Commentary: Health insurance and the savage doctrine of personal responsibility

The Kansas City StarOctober 24, 2012 

SHELLY BARBARA KC

Barbara Shelly is a columnist for the Kansas City Star.

MBR — Kansas City Star/MCT

It seems like poor form to spit on the graves of dead people, but such are the passions inspired by our health care debate.

Last week I wrote that, contrary to what Mitt Romney has said in his campaign, Americans do die for lack of health insurance. Every day, in fact.

Oh, the fury. Emails and telephone calls ranged from the generic “you are an idiot” to a reader’s account about a woman who died of leukemia after passing up COBRA insurance because she didn’t want to pay $400 a month.

“You may report that she died because of lack of insurance,” my correspondent wrote. “I believe she might have died anyway, but if it’s anyone’s fault it was her own for failing to exercise personal responsibility.”

The deceased was her sister.

A strain running deep in the American psyche will always want to shrug off the burden of a social compact in favor of the personal responsibility argument. I’m all for personal responsibility myself, but, honestly, we’re talking about people’s lives here.

New York Times columnist Nicholas Kristof wrote this week about a former college roommate who had opted to go without health insurance and doctor’s visits and was seriously ill with advanced prostate cancer.

“In other modern countries, Scott would have been insured, and his cancer would have been much more likely to be detected in time for effective treatment,” Kristof noted.

I figured he’d hear it from the personal responsibility crowd, and indeed he did.

“I was taken aback by how many readers were savagely unsympathetic,” Kristof wrote in a column published on line on Thursday.

Typical was this response: “Not sure why I’m to feel guilty about your friend’s problem. I take care of myself and mine, and I am not responsible for anyone else.”

Kristof’s former roommate, Scott Androes, died this week. He was 52.

There is a distinction between poor choices and calculated risks. Driving drunk is a poor choice. Forgoing a prohibitively expensive insurance policy if you’re a reasonably healthy person is a calculated risk.

But not everyone has a choice. People in low-wage jobs without benefits, or those who are out of work for long periods, often flat out cannot afford to pay for insurance and keep a roof over their heads.

In any case, sick people at some point have to receive care. And we all pay for that through government expenses and higher health care costs.

Last weekend, a musician named Amanda Palmer read Kristof’s piece and fired off a few tweets about her own experiences, which included the death of an uninsured step-brother. Her Twitter feed “exploded,” as she said, with people telling their stories.

Palmer set up an informal poll on Twitter, which users of that social media site can check out at #Insurance Poll. There, and on a related blog, people from around the globe are still sharing stories.

Like this one: “Almost nine years ago I started treatment for cancer. I had insurance and I still have over $50,000 of medical debt because treatments to save my life were not covered. I’m now uninsured with two pre-existing conditions and cannot get insurance. I live every day with the fear that if the cancer returns I will likely die with lack of proper care.”

And this: “Friend’s dad in Texas had a stroke. He worked all his life, owned his own home, had insurance. But the stroke was severe, insurance money ran out. His house will have to be sold. If he ever recovers enough to go home, he won’t have a home to go to.”

The Affordable Care Act provides a way to get nearly all of Americans insured. President Barack Obama will see that the law goes into effect. Challenger Mitt Romney says he’ll repeal it.

Part of what is at stake on Nov. 6 is a question of character. Are we a nation that derides people for being too irresponsible, or too poor, to purchase health insurance? Or do we support solutions, however imperfect, and pull together to make them work?

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