by Dan Savage
Hospitals were required to provide emergency care to the uninsured (and they still are) if they wanted to participate in the Medicare program (which all of them do, though in theory they could say no to Medicare patients and the uninsured), costs that were passed on to the insured in the form of jacked-up prices that led to jacked-up insurance rates (and they still are). But hospitals could refuse to treat the uninsured, and many of the uninsured didn’t seek treatment for fear of being bankrupted. Thousands of Americans died annually as a result—including children (and they still do).
“Lack of health insurance might have led or contributed to nearly 17,000 deaths among hospitalized children in the United States in the span of less than two decades,” according to research from the Johns Hopkins Children’s Center. The study—published on October 29, 2009, in the Journal of Public Health, which reviewed more than twenty-three million hospital records in thirty-seven states—is one of the largest to look at the impact of insurance on the number of preventable deaths among sick children in the United States. “If you are a child without insurance, if you’re seriously ill and end up in the hospital, you are 60 percent more likely to die than the sick child in the next room who has insurance,” lead investigator Fizan Abdullah, MD, PhD, a pediatric surgeon at the Johns Hopkins Children’s Center, wrote in the report’s conclusion.
This is the sort of thing that happened to children—routinely—under the health care status quo that candidate Mitt Romney defended:
Twelve-year-old Deamonte Driver died of a toothache Sunday. A routine, $80 tooth extraction might have saved him. If his mother had been insured…. By the time Deamonte’s own aching tooth got any attention, the bacteria from the abscess had spread to his brain, doctors said. After two operations and more than six weeks of hospital care, the Prince George’s County boy died.
Yes, if someone without insurance had a heart attack or was in a car accident, an ambulance would deliver that person to an emergency room, and the doctors in the ER would have to treat him. But he would still be billed—and he could still be bankrupted—for the treatment he received, and that includes a bill that can run into the thousands of dollars for the ambulance ride alone. But if someone who didn’t have health insurance needed a heart transplant, or had a chronic condition, or was a twelve-year-old boy with a fucking toothache, that person could not simply stroll into an emergency room and demand treatment—not until it was an actual emergency. Deamonte Driver couldn’t get a tooth pulled, because he didn’t have insurance. Only when his condition worsened to the point where he needed emergency care was he admitted to a hospital. But it was too late to save his life.
A few years ago an emergency room doctor—a friend of a friend—told me that she saw people every day who had diabetes but couldn’t afford their insulin. They didn’t show up in the emergency room until they were very, very sick, and many wound up losing limbs because they couldn’t afford medication or preventive treatment. An emergency amputation costing thousands of dollars and requiring an extended hospital stay? Yes, you could get that. But the insulin and regular checkups that would’ve kept you from losing that limb in the first place? No, you couldn’t get that.
This was the system—the pre-Obamacare system, approximately fifty million Americans uninsured, tens of thousands of men, women, and children dying every year for lack of access to care—that Romney was fighting to protect.
Justin Bieber said it best in a 2011 interview with Rolling Stone. Asked if he thought about becoming an American citizen, the Canadian-born pop star flatly refused, citing Canada’s system of socialized medicine as the chief reason. (A recent poll by the Association for Canadian Studies found that 94 percent of the Canadian citizens surveyed said their universal health care system was a source of collective pride.)
“You guys are evil,” Bieber said. “Canada’s the best country in the world. We go to the doctor and we don’t need to worry about paying him, but here, your whole life, you’re broke because of medical bills. My bodyguard’s baby was premature, and now he has to pay for it. In Canada, if your baby’s premature, he stays in the hospital as long as he needs to, and then you go home.”
But now that Barack Obama has been reelected, now that Obamacare is safe for at least the next four years, it’s time for liberals and progressives to come out of our defensive crouches and admit that Obamacare—as good as it is, as much of an improvement as it is—is still kinda evil. It’s the lesser evil, sure. But it’s still evil.
