Certain life events focus the mind extraordinarily. Famous examples are the prospect of being hanged or the experience of being shot at. Other life events resonate with irony. I just had a life event that falls squarely in both categories.
First the irony: I just retired from my most recent job, with Pima County. After seven and a half years with the County my effective retirement date was November 13th. I was looking forward to a new stage in my life in which I could still do interesting things, but at my pace. Then, on the first day of my retirement, I suffered a massive heart attack. There it was: the hot breath of the irony dragon.
The focusing came the next day, after I was rushed into the catheter lab to have a stent implanted that restored normal blood flow and eliminated the pain. Neither the pain nor my concern that I might spend retirement in an urn on the mantle focused my mind. It was this: the realization that I was lucky. I had health insurance and extraordinary medical treatment at a highly capable facility. I thought about my fellow citizens who did not have access to these services.
No American hospital can legally refuse to treat a victim experiencing a serious medical episode, such as a heart attack, but the legal mandate is limited to stabilizing and treating the victim. In a case such as mine, that leaves troubling questions. How would a poor, uninsured person pay for the medication? How would he or she pay for rehabilitation and other follow-up services? There is also the worst-case scenario: avoiding treatment altogether. How many of our fellow Americans suffer needlessly or die because they lack guaranteed health care? Let me put it more bluntly: How many of our fellow Americans do we kill with apathy?
The World Health Organization characterizes health care as a fundamental human right and most developed nations provide some form of universal health care. While the Affordable Care Act (ACA) expanded the number of Americans with health insurance, many were left out and the President-Elect promises to eliminate the law altogether. The issue is not the law per se. It’s the need for universally provided health care. Our political leaders who argue over whether the optimum solution is keeping the Act, changing the Act, opting for Health Savings Accounts or a single-payer system, strike me as latter-day Neros. They fiddle while people die. We are better than this.
The recent election was neither an endorsement of Republicans nor a repudiation of Democrats. It was a repudiation of both political parties, a battle cry from those whose leaders don’t care about them. While the ACA has become a political chew toy, it’s unwise to read the election results as a rejection of the Act. Think of the Kentuckians who disparage “Obamacare” but feel more favorably about Kynect, not realizing that Kynect, the state exchange, was created by the ACA. One enrollee who had just signed up for Kynect bragged that it was “better than Obamacare.” How will he feel if the Act were eliminated, without a viable replacement? When many Americans rose up in a revolutionary election, it was because they felt discarded, willing to take a chance on a remarkably untested candidate. Nothing is more fundamental than mortality. Nothing says “I don’t care” like allowing someone to die. While debates over immigration, wages and trade agreements sucked up much of the political oxygen, the election was also about health care. If Republicans don’t get it right, they will be licking their wounds after the next election.
Health care is not cheap. The Center for Disease Control estimates the total national cost in 2014 was approximately three trillion dollars, more than a sixth of the Gross Domestic Product. Per capita expenditures were $9,523. That includes all public and private funding sources, such as Medicaid, Medicare, Veteran’s Health Services and employer-based health insurance. By the end of 2015, some 28.5 million Americans lacked health insurance. Based on the above-referenced per capita average expenditure, the cost of medical care for the uninsured totals $271 billion. As of 2013, approximately 243 million American adults paid some type of federal taxes. That comes to about $1,117 per taxpayer, a little more than three dollars a day. That’s what it theoretically requires to close the gap, if everything else remains unchanged. Three bucks a day. Would I pay three bucks a day to ensure that a fellow American, facing the same challenge I just faced, would not have to forego potentially life-saving medical care because of the cost?
In a heartbeat.