politic

(Note: I wrote this early winter 2008 during the primary debates, and never published it, but decided to put it up today for two reasons: We are three days before a presidential election that, with either candidate, will change how America's insurance system works. That today is Dia de los Muertos is appropriate as well and I choose it to remember all those who have lost their lives to the injustices of the system.  Please vote on November 4!  Peace. -j.g., PDX, 1 November 2008)




UNINSURED IN AMERICA
OR, HOW I HAVEN’T YET EARNED THE RIGHT TO BREATHE
BY  
JACK GOLIGHTLY


“…She just loved drugs so much that she could not bear to be away from her cocaiana.”  We were dying of laughter, picturing Henri’s doe-eyed ex-girlfriend, who had been arrested at the Amsterdam airport for carrying a $1,000 brick of cocaine in her carry-on luggage.  “What’s worse,” he said, “was that she was not concerned for any of the normal reasons that you or I would have been in that situation.  She did not care that she had just lost a thousand dollars, or that she was going to be arrested.  Katarin was sorrowful only over the loss of her beloved drugs and worried that now she would have to find more.”  Henri described the change that came over Katarin when she talked about her cocaiana, and said he often felt a jealousy for her affection.  “She never looked that way when she spoke of me,” he said.  “It was the look of someone who was truly in love.”

Days later, my friend Magi and I were dreaming on her porch.  We would buy an island, that was the solution, and would furnish this heaven with our ideals.  The list was getting more and more ridiculous- in addition to massive libraries and the freedom of architecture and color, we would have government-sponsored hammocks by the beach.  “And universal health insurance,” said Magi, an East German who had married an American and has now lived in the U.S. for four years.  We were both quiet a moment, our eyes shining, looking at the stars and thinking of this fantastic place.  I looked over to find Magi’s expression as wistful as mine.  “Do you realize,” I said, “that when we talk about health insurance, we have the same glow as Katarin when she talked about her cocaiana?”  It was true.  We were in love with the fantasy of universal health insurance.

The idea of equal access to health care is now surfacing in the presidential debates, with good reason: The U.S. Census Bureau announced that in 2006, 47 million Americans – 15.8% of our population – were uninsured for the entire year.1   Add to this the number of Americans who were uninsured for only part of the year and the number leaps.  85.2 million Americans comprised this category in 2003, exceeding the combined population of thirty-two states and the District of Columbia,2  and that year’s underinsured added 17.1 million to the number of Americans lacking adequate health coverage.3   

American perceptions of the uninsured are strikingly different.  My Republican father would tell me that these people just need to go find work, and if they really wanted insurance they could get it.  “It’s just not a priority to them,” he has said.  “They choose to spend their money on other things.”  American Ingenuity won the West; American Ingenuity still works for those who are not too lazy to go out and get what they want; or so the idea goes. It may surprise my dad to learn that four out of five – 83.7 percent – of the un- and under-insured are active in the labor market.  According to a Families USA report on uninsured Americans in 2003, a full seventy-eight percent were employed, and 5.7% were actively looking for work.  Only 16.3% were not in the labor force, because they were family caregivers, disabled, chronically ill, or not seeking employment for other reasons.4

The cost of being uninsured is deathly high.  While the United States spends the world’s highest percentage of GDP on health care – 15.2% to, for example, Canada’s 9.9%5  – coverage has become so expensive that fewer are being treated for chronic health conditions, receiving preventative care, and maintaining treatment regimens for manageable chronic conditions.  To quote the American College of Physicians: “Every year, the deaths of 18,000 people between the ages of 25 and 64 can be attributed to a lack of health insurance.  This makes uninsurance the sixth leading cause of death, ahead of HIV/AIDS and diabetes.”6

At the end of 2006, I quit social work cold-turkey.  For five years I had worked with homeless adults in Seattle, in shelters and housing and as part of a mental health street outreach team.  I met hundreds of individuals from all walks of life, and witnessed the ugly reality of uninsurance as I spent a majority of my time trying to secure health services for them.  Poverty, it seems, is equal opportunity; I met men and women with advanced degrees, people financially ruined by catastrophic health issues or family breakup, and the extreme: Those too ill to seek care and services for themselves.

