Why Should Life or Death Be Decided By Income?

[Bob Geiger]

"Does this sound more like your husband?" asked the neurosurgeon, as my very-worried wife was escorted into the hospital's operating room in November of 2004. "Yes," she tearfully replied, as she walked in on a somewhat lucid discussion about medical tort reform that I was having with the man who had very possibly just saved my life -- a conversation I would not have been capable of having a half hour before.

In the previous 20 minutes or so, the neurosurgeon had drilled a hole straight through my skull and drained what looked like about a beer can's worth of blood that was exerting enormous pressure on the left side of my brain. An acute subdural hematoma, in clinical speak. The previous seven to ten days remain a blur – over two years later – as I was, functionally speaking, out of my mind during that period.

Perhaps mercifully, the 2004 presidential election fell right in the middle of my pre-surgery blind-spot, so I have no recollection of the day 60 million people, more brain damaged than I was at the time, voted for George W. Bush.

But fortunately, the symptoms of what we at first thought was a sinus infection – debilitating headaches, dizziness, slurred speech and spontaneous nausea -- became so profound that my sinus doctor ordered a full brain MRI. The test revealed a giant blob of blood on my brain and I was rushed into emergency surgery.

With a flawless procedure performed by a well-known brain surgeon and an exceptional ICU staff, I was released in only three days and was quickly on the road to what has been a full recovery.

"Do people still die from a subdural hematoma?" I asked one of the nurses, while still in my ICU bed. "Yes," she replied. "Just not people like you." When pressed for what she meant by that statement, she said "People with good health insurance, who can afford a neurosurgeon from Scarsdale don't die from these as much."

That comment has stuck with me and, as I researched the subject further, I found that a large number of people do indeed still die from the inability to easily obtain a 20-minute surgery, a procedure that has become a simple, routine operation for all neurosurgeons.

With a new Democratic Congress about to broach the subject of some degree of universal health care -- and with Republicans undoubtedly poised to remain as steadfastly hostile to the issue as they have for decades -- this becomes a very personal issue as I ask what seems to me to be an obvious question: Why should anyone die because they're not like me?

I'm inherently worth no more as a person than any other husband, father and friend and yet, in the case of a medical crisis like mine -- and more recently, South Dakota Senator Tim Johnson's condition -- the ready accessibility of an emergency procedure can be the difference between life and death.

In one of the richest countries in the world, death should not be the penalty for having no health insurance. Yet, 47 million Americans still have no basic coverage and too many of those would die for lack of the same short procedure I so easily received.


Americans of all political stripes like to think that we are a caring, humane society and yet the essence of pure physical survival is not fully endorsed as a right in our society.

With so many Americans lacking basic health insurance and any Democratic proposal due for a tooth-and-nail fight from the Republican party, we are once again faced with a societal turning point where we must question how good a people we really want to be. It's not enough to wave American flags, sport patriotic bumper stickers on our cars and loudly proclaim our nation as the greatest country on earth. We must actually be great to say we truly are an exceptional standard by which the rest of the world should be measured.

Of the 28 primary industrialized nations, the United States is the only one not offering some form of health-care safety net for all its citizens. Twenty-six of those countries have single-payer universal health care systems, while Germany has a multi-payer system like President Clinton proposed for the United States in 1993. America now offers nothing.

Democratic Senator Ron Wyden of Oregon has proposed the Healthy Americans Act that, according to Wyden, will guarantee, "health coverage for every American that is at least as good as Members of Congress receive and can never be taken away.”

How that legislation will do in the next Congress is unknown. In the absence of such a system, it is tacitly implied that the only way to get good basic health insurance is to get a job that will provide it and, if you can't swing that for you and your family, tough luck. That's certainly been Bush's take on the subject and, since he became president, almost eight million more Americans have no medical coverage.

