I just returned from a follow-up visit at one of the finest cancer hospitals in the world. The doctors were first-rate, the technicians and nurses seemed to know almost as much as the doctors, the equipment was the newest and best, and the atmosphere in this institution where so many children and adults suffer and die from incurable cancers was unexpectedly warm and caring. Almost everyone, even children with head bandages walking down the hall, was smiling.
Between Medicare and a costly private medical insurance policy, my bill totaled zero. My only expenses were transportation to and from the hospital, lodging, and meals. I am lucky; I would have almost certainly died seven years ago without Medicare and private insurance.
U. S. citizens under 65 are not eligible for Medicare, and as a federal retiree, my private policy is subsidized by the U. S. government. Otherwise, it would be beyond my means.
Only a small minority enjoys these kinds of benefits. Many who barely scrape by earn too much to be eligible for Medicaid but not enough to buy a decent medical insurance policy. 11.4% of the population is uninsured, amounting to approximately 34 million people. These are the people who have slipped through the cracks in the system. When they become sick, they must resort to hospital emergency rooms and incur medical and hospital bills they have no hope of paying.
Eight-year-old Susie may have been complaining of a sore throat for a week, but her single mom has put off seeking medical help because she knows it will cost her dearly and she will be docked for the time she takes off from one of her two jobs to drive Susie to a clinic. She drives Susie to school as always (where she mingles and plays with her classmates) and picks her up on the way home from her first job. When they arrive home, Mom prepares a sandwich for Susie and puts it in the refrigerator for Susie to have later.
Then she plays with Susie for a half-hour but must leave to arrive in time for her second job as a convenience store clerk. She puts Susie on the couch in front of the TV, furnishes her with DVDs of children’s movies, and kisses her goodby until bedtime. Mom doesn’t eat supper because she can’t afford it, and besides, her employer frowns on employees taking a break for meals. Mom arrives home about the time for Susie to go to bed. She tucks Susie in and if she has any energy at all, reads her a bedtime story. Then she pours herself a stiff drink of Taaka vodka and orange juice. Sometimes, she makes herself a second one. Exhausted, she cannot clean or straighten up the apartment and falls asleep on the couch. She and Susie act out the same scenario six days a week, and by the time she is due a day off, she spends most of the day in bed, trying to recuperate. Susie is on her own.
One day Susie starts complaining about her throat; four days later, she starts to run a high fever. Her arms break out in a rash, and she starts throwing up. Now there is no alternative; mom must take off work and drive Susie to the emergency room. As luck would have it, she couldn’t start the car, so she and Susie walked to the bus stop three blocks away and rode to the hospital.
At the emergency room, the doctor took one look at Susie and ordered her admitted. The administrative office wouldn’t approve the admission, however, until mom filled out and signed stacks of forms, dealing with as many legal and ethical issues as the hospital’s lawyers could think up. The paperwork took about 45 minutes, during which time Susie sat in the ER waiting room, her temperature rising, and her eyes becoming blank.
Once mom had taken care of the paperwork, the administration approved Susie’s admission; about 15 minutes later, orderlies put her on a bed and rolled her to a standard hospital room, where a nurse started her on saline drips. After about two hours, a doctor arrived who examined Susie’s throat and arms, still covered with rashes. His diagnosis was a staph infection and maybe a virus and prescribed intravenous antibiotics.
During the next five days, Susie nearly died. On the second evening, she had difficulty breathing and was put on a ventilator. She gradually recovered and was discharged after ten days. Mom had stayed in her daughter’s room almost the entire time, sleeping in a reclining chair. Because she was away from work for ten days, both of her employers had fired her. Two days after Susie and her mom went home, mom received a bill from the hospital for $145,000. She fainted when she read the total due.
The reader can easily fill in the remainder of the story. Susie and her mom, who had no income, were evicted from their overpriced apartment a month later. She had no unemployment benefits because her employers contested all unemployment awards on the grounds that the firing was for cause. Employers usually lost these contests, but the proceedings delayed mom’s unemployment checks for several months and forced her to hire a lawyer on a contingency basis.
After a few more months, during which mom could not and therefore did not make any payments on the hospital bill, the hospital turned the account over to a bill collector. Then the ancient cat and mouse game of debtor-creditor began in earnest. Mom availed herself of the invitations of friends and acquaintances to stay in their homes, but wherever she stayed, the bill collector would track her down and begin the harassment all over again, forcing her to move to a different dwelling.
There are many ways this narrative could end, and most of them are not good. Most likely, Susie will be placed by a youth court in foster care, since mom can’t take care of her. It is almost impossible for mom to get a job because the bill collector will immediately serve papers on her employer and garnish 25% of each paycheck. She can’t even scrape up the money to retain a bankruptcy lawyer. If she finds a new job, she will take home three-fourths of a subsistence paycheck.
The only way she can survive is to work off the books, either as a free-lance prostitute or for an employer that pays exclusively in cash. She is likely to live the rest of her miserable life in a Hobbesian state of nature in which her life will be nasty, brutal, and short.
This story repeats itself over and over in the wealthiest nation in the world. It is difficult to believe that U.S. citizens are too stupid to establish a universal healthcare system, a system that every other advanced country in the world has provided to its citizens for many years. Whether we believe it or not, health is a communal responsibility; those living in poverty are prone to become sick, and, being unable to afford healthcare, spread diseases far and wide. We are watching this unfold before our very eyes with the Covid–19 pandemic. Will we learn this time? I’m not holding my breath.
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