Obamacare is still health insurance. It’s not single-payer, it’s not socialized medicine. People can still lose their health insurance, or risk going without it, or wind up bankrupted even if they have health insurance, or wind up dead if they don’t. Fewer American children will die of toothaches, it’s true, but American children—unlike, say, Canadian children or German children—will still die of toothaches.
Obamacare—which is good, which is a start—isn’t universal health care. “Rather than simply providing health insurance to everyone by extending Medicare to cover the whole population,” Paul Krugman wrote of Obamacare after Obama was reelected, “we’ve constructed a Rube Goldberg device of regulations and subsidies that will cost more than single-payer and have many more cracks for people to fall through.”
Obamacare will leave millions of Americans uninsured. Some will be uninsured by choice—foolish choice—but millions of other Americans will be uninsured because they cannot afford to purchase health insurance even with subsidies. So even with Obamacare, we will still see flyers taped to windows in small-town diners announcing spaghetti feeds to raise money for an uninsured child’s medical bills. We will still get e-mails from those in need, like the one I got last month asking me to donate money to help pay for the medical expenses of an uninsured dancer who broke both her legs in a car accident.
And we will still be reading headlines like this one from the Associated Press: BARTENDERS RALLY TO HELP FAMOUS SEATTLE BARMAN. Murray Stenson, an internationally known and much-loved Seattle bartender, was diagnosed with a defective heart valve after blacking out and breaking his arm on his walk home from work one night in the fall of 2012. Like most in the restaurant industry, Stenson does not have health insurance. When word got out, fund-raising efforts began in earnest in bars all over Seattle, and as far away as Singapore and Australia, to raise money to pay for the heart surgery that Stenson needs to live.
“What’s amazing is that I don’t know half the people who have donated,” the sixty-three-year-old bartender told the Associated Press.
When these kinds of stories are reported—and they will continue to be reported under Obamacare—they are packaged as “feel-good” human-interest stories. Isn’t it wonderful how this man’s friends, and even perfect strangers, rallied to his side, from all over the world, to raise the money he needs for his heart surgery? After the mass shooting in Aurora, Colorado, we were supposed to be delighted when three of the four hospitals where the victims were rushed elected not to bill the uninsured victims for the care they received. (Don’t feel bad if you can’t remember exactly what shooting I’m talking about. There are so many, after all, that it’s easy to lose track. The Aurora, Colorado, mass shooting was the one at the late-night screening of the newest Batman film. That one.) Some of the victims, however, still face a long recovery ahead and the associated medical costs—all without health insurance. But, hey, a feel-good story: Three hospitals declined to bankrupt the Aurora shooting victims, and yes, that’s good news for the uninsured victims of the Aurora movie-theater shooting. Uninsured shooting victims who weren’t fortunate enough to get shot in a particular movie theater on a particular night are out of luck, however, as are the Aurora victims who had the misfortune of being rushed to the one hospital that did decide to bill—and likely bankrupt—the uninsured victims.
And it’s not like the insured are safe from bankruptcy.
The insured and uninsured alike will continue to go bankrupt even after Obamacare is fully enacted because
, even as good as Obamacare is (and it’s good; it’s better than what we had before!), it isn’t single-payer; it isn’t universal health care. It’s health insurance. And, yes, while some of the worst abuses of the health insurance industry have been banned, does anyone really think that the health insurance industry—where the practice of canceling the health insurance policies of the sick was so routine that it had a name (rescission)—isn’t capable of coming up with brand-new abuses?
The story of the Colorado shooting victims, the story of the Seattle bartender, stories about spaghetti feeds for sick children—these are not feel-good stories. They are feel-bad stories. Or, more to the point, they are we-ought-to-be-ashamed-of-ourselves stories.