That is not the stance of a civilized nation. My personal story highlights but one example of maladies for which cures exist but that either no care at all or a significant delay in receiving treatment may mean you die. Think of what it says about us that any husband, wife, mother, father, child or friend should ever be taken from their world because they live in a culture where they are not wealthy enough to be allowed to live.

How many families have been destroyed spiritually because of a needless death or financially ruined because the mere act of staying alive has drained their life savings?

Governing is about choices. And right now, the Bush administration is choosing to wage a war in Iraq that is nearing a price tag of $360 billion. Initiatives like Wyden's have, in previous Republican-controlled Congresses, been destined to go down in flames in favor of this pointless war and yet more tax cuts for people who do not need them.

Conservatives like to talk about self-reliance and how we should all pull ourselves up by our bootstraps. That's certainly what many of us have endeavored to do with our lives. I have good health insurance because I went into the military, got the G.I. Bill and worked my way through college. That education has afforded me a nice life and, my more conservative acquaintances have said, the right to have more of everything than the people who currently have so little.

But they are heartless and they are wrong.

In our society, failing to hold that brass ring should mean you drive a lesser car or take modest vacations – not that the last expense your family incurs on your behalf is for your funeral.

You can read more from Bob at BobGeiger.com.

[Bluzmann57]

1. Health care is a right

and not a privilege. I too am fortunate because Organized Labor has fought and sacrificed so that working people can have health care by partnering with the employers. Not everyone is so lucky. There is absolutely no reason that the most developed nation on earth, one which people in many other countries wish to come to, should not have universal health care.

[Nederland]

18. No it is not

Rights are things that you have until someone takes them from you. Health care is something you don't have until someone gives it to you. It requires the services of another person who, by necessity, needs to be compensated for their time. Health care is more like Social Security, an entitlement contingent upon certain actions of the recipient--paying taxes, etc.

[sandnsea]

25. We have no more rights

We have the right to live? No, because you need a fishing license to fish, hunting license to hunt, some places you need licenses to pick wild berries. You can't grow anything unless you own land. Transport is a right, except you have to have permits for trails and licenses to drive, you can't walk on most freeways that are safe and lit. You aren't free to pitch a tent anyplace you want. If you want to get out of the weather you are required to participate in a capitalist system you didn't create. The right to other so-called rights, like to speak or assemble, is highly contigent upon your social standing. Look at little odd and say the wrong thing, you've lost that job that gives you the money to exercise your 'rights', or worse, end up in jail.

A capitalist system was created by choice. We pay people to put down roads and sidewalks, with the agreement that we all have the right to freely use them (if they have a license). We build schools and not only give every child the right to attend, we mandate attendance. We created a justice system and pay judges and lawyers based on the Constitutional right to a trial. Paying someone for a service does not negate a right to that service, in this country. There's no reason we can't implement a health care system under the exact same basis, and even pass a Constitutional Amendment to guarantee it. I'm sure many people would say the basic right to stay alive on the planet is at least equal to the right to live on the planet free from govt harrassment.

If you lived in another time, you might not think you even had the basic rights outlined in the Constitution. There's lots of people in the world who still don't have them and don't know they should.

[mantis49]

2. k&r

As a nurse, I see the inequities on a daily basis. At times I just want to :puke:

[tavalon]

5. Me too

I have a bumpersticker on my car that says I'm sick and tired of not having universal healthcare and I am. It is horrible.

[The Flaming Red Head]

26. You'd be surprised how many nurses don't have health insurance

I watched a 39 y/o friend who was a nurse die for lack of insurance. She needed a liver transplant (They balked at putting her on a transplant list because of it and in the middle of her crisis her doctor who she had privately paid walked into her room and told her he was divorcing her as a patient and refused to care for her anymore) She left behind a 13 y/o daughter.

[KKKarl is an idiot]

3. It is amazing the right does

everything to show us how wrong abortion is, but they then spend their whole lives ensuring that the un-aborted child's live is made as miserable as possible.

