By John D. Stobo
Call her Mary. I met her in her hospital room recently when I joined a group of physicians and medical students on regular hospital rounds. She is forty-three, married with two children, and works on Galveston Island in a small restaurant. Not long ago she was admitted to one of our hospitals through the emergency room complaining of a desperate shortness of breath that had begun nine months earlier and gradually worsened. I asked her to tell us about what she’d done when her trouble breathing first began.
She said she’d gone to see her physician, who ordered an X-ray of her lungs. But she didn’t get the X-ray done because she didn’t have health insurance. Her employer, a small business owner, didn’t provide it, and she could afford neither private insurance nor the cost of the X-ray. I asked whether she ever went back to her physician. She said she hadn’t because she couldn’t afford to pay for a second visit to the doctor.
Mary has lung cancer. In the nine months since she saw the doctor, it has spread aggressively and now amounts to a death sentence. Today the only medical help we can offer is aimed at alleviating her symptoms, not curing her disease, which went untreated for too long. Had she had the X-ray and been diagnosed nine months ago, it’s possible we could have done more for her.
Ours is the only developed country in the world that doesn’t provide some form of health insurance to all of its citizens. More than forty-three million people in the United States lack health insurance, many of them people like Mary who work in low-paying jobs trying to make ends meet. While Mary’s case illustrates the individual human tragedy concealed by these appalling numbers, compounding the shame is the fact that we could avert many such heartbreaking occurrences in the future for about what we’re willing to pay for prescription drugs for those on Medicare.
The number of those without health insurance roughly equals the forty-one million Americans who receive health insurance under the federally funded Medicare program. Recently, Congress passed, and the President signed, a Medicare prescription drug bill that provides to all Medicare beneficiaries pharmacy benefits the White House now estimates will cost $534 billion over the next ten years, or more than $50 billion a year.
One study by respected analysts Jack Handley and John Holahan estimates that providing basic health insurance for all the uninsured in this country would cost the nation an additional $69 billion a year if the insurance were typical of the sort now held by middle- and low-income Americans. The same study pegged the figure at just $34 billion if the uninsured were integrated into public insurance programs such as Medicaid and the State Children’s Health Insurance Program that pay providers much lower fees. In other words, for close to the same amount of money we will be spending to provide pharmacy benefits to Medicare recipients, we could provide health insurance to the forty-three million uninsured so they would not be denied the health care they need and deserve.
While one may argue about the wisdom of this particular prescription drug bill, helping our Medicare recipients pay for prescription drugs is a worthy goal. But what about those with no insurance at all? Don’t they deserve at least the same consideration? Can’t we now apply our political will and social resolve to creating affordable health insurance for all Americans?
If we can afford to help pay for drugs for all those on Medicare, we surely should be willing to identify resources to make sure everyone in our society has basic health care. Until we do that, uncounted and largely unseen human tragedies like Mary’s will continue to play out every day in hospital rooms and clinics across the nation.
John D. Stobo, M.D., is president of the University of Texas Medical Branch at Galveston. This essay first appeared in the Houston Chronicle on May 10, 2004.