Wes of Walk in Brain is doing a book club of the blogs this week on "Uninsured in America: by Susan Starr Sered and Rushika Fernandopulle. I thought I’d chime in with some thoughts on this powerful and painful book.
This book presents the real-life stories of a number of people who have slipped through the ever-widening cracks in our patchwork of health care. They argue that to even call it a "system" is not accurate, since there is no organizing principle behind the assortment of state, local, private and public providers of health care that folks have to contend with.
The authors organize the book around a few concepts, most importantly the "Death Spiral": In our employer- and family-based health care system, if one is disconnected from these lifelines through job loss, inadequate coverage offered by the employer, or divorce or abuse, it becomes that much harder to stay healthy, which leads to dimmed job prospects, worsening health, and so forth. If they’re available — and they often are not — the safety nets of Medicaid, workman’s comp, and charity care are generally inadequate to the task of actually making people healthy enough to pursue employment at full strength.
Put it this way: It’s impossible to have an employer-based health care system when employers don’t want to hang on to their employees for most of their lives. With lifetime employment, the employer has a significant interest in keeping the employee healthy and productive, reducing costs throughout a lifetime. With the instability of the contemporary labor market, health costs are a hot potato to be passed off on someone else as quickly as possible. And some of those potatoes — people, actually — get dropped.
But the book isn’t as wonky as I’m making it sound: It’s made up of anecdotes about real people, ranging widely in socio-economic status, who all happen to find themselves without insurance. There’s the hairdresser who makes $900 a month, who can’t afford $200 a month in insurance (+ deductibles and co-pays, doubtless), and has a malfunctioning gall bladder and a history of ovarian cysts and endometriosis. Or the bar manager who sands down his bone spurs with an electric sander. Or the construction workers with mangled hands, hips, and backs.
The book uses the idea of "caste" to describe how the uninsured and unhealthy become a separate and permanent underclass in our society, marked by their infirmities in their very bodies. I actually disagree with this metaphor: their condition isn’t permanent, it devolves before our eyes. They’re mobile: downwardly mobile.
The more apt comparison is that of Social Darwinism: We’ve all seen the nature shows in which the antelopes come to the watering hole, stalked by the lion; the lion springs and the herd flees; and left behind to be torn apart are the old, the slow, the unlucky. In our health care system, we literally live like animals.
Look, you don’t need to read a book to see this stuff: It’s all over our area. Just go to Central Square, or ride a city bus (the 134 in Medford, for instance), and you can see it yourself: People too poor or unlucky to get decent medical care. I’m sorry, but all talk of "moral hazard" or "lifestyle of dependency" just goes out the window for me. Maybe some people will become "dependent" on the system — so what? We are human beings — we are not perfect, and should not expect everyone’s health, genetics, intelligence, foresight and morality to be so. Given a choice between that and having our neighbors lose their teeth and become bent, mangled and broken because they can’t afford to see a doctor, give me "dependency" every damn day.
It’s funny that this should come up now. I actually have health insurance, but it’s terrible. The company I work for shops around for the best rates every year, and in the four years I’ve been there, I have 3 different providers. I absolutely refuse to go chasing after doctors who use the current health insurance du jour, which means we are now “out of network” and pay practically as much out of pocket as we do for the insurance, which ain’t cheap. But we at least have another option, as my wife is self-employed. This means we can search out other groups to bond with for insurance purposes.What a stupid “system”.
jdarnold,We’re going to have an opportunity and a designated place to tell your story later this week — watch out for it. (If nothing else, can we re-post this comment then?)
It is unfortunate to hear so many lack health insurance. We really need to improve our health care system. Health insurance is a major aspect to many and we should help everyone get covered.