Wednesday, 18 April 2012 03:20

A Cruel Ethos - Pay Upfront or Die

Written by  Ron du Bois | Oklahomans for Universal Health care

Our acceptance of death for those who can’t afford medical care is unique among the advanced industrialized nations of the world. This ethos allows people who don’t have enough money or enough medical insurance to die everyday. We remain blind to the humanistic healthcare ethos of other nations, that result in greatly reduced costs and superior outcomes.

At least 18,000 Americans die each year from lack of healthcare coverage. My son’s cancer is an illustration. A medical doctor, he contracted mylodysplasia, a life threatening blood cancer. To live he needed a bone marrow transplant. The treatment has a 50% mortality rate, sure sterilization, and prohibitive cost. Neither cure nor normal life expectancy is guaranteed. Still the chance to extend his life and medical service could have been his reward.

My son’s insurance did not cover the search for a compatible donor. The Financial Director of a famous cancer clinic called to ask, “What can you contribute to initiate the search?” With my son’s life at stake my wife said we could manage $5,000. We are senior citizens living on a fixed income. Later I called for clarification, “What happens if we couldn’t afford anything? A long pause. Finally she said, “You must make arrangements to pay in full”. “And if we can’t, what happens?” The financial director hesitated. She didn’t want to say that no donor search would be initiated and that my son would die... but her hesitation said it for her. Her philosophy was clear. She wore the blinders of her culture. She worked for a for- profit clinic that believed in the bottom line. She believed in that policy herself. It was the only thing she knew. How could she understand the concept of “Healthcare as a right regardless of ability to pay”? Yet this is the ethical gold standard of every industrialized nation with the sole exception of the U.S. Her mind could not process that the health outcomes in other nations are superior and the cost half to two thirds less.

Another illustration is the case of a child born three months early. The cost of incubator care and treatment while the lungs and heart developed was $ 500,000. I asked the mother, “How did you pay for it? “ She replied, ”Fortunately, we qualified for Medicaid.” I asked, “What would have happened without Medicaid? ” She replied, “It would have been a choice of letting her die or going bankrupt.” Without Medicaid she would have joined the legions of other Americans whose lives have been diminished forever by bankruptcy.

Who will break the unspoken American cultural ethos, “ You deserve to die or be ruined if you can’t afford to pay”? What will it take to break the ethos that it’s OK to expect weakened persons to spend most of their time writing letters, e-mails and telephone calls to insurance companies intent on delaying and rejecting valid claims resulting in wrongful death. These tasks would be daunting for a person in good health, yet for a sick person the ethos is , “Fill out the forms or you deserve to die.”

The Greek philosopher,Socrates said, “Character is destiny.” With regards to healthcare I wonder how he would have compared the character of Americans relative to that of other nations... who have opted for universal health care as a birthright? Nobel Laureate Harold Pinter wrote, “ What has happened to our moral sensibility? Did we ever have any? Is all this dead?”

Medical doctors with life threatening cancer fare no better. The same ethos prevails. “If you can’t pay you deserve to die”. The Hippocratic Oath no longer holds. Physicians, it appears, also wear cultural blinders. Their allegiance, it appears, is to words not actions.

Health care reform requires moral commitment. It is an ethical issue. The cruel seemingly impenetrable cultural bubble needs to be broken to let in the fresh air essential to maintaining the values we say we hold dear. Our certainty that our present highest cost in the world privately run medical/ insurance industry is “the best in the world” must reach the point of cognitive dissonance. This false assumption must be replaced by the truth... so called socialized medicine (single payer) as practiced in every other industrialized nation makes a stronger and healthier nation .

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