Dear Dr. Starner Jones (I doubted you were real, but you are. I looked you up. I still blame Sarah Palin for this.),
Your letter was enlightening. Thanks for putting yourself out there. But I have some questions/statements in response. In the interest of full disclosure, I’ve been a socialist-thinking type since long before it was all the rage. My degree even has the word social in it.
So with regard to your letter. I am bothered by the prospect of you working in the ER. I imagine it was not your first choice, that you were hoping for a match in Plastics or something a bit more glamourous. But while you’re there, please take it as an opportunity to see how the other half lives.
You cite this patient’s smoking, eating, drinking and dentistry habits as evidence that ‘Obamacare’ is unwarranted. Do you know how much private insurance costs? On the cheap end, it’s about $300 a month for a single person. And this doesn’t cover prescriptions or pay for a significant portion of any surgery or acute medical care one might need, if one were to actually get sick. It doesn’t include dental (thus addressing the need for ornamental dentistry), or nutrition, or smoking cessation services, or myriad other needs. And it costs $300 a month. Generally people like you and me, who have been blessed with good paying jobs, have health insurance given to them. I pay like $80 a month for mine. But the average American who has no insurance, works a minimum wage job, making at most $7.25 an hour. If you work two part-time jobs (as minimum wage jobs are rarely full-time), you make about $14,000 per year. This is just above the poverty line for a single adult. [And just so we’re clear, these people don’t qualify for Medicaid. To qualify for Medicaid, one cannot make more than $700 per month (in New York) and/or must have a very expensive chronic health condition (i.e. cancer, AIDS, etc.) and even then you are rarely treated appropriately for any acute illness.] So let’s think about that. You make roughly $1000 per month. You must pay for rent, bills and food (you don’t qualify for food stamps either). Very conservatively that’s about $975 per month—rent being $700, utilities about $100 and then $175 for groceries (see below). And then you have to pay for your really crappy health insurance. That leaves you with -$275 per month. So you use credit cards to cover that. But then you have to add that to your budget, and with interest you’re never going to pay that off. So that $275 per month ends up costing you thousands of dollars. And that’s without you ever having gotten sick. Hmmm…seems I’ve hit a dead end.
Now let’s talk food for just a brief moment. I, a single person living in an expensive city who tends to eat organically, spend about $200 each month on groceries. And then maybe another $100 on eating out (a girl’s gotta have a social life). But the average, non-organic-eating, non-New York-living, person spends a bit less. According to the USDA, in 2004, the average food expenditure per person per month was $125. But then food prices have risen significantly since then, so it would be more like $175 in 2010. And once again, our example person, who has no health insurance, makes about $1000 a month (see budget above). And our example person doesn’t even have children. In a very strange paradox, obesity and hunger have become linked. Hunger is no longer about thin frail children. It’s about children who eat only processed foods, because their families cannot afford fresh vegetables. Or even better, there are no stores nearby that sell fresh vegetables. So vegetables turn into canned corn, or white rice, or French fries with ketchup. But that’s for another time.
I will leave you with a personal story of the woes of the badly insured. My second year of graduate school, I started having debilitating headaches. Anyone who knew me during that time would say that I was teetering on the edge of something really terrible. But I was insured through my university and thus went to the student clinic. I was seen by urgent care, referred to my regular doctor, sent to three specialists and physical therapy, and found no relief for months on end. I spent a night in the ER when it go so bad that I couldn’t swallow, and then two days of my life waiting for clinic appointments and being told these headaches were all in my head (in a metaphysical sort of sense). In the ended, I elected to have surgery to fix my wonky sinuses and received amazing relief for a couple of years. But my insurance only paid for 60% of the surgery and hospital costs, leaving me with a bill of about $15,000. And this was for a day surgery. Very thankfully, my doctor was a very kind gentleman and didn’t charge for his portion of the fees, about $12,000, and the rest went on my credit cards. A good portion of my debt comes from this incident and a couple years later when I had just changed jobs, and was thus without insurance, and my headaches became acute again. And I have since age 18 been gainfully employed, and insured, responsible with my ER usage and hospital choice. And here I am, with millions of other Americans, carrying large debt in the interest of my health, hoping that I can forgo another crisis.
Working in social services, I know very well that there are people out there abusing the system. People who could work but don’t. Who fake illnesses to live a life on disability. Who always choose the easy way. Or make vastly irresponsible life choices. But these people are few and far between. What we’re talking about here is families becoming homeless because one of their members needed life saving medical treatment. Or even worse, people dying because they can’t afford to see a doctor and wait until it is too late. I have seen this with my own eyes. No one should die because we have judged them unworthy of medical coverage.
Brooklyn, New York