Malicious Medicine

From a West Virginia Newspaper Comes the Story of Christopher Thaxton, two years old. Christopher has an incurable liver disease. His unwed teenage mother works at a nursing home, but her job-related insurance plan will not cover Christopher because of his pre-existing condition. Christopher needs a liver transplant soon to survive. The large medical center that has treated him thus far specializes in such surgery, but says the operation will not be performed unless it receives 75 percent of the costs up front. The bill could eventually reach half a million dollars. The state where Christopher lives will pay $75,000 toward the operation if it is done at another, less expensive hospital. Christopher’s doctors have told his mother if her son goes to another hospital, delicate tests that could dangerously weaken his condition will have to be repeated. His mother doesn’t know who to believe or what to do.

Christopher’s picture accompanies the article that reports his story. He is a slender baby with a beautiful, quick face. I look at him and fear he is about to become the victim of a murder.

Walk into a fast-food restaurant or convenience store in any small town and you are likely to see a jar with a hole in the lid, and a homemade sign with a Polaroid portrait taped to it, a modem alms basin collecting pennies toward some gargantuan medical bill. Sometimes the most spectacular stories make the newspapers. A migrant worker’s child is turned away from a hospital’s emergency room and dies before she receives care. Cancer kills a boy who could have been cured with early diagnosis; but his father had lost his job and the son didn’t want to be a burden so he kept his symptoms to himself. A woman and her friends demonstrate outside a hospital that has refused to treat her cancer without payment up front.

Payment up front. Americans are hearing these words more and more often, and they are in direct opposition to the Hippocratic Oath, the bloodless code of capitalism overriding the call to heal. Few of us can purchase our health without the backing of an insurance company, and even then, the holes in our coverage can saddle us with crippling debts.

Perhaps the greatest damage to our national well-being is done quietly, almost invisibly. Preventative care, so vital to health and in the long run, economical, is almost nonexistent in this country because no one from the middle class on down can afford it. Its inadequacy shows up in cancer rates, in infant mortality rates, in poor diets, in all the statistics where the United States performs more like a Third World country than an advanced industrial nation.

The lack of preventative care is hardest on women and minorities. U.S. Health Secretary Louis W. Sullivan recently said that infant mortality and life expectancy in African-Americans were two examples of “clear, demonstrable, undeniable evidence of discrimination and racism in our healthcare system.” Sullivan said that black infants are twice as likely to die as white infants, and that blacks wait twice as long as whites for transplants.

I have my own story to tell. I feel a bit sheepish for complaining, because I’m one of the lucky ones. What makes my situation worth sharing is how ordinary it is. I am middle class, single, and self-employed. I’m also pretty healthy. I’ve never had a major illness or accident, and I’m a member of that dwindling tribe of Americans covered by health insurance. Between 31 million and 38 million of us have no medical coverage, and that percentage is growing as incomes fall and employers drop then group plans. But so far, although it hasn’t been easy to provide coverage for myself, I’ve been one of those people the government isn’t worried about. The American healthcare system is taking care of me.

In fact, I’ve often experienced the unfairness and downright nuttiness of American health care. As a self-employed writer, I have provided my own medical coverage, but I have taken temporary jobs from time to time. Some of them offered relatively low-cost group medical benefits, so I dropped my own insurance company.

When I quit a job several years ago to write full-time, I didn’t expect a problem. But I had the bad luck to contract a case of mononucleosis just as the job ended. I was diagnosed the same week I filled out my new application for health insurance and, naif that I am, noted this on the form under Current illnesses requiring a physician’s care.

I was turned down. Finally I applied to Consumers United, an insurer that prides itself on being socially responsible. I was told I could be covered after a waiting period, and after a physician had certified that my blood tests were normal. Since I am often anemic, the latter took a while. Altogether, I spent almost a year without health insurance.

It was a worrisome year, but I dodged the bullet. I didn’t have any automobile accidents or illnesses requiring hospitalization and I had made enough money to cover the treatment for mono. Finally I was back on insurance to the tune of $1,500 a year. A Pap smear caught precancerous cells on my cervix that required surgery. But I was covered. Never mind that I still spent more than $800 to make up what my policy didn’t pay. It was better than being in debt for thousands of dollars.

That was a year and a half ago. The book money is gone and my finances are tight. I’ve survived by cobbling together part-time jobs and writing assignments.

Last winter I suffered through weeks of a sore—possibly strep — throat and a hacking cough because I couldn’t afford to go to a doctor to get a prescription for antibiotics. I’ve postponed mammograms and eye exams (the vision is down in my left eye) as unaffordable luxuries. I haven’t been to a dentist in two years. I needed another Pap smear as a follow up to my surgery, but I put it off for over a year.

It’s a situation Kafka would have appreciated. I’m still paying my insurance premiums, but just barely. And when I’m done, there’s no money left to go to the doctor.

The American medical system is more than just broken, it is malicious. How do we fix it? Some progressives are calling on the United States to adopt a health care plan similar to Canada’s. Neocon Democrats in Congress, responding to input from big business, have their own idea. They would set up a national insurance plan supported by employers, for employees. But how would this help the unemployed, or the self-employed? How would it provide preventative care, or help the working poor who can’t pay deductibles?

According to a recent statement by the president of Mountain State BlueCross and Blue Shield, I shouldn’t worry. Americans, he assures us, wouldn’t want to be like the Canadians, because their country administers a single plan for everyone. “In America,” he says, “we want and insist upon a choice in health coverage, just as we do in automobiles, hamburgers, and television sets.” He admits that “the cost of administering variety is a whole lot more,” but that’s OK. After all, “What do you suppose pays for the Canadian health-care system? Taxes.”

I look at the weapons my tax money is building, and Canada sounds good to me. Another newspaper brings this headline — Hospital tried to turn away Soviet with little insurance, angry friends charge. It seems poet Bulat Okudzhava was stricken with serious heart problems while visiting Los Angeles and his friends were asked to provide prepayment guarantees. They were shocked.

Where did they think they were, Moscow? Or Libya perhaps, where there is free universal health care? Or Cuba, which also provides free universal healthcare? Or maybe pre-war Iraq? We’ve done a good job of making sure Iraqis, at least, don’t have a better health care system than we do. It’s odd that our supposedly greatest enemy, for all their sins, do a better job taking care of their own people. Maybe we aren’t supposed to travel to those countries because we might get some ideas.

Sure, those are poor countries that lack some of our sophisticated equipment. It’s nice to know the American rich have the high-tech best. In the meantime, I have just received notice that my health insurance premiums will increase 25 percent this summer. I’ll have to decide if I can keep paying. The Pap smear results have finally arrived too. The pre-cancerous cells are back and I may face more surgery. Oh yes, and I’ve got a bad tooth that forces me to do all my chewing on the right side of my mouth. I’m trying to decide how long I can put off seeing the dentist before I get toothaches. It’s great to be an American and exercise my freedom of choice.