact I was back in the hospital again a few months later: I was not recovered or in remission when I called the insurer and lost benefits on account of optimism.

The observant among you will recognize that my word as a nine-year fighter against the disease was not good enough to get benefits when I could not sit or work for an hour at a time, but all I had to do to lose benefits was say that I thought I was having a pretty good day.

Nine months later, the federal government agreed I had been disabled all along and I ended up with back benefits for the entire time (one more hospital stay as I mentioned and two emergency room visits in the interim helping confirm the judgment).

While we were awaiting the decision, though, we pushed every credit card to the limit, including a new one we were able to get just before running them all up, got a small bank loan thanks to a long family history of timely repayments with that bank, and started packing up everything in the house, because we would have to sell if benefits were denied. We bought this house when both of us were working at salaries substantially higher than Suzy’s current rate. The disability benefits push us to about two-thirds of the income at which the mortgage was originally budgeted.

Now, we chose to get out of the jobs we had when we bought the house; I chose to call the insurer and report my perceived improvement; we chose during this time to give some financial support to family and friends in even worse straits; so we made our situation tighter than it needed to be. Still, we did most everything the way we were supposed to: We do not spend on trivialities and we stayed current on our insurance and our bills. We budgeted and watched every penny; we followed doctors’ advice, kept appointments and monitored diet and condition; I was active, durable and healthy, even regularly ran 10-12 miles non-stop at seven minutes a mile up until my hospitalization in 2003. Yet a chronic disease contracted through no known risky behavior put us one bureaucratic decision away from “must sell” on our house.

Some numbers that are perhaps none of your business and more revealing than may be wise in these days of Internet insecurity, but I think the point is necessary: Through Suzy’s employer, we now buy health insurance, including vision and dental, for two. Our premiums are about $2,000 a year, and we also have taken specialty cancer insurance for another $1,000 a year. Our basic health and prescription deductibles are $6,000 a year. That’s $9,000 a year. We have life, home and auto insurance, utility and phone/satellite/Internet bills, plus our mortgage. That and property tax add about $19,000 a year, for $28,000 so far. I have not counted groceries, gasoline, auto or home repair, pet care or income tax.

The median income in the United States is $32,000. Half of Americans who have jobs are paid less than that. As a childless, college-educated couple with two pets and low entertainment expenses, we spend $28,000 a year on insurance, utilities and a mortgage. Groceries at $70 a week would put us at spending the median American income, just on “being here.” Everything else we spend, including income tax, comes out of my disability benefits. If I lose my disability benefits, we are effectively broke and would be even if Suzy made several thousand dollars more than the median income.

One of the maintenance medicines I have been getting for the past year through a grant program is not covered by our prescription plan. With the disability benefits, we no longer qualify by income for the grant, but the monthly uncovered prescription cost effectively wipes out the disability payment. If we don’t find a funding alternative, paying for the drug would effectively put our income at the level to qualify for receiving it free. I can have medicine or disability benefits, but not both, and if we pay for the drug, every expense not tallied above will be deficit spending.

True, if we had a smaller house, we would have lower utility bills, taxes and hazard insurance, so we have some fall-back options. But stop and think what a larger family’s additional expenses would mean, even in a smaller house than ours. How are people at that level to overcome any health setback without a safety net? If half of workers earn less than $32,000, and $9,000 is a typical outlay for family health coverage (it is here in Arkansas, judging by the plans of the three employers through which we have had coverage since 2006), an awful lot of us must be always living on the edge.

We have done the right stuff and been careful all along, yet we are one decision away from collapse. Without insurance, we would already be buried, at least financially but perhaps literally. I was in the hospital for three to seven days on four separate occasions in 2007. I’m not looking it up, but I think the smallest bill was $12,000 and one was upwards of $18,000. This year, I have had only a single emergency room visit (doctor’s offices were closed early on a holiday weekend when I had an infection), but with that and my daily maintenance prescriptions, we met my deductibles by midsummer in this almost silent medical year.

Any infection, any departure from quiet maintenance of my chronic condition, eliminates our cushion and puts us at the mercy of the system. If Suzy loses her job, if I lose Social Security disability, if I reach a lifetime cap on hospitalization coverage, if Suzy’s heart condition (mitral valve prolapse — I’m not the only one with a chronic condition) turns bad, we are wiped out.

We’re not extraordinary; we don’t live dangerously or extravagantly; we didn’t choose an unhealthy lifestyle. Yet we live on the edge.

What do people without my options, my education, my salary history, my good fortune, do when illness strikes them? Whether the number without insurance is 1 in 7 or 1 in 60, whether we think some of them might be scamming us or living wildly and so deserve their suffering, it’s simply not good enough for the rest of us to protect what we have.

It’s not good enough to settle for letting “them” die for all “we” care. Every time “we” look in the mirror, “they” must be the ones we see.

In our “money matters” system, the face in the mirror is a death mask.

As with my grudging gift of a sandwich half a lifetime ago, all rationalizing aside, it’s simply not good enough.


2 Responses to “Simply not good enough”

  1. Bruce – thank you so much for writing this – I tend to support reform in this area for the very general reason that it feels like the right thing to do, to make this system work better for people who are not being helped by it. I readily admit, however, that I am not interested in politics, and so I tend not to pay much attention – or really even try to learn about the situation. I so appreciate you putting this into a framework that I can understand and relate to. Thank you.

  2. Ben said

    This is an important essay. The muscular opponents of health care reform — and they’re not all conservatives or Republicans — as you know care not a whit about solid statistics, logic or compassion so you wisely do not use those as a weapon. You use yourself.

    You recognize that foes and fence-sitters should see themselves in you, college-educated and middle class and not afraid to work or to take care of yourself even when healthy. But we all get real sick eventually, you sooner than most.

    You did right, did great, with the sandwiches. The guy may have craved a drink or dope money, but he must have been hungry. You gave him a day. Columnist Steve Lopez (“The Soloist” about homelessness in LA) hands beggars cards with the addresses of effective shelters (with rehab and job training, not just meals and prayer).

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