[no_hypocrisy]

4. That's because denying healthcare to all individuals is de facto

eugenics, allowing the weaker and less worthy to perish in order to build an uber-race for the survivors.

[tbyg52]

21. Yep,

with "weaker and less worthy" being defined as "not having enough money."

[Ian_rd]

6. Your mention of the G.I. Bill is highly relevant to this discussion

The G.I. Bill is one of the most liberal and progressive pieces of legislation to ever come out of the New Deal. It offered government financial aid for education, unemployment, and low-interest home loans to millions of Americans who would otherwise be stuck in a status of working poor for the rest of their lives. This bill created a housing boom, higher education enrollment went through the roof, and wealthy conservatives gnashed their teeth at all the commoners sitting aside their better-bred children in college (and outscoring them in grades). It was a great equalizer and served as a true means for anyone to achieve the American Dream. And it is patently the kind of thing that Republicans will fight against from dawn to dusk, including quality healthcare for people other than the rich.

If you weren't born with it, then God thinks you must not deserve it, they think deep down. They've already tried to kill financial assistance for the non-wealthly in our senior years (social security), they will continue to do everything they can to prevent universal healthcare if it's at the expense of Pharma and insurance coporation profits, and if they could kill the G.I. Bill, holy shit they would in an instant.

[Bluerthanblue]

7. sadly income decides far more than we'd ever imagine-

beyond health care- to life opportunities-

consider the effects it has on educational 'choice'-

reproductive decisions (how many in vitro children are born to the lower middle class?)-

career advancement (there are a FEW 'self-made' successes, but lets face it, if you haven't got the $, influence, physical beauty, or dumb luck, your chances of creating a comfortable life in the US are pretty poor)-

people with low incomes can't afford the best legal representation, and are far more likely to have poor outcomes in courts-

people with low incomes pay proportionately higher taxes-

people with low incomes often are not truly free to 'choose' where they will live, what schools their children attend, to buy the most nutritious foods, to drive the safest vehicles, to lower their 'stress' and any number of things that lead to longer, more satisfying lives.

I don't mean to say that being 'rich' brings happiness- but a persons income does 'set a bar' or allow some to by-pass barriers that many of us have to either struggle to overcome, or die trying

[DixieBlue]

8. k&r

[Lasher]

9. If freedom were a thing that money could buy...

You know the rich would live
and the poor would die

All my trials, Lord,
soon be over

Folk song based on Bahamian lullaby

Thanks for this very good article, Bob. I have bookmarked this for future reference.

[ewagner]

10. Bravo!

wonderful post.........

this has been a mantra of mine for a while....Life and Death should not depend on the size of your wallet, (or your health insurer's wallet either).

So

tell me.....

exactly how much do you fundies value human life?

Are you (fundies) practicing social darwinism here? You know, those who are too poor to afford health insurance are being culled from the herd so only the wealthy (an therefore socially significant) persons survive? :sarcasm:

[kestrel91316]

11. Simple - only the wealthy are deemed worthy of life.

[kentuck]

12. As Marx said, the very oxygen you breathe is determined by....

your income. Some people work in very unhealthy conditions. He was right about that.

[stellanoir]

13. Here is a PSA

I've no health insurance and tend to rely on alternative medicine for my health and well being.

A couple years ago I suddenly felt as though I had an enormous fish hook penetrating my rib cage on my right side.

I had broken ribs before and it sorta felt similar, though I had no injury. I wanted to get an x-ray just to see what was going on. A friend had recently had pleurisy and my symptoms were similar to his.

I went to the ER in the nearest hospital for a diagnosis. The doc was very nice and kept on requesting tests that went far beyond the x-ray I requested. He ordered blood tests, a CAT scan, etc.

I kept saying to the nurse, "How much does this cost?" He kept saying, "Don't worry about it." After hearing his response more than 3 or 4 times I said, "That's easy for you to say. I want to have a clue of what sort of debt I'm incurring."