It was always an uphill battle, the race of finding appropriate resources – applications for benefits, one-time grants to see a doctor, community appointment slots three months away at the downtown clinic – against the development of some chronic or progressive illness.  Many had not seen a primary care provider in years, if ever, and even fewer had received preventative care since being on the streets.  When asked who their primary care physician was, a not uncommon answer was “The E.R.”  

A number of the men and women I worked with had given up on medical care altogether.  “It don’t matter no more,” said Jamie, who had been on the streets for 25 years.  “I’m gonna die when I die, can’t nobody do anything about that.  I got other stuff to think about like where I’m sleepin’ tonight.”  It was not uncommon to have a resident fall gravely ill upon moving from the streets to an apartment.  My supervisor explained it like this:  “People have an amazing capacity to survive.  The body will keep itself running as long as it can.  Sometimes it just shuts down when it feels it’s no longer in an emergency survival situation.”

This battle finally ruined me, and I joined the ranks of the previously young and idealistic social workers now cynical and burned-out.  I found myself losing hope: If it is so hard for someone so obviously needy to obtain care, what could I expect for myself?

And so it began.  I have now been without health insurance for a year.  After my exodus from social services, I furiously applied for jobs and, and feeling the strain in my wallet, took a job as a barista – a career that I had, in college, vowed would end when I completed my undergraduate degree.  Though the coffee shop didn’t offer health insurance, I made enough money to pay most of my bills.  I hoped fervently that I would not become sick, and that my inhalers would last until I found a job with adequate coverage.

I require inhalers in order to breathe sometimes, as I have had chronic asthma for a quarter of a century.  When unmanaged it can become emergency-room severe, but with a daily treatment regimen including long-acting inhalers I am quite normal, and able to perform even the most strenuous of activities without so much as a wheeze.  The inhaler I require for daily maintenance costs between $200 and $300 per month without insurance, and I have the choice between purchasing it and paying rent.  Currently I have decided to remain housed, carrying a rescue inhaler that costs $40 instead (this price increased from $17 last year when new regulations were enforced requiring inhalers to be CFC-free, and there are no generics yet), and use this to fend off attacks.  When properly treated I have little use for a rescue inhaler other than to have it around for the rare emergency.  When properly treated I breathe easily all the time.

I know this is risky, and expensive, business—especially in this country.  Compare two emergency room visits I have had within the last ten years because of asthma.  On a college trip to Europe in 1998, the pollution in London aggravated my lungs to the point where, three days later in Paris, I couldn’t breathe.  I hobbled to the ER by my hostel and received a diagnosis of Bronchitis following a complete examination, chest x-rays, and breathing treatments.  The total, including prescribed medication, was US $142.  Fast-forward three years.  I had just moved to Washington from central Colorado, and the wetter, warmer climate provided new allergens that seized my lungs within a few days.  This time, my bill was over $15,000, and my first round of prescriptions totaled $450.  Ultimately, the WA Department of Social and Health Services provided me with emergency coverage of much of this bill, but my spotless credit took a hit, and I continue to pay off credit cards I charged for my medicine and care to this day.  

So, I have to ask:  Why can’t I walk to the hospital down the street and see a doctor?  Why can’t I have health insurance like other working people my age?  I can only come up with one answer, and that is:  According to those that get to decide, I must not yet have earned the right to breathe.  

Experience has already shown me how costly it is to seek medical care in this country without coverage, and I join the millions of working uninsured in hoping that nothing happens until I can get a job that provides health care.  I also pray that when I find such a job that I will not be denied for having a pre-existing condition.  After sending out dozens of resumes over the months, I have become decidedly un-optimistic. I simply cannot afford health coverage at this time, though the price I will pay is high in any case:  An untreated chronic condition, lack of preventative care, and in an emergency, possibly my life.

