The Devil in Doctor Jones:
A Healthcare Commentary
The following is a bona fide letter written by a young, real-life, reportedly poorly rated Mississippi doctor of medicine:
Dear Mr. President:
During my shift in the Emergency Room last night, I had the pleasure of evaluating a patient whose smile revealed an expensive shiny gold tooth, whose body was adorned with a wide assortment of elaborate and costly tattoos, who wore a very expensive brand of tennis shoes and who chatted on a new cellular telephone equipped with a popular R&B ringtone.
While glancing over her patient chart, I happened to notice that her payer status was listed as “Medicaid”! During my examination of her, the patient informed me that she smokes more than one costly pack of cigarettes every day and somehow still has money to buy pretzels and beer.
And, you and our Congress expect me to pay for this woman’s health care? I contend that our nation’s “health care crisis” is not the result of a shortage of quality hospitals, doctors or nurses. Rather, it is the result of a “crisis of culture”, a culture in which it is perfectly acceptable to spend money on luxuries and vices while refusing to take care of one’s self or, heaven forbid, purchase health insurance. It is a culture based in the irresponsible credo that “I can do whatever I want to because someone else will always take care of me”.
Once you fix this “culture crisis” that rewards irresponsibility images and dependency, you’ll be amazed at how quickly our nation’s health care difficulties will disappear.
STARNER JONES, MD
Let’s put aside whether you want that guy for your doctor. The bottom line is, doctors get to be people, too, and as such have quite strong opinions about things they don’t really know that much about. For example, I know a well-educated, well-respected doctor who had no idea abortions ever occurred before 1972. Guess he never read the Bible. (Incidentally, the first state in the U.S. to ban abortions was Connecticut, in 1821; the last state banned it in 1965; those laws were all overturned in 1972.)
So let’s see if we can go about rebutting this thoughtfully.
I certainly understand where Dr. Jones is coming from, but I think the lady he’s complaining about is the exception, not the rule. Medicaid, for example, is generally for children, the elderly poor, and disabled people; most people who live in poverty do not qualify for it. Dr. Jones might even have accidentally uncovered a disability scam here.
Also, it seems pretty clear that, while he doesn’t come out and say it, the woman Dr. Jones was treating was African American—and indeed, it is a common assumption among conservatives that emergency rooms are clogged with poor minorities. Yet according to statistics kept by the CDC, the use of emergency rooms by the poor and uninsured has remained steady since 1992, while usage by the affluent and insured has risen tremendously since 1996.
The point is, what if in fact most people without insurance are not perceptively exploitive?
Here’s a story. Twenty years ago I had a minimum wage job at a national company working about 40 hours a week. Even though I worked full time, I wasn’t called “full time,” because then the company would have been required to give me benefits like paid sick days, paid vacation days, and our old friend health insurance. I made about $70 a week that way (the income on my tax return for that year was $6,000, which means I often worked over 40 hours), and I didn’t ask my mommy and daddy for help because I had it in my head that I wanted a Real Life Experience, all on my own.
After cutting back on expenses like perishable food, OTC medications, toilet paper, and long-distance calls, the next thing to go was my $200+ a month health insurance. I was young and impoverished—what could possibly go wrong? Naturally, during this time I ended up in the emergency room for a couple of hours and came out with some antibiotics and a bill for $1,200. It literally took me years to get that bill paid. To pay back even $50 a month was a huge burden to someone whose food budget was $5 a week. Or maybe my food budget was $5 a week because I was paying that $50 a month. At one point a homeless man bought me groceries in exchange for me letting him sleep in my kitchen, sans shenanigans (shout out to Bill from Chillicothe!).
So anyway, what if most people without insurance are not like the lady in Dr. Jones' Mississippi ER? I didn’t do anything particularly special by cutting expenses—almost everyone I worked with was in the same boat and doing the same thing, except this was their real career, not an experiment that their parents could bail them out of. People had weird things wrong with them, like gout, that they never treated because it was a double whammy: not only would you not get paid for the time you took off, but you’d also have the added expense of a doctor bill. People who were 40 looked 60. There were a surprising number of googly eyes.
Nowadays, minimum wage is $8/hour in Illinois, higher than the national average. If you work 40 hours, that nets you $320 a week for a total of about $1,280 a month, or $16,640/year—all before paying taxes, and almost always without any benefits, including health insurance. Guess how much your insurance policy will cost? About $11,000/year in Illinois, according to the private sector Public Policy Institute. Most employers participate in a group plan, and pay $5,600 per employee per year to insure their employees. (Walmart offers a $10/week plan, but caps payouts at $1,000—which wouldn’t have covered my 1989 ER bill.) And unless you're old and/or disabled on top of that, you don’t qualify for Medicaid, Medicare, etc.
These are the kinds of people who need to have coverage. Otherwise, they do clog emergency rooms, come out with disproportionately monstrous bills, and take years to pay them—if they ever do. What if that’s the face of the uninsured?
Jobs are pretty scarce right now. Even if that weren’t the case, we’ll never have a country where all jobs are salaried and come with health insurance. We’ll always have hourly workers to deal with, and we’ll also have highly skilled contract workers who have to pay that $11,000 a year. So we need something besides coverage you can only receive by being defined as “full time” by your employer; we also need something other than “the poorer you are, the more you pay.”
But what I think we need most is to remove the prejudice that makes us demonize the “other side” of an issue. And, obviously, we can’t base our national policy on the one person that made one physician want to pull the plug on everyone.
Copyright 2010, Denise Pace
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