A single-payer system means not having to worry about medical bills, or going bankrupt, or losing your home, if you or your child should get sick or injured, or if your baby is born prematurely. And, again, it’s not just the uninsured who are one tumor or broken bone from financial ruin. According to a 2009 Harvard University study, roughly nine hundred thousand Americans go bankrupt each year due to medical bills. “Unless you’re a Warren Buffett or Bill Gates, you’re one illness away from financial ruin in this country,” said Steffie Woolhandler, MD, lead author of the report. “If an illness is long enough and expensive enough, private insurance offers very little protection against medical bankruptcy, and that’s the major finding in our study.” [Emphasis added.]
Woolhandler noted that of the 2,314 bankruptcies they investigated, three-quarters of those who had medically related bankruptcies had health insurance.
“That was actually the predominant problem in patients in our study—78 percent of them had health insurance, but many of them were bankrupted anyway because there were gaps in their coverage like co-payments and deductibles and uncovered services,” Woolhandler noted. “Other people had private insurance but got so sick that they lost their job and lost their insurance.”
Obamacare is good. It’s better than what we had. But it’s not universal care. Even after Obamacare is fully implemented, millions of Americans will fall through the cracks. Millions will remain uninsured; millions with insurance will still be ruined; millions will find themselves without insurance—by choice or by circumstance—at the precise moment they need it most, and the larcenous and immoral insurance companies will still come up with new abuses.
Our health care system is less evil than it used to be.
But it’s still evil.
And speaking of evil…
During one of the 2012 GOP nomination debates, the candidates were asked to share a story about an event that shaped their religious convictions. Rick Santorum spoke about his youngest child, Bella, and Newt Gingrich spoke about the child of a friend. The lives of both of these children were saved after extraordinary medical interventions: weeks in neonatal ICUs, round-the-clock care, heart transplants, multiple brain surgeries. Both of these children were expected to die at birth and both survived. In Santorum’s case, doctors had all but declared his newborn daughter dead; the doctors, according to Santorum, coldly advised him and his wife to “accept the inevitable” death of their newborn daughter. (No one ever got the doctors’ side of the story.) But both children deserved a chance at life, and by God, Rick Santorum and Newt Gingrich made sure they got their chance—even if it meant defying their doctors and the odds. Santorum and Gingrich pledged that, should either be elected president, no child would ever be denied a chance at life because every single life is precious.
Anyone who hadn’t been paying attention during the fight over the Affordable Care Act, which was signed into law six months before this particular debate, would have come away with the impression that Rick Santorum and Newt Gingrich supported the PPACA and that Barack Obama opposed it. Hell, if all you had to go on was what both men said during this debate, you might’ve gotten the impression that the Obama administration had issued new regulations requiring hospitals to pull sick infants out of incubators and toss them out windows.
But both Rick Santorum and Newt Gingrich opposed Obamacare. And both men, in the very next breath, at the very same debate, pledged to repeal Obamacare if they were elected. (Every Republican at every debate pledged to repeal Obamacare.) Gingrich and Santorum are both Roman Catholics who say they oppose abortion, access to contraception, and gay marriage because their faith demands it. Yet both men oppose the Affordable Care Act despite Pope Benedict’s rather unambiguous statement about health care: Governments have a “moral responsibility” to “guarantee access to health care for all of their citizens, regardless of social and economic status or their ability to pay.” And both men would regard the creation of a single-payer health care system—like the one Justin Bieber enjoys—as an unacceptable socialist assault on freedom. Because letting other people’s children die of toothaches while his own enjoy access to every available medical treatment is a price that Rick Santorum is willing to pay for freedom.
A little more credit for Pope Benedict: He doesn’t just talk the talk when it comes to states guaranteeing access to health care for all citizens. He walks the walk. The pope is a head of state, and the state that Benedict heads provides universal, single-payer health care for all its citizens. (Vatican City’s health plan doesn’t mandate birth control coverage—one controversial aspect of Obamacare—but altar boys don’t get pregnant).