He said, "Look I used to work at a private hospital and their primary concern is the bottom line. This is a charitable hospital run by the church. Our primary concern is care. If your costs are disproportional to your income you will be charged accordingly."

My bill was 5 grand to have confirmed what I already suspected. I had pleurisy but it was an unusual case where it was not accompanied with pneumonia, so it required no pharmaceutical treatment. I expedited my healing process by taking an Oriental expectorant which costs under 3 bucks.

After reviewing my income the hospital billed me 150 bucks.

If you are uninsured, and need be go to a charitable hospital.

[nashville_brook]

14. wow -- that's good information

[philb]

15. sorry,

not the kind of guy that wants things given to him.........

and being healthy but unable to find work for FIVE (5) years?

Puuuuuuuuuuuuuuuhhhhhhhhhhhhhlllllllllllllleeeeeeeeeeaaaaaaaaase!

[Manifestor_of_Light]

16. you think just because you are healthy you can find work?

I've got three degrees, including a doctorate, and plenty of experience and skills, but I committed the sin of passing the age of 40.

Nobody wants to hire you if you are over 40 and have a good education, like a master's or a doctorate. If you're over 50 it's even worse, you are on the scrap heap. Besides, employers don't want to pay anybody more than minimum wage. I fell out of the middle class in the 90s.

If a person is educated, competent and intelligent, they are threatening to the American way of the mediocre managers. "Dilbert" has gotten wildly popular because he's reflecting the insane thinking of the managers.

I lost my health insurance this past spring when my SO lost his job. However his job was low paying, and the stress was literally killing him.

[noamnety]

17. some good reading on the subject

At the time of the second watershed, preservation of the sick life of medically dependent people in an unhealthy environment became the principal business of the medical profession. Costly prevention and costly treatment became increasingly the privilege of those individuals who through previous consumption of medical services had established a claim to more of it. Access to specialists, prestige hospitals, and life-machines goes preferentially to those people who live in large cities, where the cost of basic disease prevention, as of water treatment and pollution control, is already exceptionally high. The higher the per capita cost of prevention, the higher, paradoxically, became the per capita cost of treatment. The prior consumption of costly prevention and treatment establishes a claim for even more extraordinary care. Like the modern school system, hospital-based health care fits the principle that those who have will receive even more and those who have not will be taken for the little that they have. In schooling this means that high consumers of education will get postdoctoral grants, while dropouts learn that they have failed. In medicine the same principle assures that suffering will increase with increased medical care; the rich will be given more treatment for iatrogenic diseases and the poor will just suffer from them.

(snip)

Bureaucratic medicine spread over the entire world. In 1968, after twenty years of Mao's regime, the Medical College of Shanghai had to conclude that it was engaged in the training of "so-called first-rate doctors ... who ignore five million peasants and serve only minorities in cities. They create large expenses for routine laboratory examinations . . . Describe huge amounts of antibiotics unnecessarily . . . and in the absence of hospital or laboratory facilities have to limit themselves to explaining the mechanisms of the disease to people for whom they cannot do anything, and to whom this explanation is irrelevant." In China this recognition led to a major institutional inversion. Today, the same college reports that one million health workers have reached acceptable levels of competence. These health workers are laymen who in periods of low agricultural manpower needs have attended short courses, starting with the dissection of pigs, gone on to the performance of routine lab tests, the study of the elements of bacteriology, pathology, clinical medicine, hygiene, and acupuncture, and continued in apprenticeship with doctors or previously trained colleagues. These "barefoot doctors" remain at their work places but are excused occasionally when fellow workers require their assistance. They have responsibility for environmental sanitation, for health education, immunization, first aid, primary medical care, post illness follow-up, as well as for gynecological assistance, birth control, and abortion education. Ten years after the second watershed of Western medicine had been acknowledged, China intends to have one fully competent health worker for every hundred people. China has proved that a sudden inversion of a major institution is possible. It remains to be seen if this deprofessionalization can be sustained against the overweening ideology of unlimited progress and pressures from classical doctors to incorporate their barefoot homonym as part-time professionals on the bottom rung of a medical hierarchy.

