Crisis of the uninsured

The enormous number of Americans without health insurance constitutes a moral and economic crisis. Perhaps we could extend coverage to these folks if only doctors, hospitals, health insurance companies, pharmaceutical companies, medical supply companies, and malpractice lawyers all decide that for the Public Good we'll do with less money.

As I ponder that last sentence, I think of which groups willingly and cheerfully work for less money than what they could be earning in the "free market". Those in the ministry (including the occasional secular do-gooder) and those teachers who shun the public school system and work for peanuts in private schools are about the only people who are willing to make that sacrifice.

For everyone else, to expect us to surrender income obligingly is to indulge in Utopianism/Totalitarianism. I say this not from any ideological perspective, but from simple observation. If you are thinking, "Well, I'd take a big pay hit for the good of mankind!", I would conclude that you are in the ministry, or teach in a private school, or are unemployed, or are less than honest with yourself.

The rest of us take pay cuts either when we're forced to, or when we make trade-offs for lifestyle considerations. We're just not wired to surrender our earning potential "for the Public Good".

The boiler-plate media portrayal of the uninsured is that of a 50 year old middle class male who gets laid off by his profit-seeking company, loses his health benefits, has a heart attack over the stress of it all, and incurs hundreds of thousands of dollars of medical bills which he cannot hope to ever pay. I'm sure this really does happen from time to time.

I'm on ER call this week so I kept track of all the uninsured folks I was asked to see. I've never met a "boiler-plate uninsured" and I thought this would be a good opportunity to look for one.

Here is my list of the uninsured:

• middle aged male with alcoholic pancreatitis. He actually was laid off and lost his benefits for his erratic behavior which I suspect was due to his alcoholism. He was a very nice fellow who thought that his three sisters were unfairly ragging on him for his drinking.
• middle aged male with alcoholic pancreatitis, in and out of the chemical dependency center. Not really interested in stopping because it was his ex-wife who drove him to drink.
• young gangsta with alcoholic pancreatitis. He is a good-looking charismatic gentleman who could amount to being a lot more than a gangsta under the right circumstances.
• middle aged male with GI bleeding. He owns his own business but chooses to save money by not covering himself. He's not worried about his bills because he was rear-ended by someone two years ago and he's going to sue the driver and all the physicians who saw him six months afterwards. "You don't have a thing to worry about, Doc". Thank goodness.
• young male with belly pain due to anxiety, and probably from karmic retribution for being such a sociopath. He also owns his own business.
• middle aged male with bad esophagitis. I'm not sure why he doesn't carry any insurance, but his responsible next of kin was his mom. That always raises a red flag for me when the patient is a middle aged male. Could it be that no one other than his mother wants to put up with the guy?

This is a random unscientific survey, of course, but I would conclude from this list that if we were to eradicate alcoholism and figure out a way to integrate sociopaths into our society better, that just maybe the problem of the uninsured would get a whole lot better very quickly.