Santorum is planning a second run for president in 2016. Maybe we should ask the pope to moderate one of the GOP debates. Because I’d like to see Rick Santorum tell the pope that the Vatican’s single-payer health care system is socialism and that it oppresses people of faith. It would make for great television.
Anyway, what was I talking about again? Oh, right—Peter LaBarbera and conservative Christian opposition to Obamacare. (Kind of lost track of Peter. Sorry about that. It’s just that, well, you know what else happened on election night 2012? Washington State legalized marijuana for recreational use. Just sayin’.) Shortly before the 2012 presidential election—while Mitt Romney was running around the country promising to repeal Obamacare—LaBarbera sent this tweet to his followers:
Jimmy John’s is a chain of sandwich shops owned by Jimmy John Liautaud, a Republican businessman who enjoys going on safari and shooting endangered animals. (Pictures of Liautaud posing with a dead elephant and a dead cheetah—and the gun he used to kill both—were posted online in 2010.) Like a lot of wealthy business owners, Liautaud, a major donor to Mitt Romney’s presidential campaign, issued threats in the run up to the 2012 election. While some right-wing businessmen threatened to lay off employees if Barack Obama was reelected, and others threatened to cut their employees’ wages, Liautaud wasn’t in a good position to threaten his employees. He doesn’t pay his workers much more than minimum wage, so he can’t cut their wages; and those sandwiches aren’t going to make themselves, so he couldn’t threaten layoffs. In addition, Liautaud and his franchisees don’t provide health insurance to the men and women who make his sandwiches—the men and women at corporate HQ are a different story—so he couldn’t threaten his employees with health benefit cuts. So Liautaud threatened his customers instead: If Obama was reelected—if Obamacare wasn’t repealed—the price of a Jimmy John’s sandwich would probably go up.3
Okay, we have to get into the weeds here for a moment: Under the Affordable Care Act, a business (with fifty employees or more) that doesn’t provide health insurance coverage for a full-time employee will have to pay a 2,000-dollar fine per employee to the federal government. Rather than pay that fine, Liautaud threatened to cut all of his employees down to part-time.
“Yes, we have to do that,” Liautaud said on Fox News in October of 2012. “There’s no other way we can survive it, because we think it will cost us 50 cents a sandwich. That’s just the actual cost.”
Faced with a choice between cutting his employees’ hours—cutting the hours of people who are already struggling to get by on minimum-wage jobs—or charging fifty cents more per sandwich and providing his employees
with health insurance, Jimmy John’s is going to cut the hours of all of his employees. The meanness, the pettiness, is staggering.
Liautaud isn’t the only founder of a fast-food chain to sound alarm bells about Obamacare driving up the cost of fast food. In August of 2012, John Schnatter, the founder and CEO of Papa John’s Pizza, warned his customers that Obamacare, when fully implemented, would raise the price of a Papa John’s pizza by upward of fourteen cents.4
Jon Stewart took John Schnatter and other fast-food CEOs to task in a postelection installment of The Daily Show after Schnatter threatened to cut the hours of his employees to avoid having to pay for their health care (costs he could’ve covered, again, by raising the price of his pizzas by fourteen cents): “Not that you guys don’t have a legitimate gripe against this president. If Obama had fought harder for single-payer health care, business owners like you would never have to pay another premium in your lives. You could stuff your pizza crusts with money and still sell them for ten dollars.”
Grumbling from right-wing Republican business owners I can understand. They are simply wealthy businessmen who want to keep their taxes low, and defending our broken employer-provided health insurance system is one way to do it. (Proof that our employer-provided health insurance model is really and truly broken? As noted, neither Liautaud nor Schnatter, brave defenders of the employer-provided health insurance model, actually provides health insurance to their employees. After all, safaris are expensive, to say nothing of having the elephant you shot in Africa stuffed, mounted, and shipped back to your home in Illinois. How can poor Mr. Liautaud afford these small pleasures if he has to extend health care coverage to the freeloading 47 percent who make his sandwiches?)