from chapter one of Tools for Conviviality: http://www.opencollector.org/history/homebrew/tools.html

There is a self-study lesson plan of sorts to go with this, at: http://www.insurgentamerican.net/intellectual-hardball/lesson-2/ (That's the study guide for this chapter.) I haven't read the whole essay yet, I've been following the study guide as it appears, because I use that as a kind of kick in the butt to get myself through dense material in small chunks, but I have gotten the idea that much of the basic medicine people should be getting shouldn't require the full medical system with 8 years of schooling and all the attendents and entourage, billing systems and insurance, etc., that doctors bring with them. That's not how it's done in much of the world. We have midwives for delivering babies, but we don't really have much that is comparable for medical care that allows a person to get basic functional knowledge to treat people without the full medical school from top to bottom.

[eallen]

19. Would you be willing to step DOWN to the global average of health care?

Be aware that that is a pretty long step down. There are billions of people who live without sanitary water and sewage systems, where people aren't vaccinated against childhood diseases, where there are inadequate public steps against infectious disease outbreaks, where there is no access to emergency care, etc. Americans worry about access to neurosurgery, because the more basic problems, the ones that kill millions in the third world, are already solved. For all of us. If we were to average across the globe, it would be a far step down, even for the poorest American.

So how do we justify a <i>richer</i> nation having better access to health care than a <i>poorer</i> nation? Among individuals, there is at least some correlation between wealth and past decisions. Partial, of course. Paris Hilton was just born rich. But many people who have good health insurance have so because they have or had a good job, which they had because they applied themselves to their career, which they entered because they studied in school, etc. Of course, some of that is luck. And sometimes it doesn't matter what your health care is. Tim Johnson was born with an aterovenous malformation. Bad luck. He survived because of the best medical care. He might not have, despite that. But at least with individuals there's some tie between past decisions and current access to health care. There's much less with regard to nation of residence. It was pure dumb luck that I'm an American, rather than Sudanese. And because of that pure dumb luck, I don't worry about cholera.

So... where do we start averaging?

:hippie:

[Solon]

27. So because conditions are worse elsewhere, we should do nothing here?

Seriously, what the fuck is wrong with you?

[eallen]

29. I didn't say we should do nothing here. In fact, I praised some of what gets done here....

What I pointed out is that "life and death shouldn't get decided by income" is an extreme principle for deciding what gets done. If that really is the principle, we should first start leveling across nations, not within them. Instead of worrying about uninsured Americans, we should spend American tax dollars to bring sewage and sanitary water to various parts of the third-world that need it. Until that is done, we shouldn't even fund emergency rooms here in the US.

Unless, of course, you're willing to accept that maybe income should have some influence on such matters.

Now, I'm quite willing to see more US money spent on health, most here, and even some abroad. But not on the basis of that principle. I wasn't arguing against public heatlh or national health care. I was arguing against stupidity.

:hippie:

[leftofthedial]

20. what are you

some sort of commie?

[AZBlue]

22. Thank you for this post. K&R

I'm glad they were able to save you! Thank you for sharing your story and this information.

My grandmother died from diverticulitis because she didn't have insurance so the hospital wouldn't admit her. I'm currently terrified for my mother's health because she's too young for social security and can't afford health insurance - so she just doesn't get health care right now.

The health-care situation in this country is inexcusable.

[Cerridwen]

23. Because "it's just business"

The second health care became corporate and about profit, our lives were decided based on our "ownership" potential; i.e., about how much we could afford to pay to get or remain healthy.

But, hey, don't take it personally - "it's just business."

[kineneb]

24. Dickens had it right in "A Christmas Carol"

"Spirit," said Scrooge, with an interest he had never felt before,"tell me if Tiny Tim will live."