The United States’ ambivalence regarding its citizens’ health is what I can only describe as inhumane.  By refusing to provide universal access to health care, my country is sending a message to its people that they are not worth keeping alive, and the “pursuit of health…” is on their shoulders alone; no matter their resources or situation, they are free to forge their own way or die.  I try not to wince in fury at the current hypocrisy of the words inscribed inside the Statue of Liberty:


“…Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tossed to me,
I lift my lamp beside the golden door.”7


Despite my anger, I still have to smile when I read the line regarding “yearning to breathe free,” wryly aware that I must not laugh too hard lest I become seized with a fit of asthma.  Today, the inscription might more appropriately read “…Send away your tired… we extinguish the lamp beside our golden door.”  

Truer words for me, I think, come from St. Augustine of Hippo (c. 354 – 430 AD):  


Hope has two beautiful daughters. Their names are anger and courage; anger at the way things are, and courage to see that they do not remain the way they are.

Though I am not confident that two years from now we will have truly universal, fair, and accessible health coverage, I hope for change and am encouraged by the current debate.  It will be through our action or inaction that our next leader will define what we, as citizens, deserve or do not deserve.  We are the uninsured; we are 47 million strong and growing; we are nearly two of every ten Americans.  We do deserve to breathe, and must now demand the rights granted to us by our founders: Health, happiness, and the pursuit of liberty.  I shall be happy when I have the liberty to ensure that my health is taken care of and need not live in fear of a medical catastrophe.  I shall be happy when I have the freedom to pursue my own survival and development without worry that my body will give up and cost me everything.  

The message I would send my government is this: The care of human life and happiness, and not their destruction, is the first and only legitimate object of good government.

These words are not, in fact, mine.  Thomas Jefferson penned them in a 1809 letter to the Republican Citizens of Washington County, Maryland, 200 years before what will be an election that could change the course of our country’s history regarding its citizens’ rights to access health care.  

2008 is the year that will call us to arms.  It is a year that demands us to stand up and be counted, to educate ourselves, and insist upon our rights and well-being.  There must be hope, and that hope must voice itself through anger and courage.  It is no longer an option to rely on others to steady our course, for soon we will be so far drifted as to render our voices irrelevant.  We must vote, speak up, act.  Our lives are too precious to be destroyed through inaction, oversight, and indifference.

 

  1. Income, Poverty, and Heath Insurance Coverage in the United States: 2006; U.S. Census Bureau, August 2007 http://www.census.gov/prod/2007pubs/p60-233.pdf
  2. Health Care: Are You Better Off Today Than You Were Four Years Ago?; Families USA, September 2004 http://www.familiesusa.org/assets/pdfs/Are_You_Better_Off_rev20053139.pd...
  3. The Uninsured in America: Number of Underinsured Grows as Insurance Premiums Rise, Stephanie Taylor, Online NewsHour, April 6, 2007 http://www.pbs.org/newshour/indepth_coverage/health/uninsured/underinsur...
  4. Health Care: Are You Better Off Today Than You Were Four Years Ago?; Families USA, September 2004 http://www.familiesusa.org/assets/pdfs/Are_You_Better_Off_rev20053139.pd...
  5. The Uninsured in America: Number of Underinsured Grows as Insurance Premiums Rise, Stephanie Taylor, Online NewsHour, April 6, 2007 http://www.pbs.org/newshour/indepth_coverage/health/uninsured/internatio...
  6. The Cost of Lack of Health Insurance: A White Paper of the American College of Physicians, 2004 http://www.acponline.org/advocacy/where_we_stand/access/cost.pdf
  7. The New Colossus, Emma Lazarus, 1903, from a plaque inside the pedestal of The Statue of Liberty

Names have been changed to protect privacy.