Earlier this month, New York Times columnist Nicholas Kristof chronicled the heartbreaking decline and ultimate death of his college roommate, Scott, from prostate cancer at age 53. Scott was uninsured, even though he could afford health insurance. He didn’t get routine health care and ignored significant early warning signs. Scott first saw a doctor when his fever hit 102 degrees, and soon thereafter was diagnosed with prostate cancer. He was treated in a hospital for seven weeks with daily blood transfusions and chemotherapy, and thereafter with additional therapies until his death a few months later. His medical bills exceeded half a million dollars, and almost all of that was absorbed by hospitals and doctors who provided the care. Kristof says up front that Scott blew it — he should have bought health insurance.
But Kristof also lays part of the blame on a U.S. health care system that fails to insure millions of people, leaving them at risk for preventable deaths. I agree, and that’s one of the reasons I support the Affordable Care Act a/ka/ “Obamacare.” One of the primary objectives of the ACA is to bring most of the 50 million uninsured Americans into the insurance system, by using carrots (subsidized insurance for low-income individuals and small businesses; insurance exchanges) and sticks (mandated purchase of insurance for individuals and large businesses; limited administrative charges by insurance companies). The ACA’s inclusion of age- and gender-appropriate preventive care in health plans makes situations like Scott’s much less likely to occur.
More than 1,000 people have posted comments regarding Kristof’s columns about Scott. Most expressed empathy for Scott’s situation — cancer and lack of insurance — but some thought Scott alone was responsible for his own situation and got what he deserved based on his choices. As one commenter said, “[n]ot even a shred of sadness for your friend.” I shuddered reading that cold and callous statement, but began thinking about others who are not insensitive yet do not understand the link between health insurance and staying alive. Some people believe that because you can always go to an emergency room, lack of health insurance is not a significant problem. Presidential candidate Mitt Romney has said, “[w]e don’t have people that become ill, who die in their apartment because they don’t have insurance.” But this is simply untrue: the link between health insurance status and mortality is well established. Since 1993, several credible studies have been released showing a direct connection between being uninsured and dying. These include the prestigious Institute of Medicine, which reported in 2002 that one American dies every 30 minutes due to lack of insurance. And researchers at Harvard reported in 2009 that 44,789 people die annually due to lack of insurance.
And there’s another reason to applaud a health care system that insures people like Scott: the huge cost of Scott’s care. Scott didn’t have enough assets, even if he sold off everything he owned, to pay the hundreds of thousands of dollars spent in treating him. The doctors and hospitals whose bills went unpaid cannot stay open to help people if “the Scott situation” repeats itself. At some point, those costs are shifted to others, including insured patients whose rates are increased and government funds that reimburse some of the costs of caring for uninsured patients. In other words, those of us who are insured and paying taxes are also paying for Scott’s care. The ACA will require that people like Scott, in the future, take responsibility for their medical bills by having insurance.
As I began to write this piece, I was visiting my friends at Vecino Health Centers, a nonprofit health clinic that provides health care to thousands of low-income and uninsured Houstonians. We started talking about the Kristof columns and the tragedies that result from lack of health insurance. In a few moments’ time, the Vecino staff recounted case after case of patients who lacked insurance and were, like Scott, too late to diagnosis and treatment. These are tragedies that we can avoid by embracing a system that makes health insurance more obtainable for all of us.
Elena M. Marks is the Baker Institute Scholar in Health Policy and the chair of the board of directors of Community Health Choice, a nonprofit organization serving more than 200,000 members. She is an attorney with a master’s degree in public health and currently works as a consultant to the health care industry. From 2004 through 2009, Marks served as the director of health and environmental policy for the City of Houston.