"I see a vacant seat," replied the Ghost, "in the poor chimney-corner, and a crutch without an owner, carefully preserved. If these shadows remain unaltered by the Future, the child will die."

"No, no," said Scrooge. "Oh, no, kind Spirit. Say he will be spared."

"If these shadows remain unaltered by the Future, none other of my race," returned the Ghost, "will find him here. What then? If he be like to die, he had better do it, and decrease the surplus population."

Scrooge hung his head to hear his own words quoted by the Spirit, and was overcome with penitence and grief.

"Man," said the Ghost, "if man you be in heart, not adamant, forbear that wicked cant until you have discovered What the surplus is, and Where it is. Will you decide what men shall live, what men shall die? It may be, that in the sight of Heaven, you are more worthless and less fit to live than millions like this poor man's child. Oh God! To hear the Insect on the leaf pronouncing on the too much life among his hungry brothers in the dust."

[ShortnFiery]

28. Yes! To wrap it up in a modern package ...

"Tim is crippled and very ill, near to the point of death. Nevertheless, he is a very happy boy and is very much loved by his parents; he is best known for the line, "God bless us, everyone!" His illness could be easily cured with the right money; however, Cratchit's low wage from Ebenezer Scrooge does not provide the funds to do so, and Cratchit dares not ask Scrooge for help.

When Scrooge is visited by The Ghost of Christmas Present he sees just how ill Tim really is. When visited by The Ghost of Christmas Yet to Come all he sees of Tim is his crutch, as sadly Tim has died. Knowing he could have prevented Tim's death the reformed Scrooge puts things right at the end of the story."

Unfortunately, "The Ghost of Christmas Future" for America reveals a country bereft of compassion and a sense of community. Far too many of our legislators, both Democratic and Republican, want to go along to get along. In other words, they put their OWN self and family wellbeing far above that of their sworn service to their constituents.

This morning I've hear Democratic Leaders repeating the "cop out" talking point, "There's only One President." <--- This is some sick logic because it indicates the RESIGNATION of our Democratic Congress to Challenge our continued occupation in Iraq.

IMO, today the only person who has unvarnished integrity in the political spotlight is Cindy Sheehan.

Stop the Occupation of Iraq; Stop giving hand-outs to the upper one present of the wealthy in the USA; and Raise Minimum Wage ... that's just a start. ;)

"GOD BLESS US, EVERYONE!"

[loyalsister]

30. There are all sorts of contradictions too

Some of the best healthcare actually goes to the very poorest people.

It is the law that people with disabilities must maintain a state of poverty in order to gain and maintain even an adequate level of functioning, sometimes. It is, a right that if we are potentially nursing home bound we are to receive services.

However, once people begin to receive Medicare and Medicaid services they begin to have access to some of the best health services and technology out there.
For example, no middle class person can afford to pay an attendant, but that is a service that is pretty much always available if you are poor enough. (This was NOT the idea of the federal government, they were just putting people away in nursing homes until the Olmstead ruling.)

Of course, the rich are comfortable regarding payment sources for health care, while people who have jobs or spouses with good health care are reasonably comfortable. Many packages make people sweat if something goes wrong.

Middle class people and working poor who have been unable to afford and\or have pre-existing conditions are screwed.

We would benefit most by distributing services, technology, and health care so that we could have more participants in our national community. It would also equalize job the market more so that we would have more people paying in.

Additionally, for insurance to be most effective you have to distribute the risk accross the spectrum of sick and healthy. That is how you get vender participation in the health care system.

The bottom line is some of this is an entitlement IF a person is sick enough. Why let it get to that point? We should beat it to the punch via a national healthcare system in which everyone has an oppotunity to participate so that there is no demand for poverty. Even better, people can get regular check-ups and we can work on our preventative care.
Healthcare is an equalizer that could pay for itself by the time incoming tax dollars pay for stuff that comes from venders who are taxed.
Of course by the time you see more people who are poor getting health care in the first place we might see a reduction in the dollars that would have been spent on entitlements.