A few months ago I noticed some sores on my scalp. A family member urged me to see a dermatologist at once. “Could be nothing,” he said, “but I had a small tumor removed once.”
I didn’t tell him, “I can’t afford a dermatologist, and I don’t have insurance.”
That wouldn’t be perfectly accurate. I could afford a dermatology visit. An average out-of-pocket visit in my area is around $130. If I drink the cheap blended whiskey for a couple of months and skip the shiatsu massage, that’d be fine.
But a biopsy or lab-work would add between $150 and $1000 to the tab, depending on factors I have no way of guessing. At the low end, I could manage it. But much more than that…? No.
Then, presuming they find something that needs treatment, there’s that to add, and that can be anything from a trip to the pharmacy to surgery, and surgery or out-patient therapy is just right out of the affordability picture, unless I skip the teak trim on the yacht.
“Thank you for choosing our practice! We are committed to the success of your medical treatment and care. Please understand that payment of your bill is part of this treatment and care.”
— Financial Policy intake form of a local dermatologist.
It would have seemed rude to just say “I can’t afford basic healthcare” to my family member. He’s well-off enough that his insurance covers most things and his savings will cover anything else, and he doesn’t really understand what it’s like to get to the end of the month and to have everything in your checking account absorbed by a need for a new tire. I do not inhabit a world where “savings” last long enough to be worth a separate account: last time I had chest-pains, I spent four years paying off the diagnosis and therapy.
That’s not the world he lives in, and it’d turn the conversation uncomfortably political to say, “And I can’t afford insurance, either, because in the United States, decent healthcare is a luxury item whereas in the rest of the civilized world it’s considered a human right.”
That is, however, the truth.
I don’t mean to make my life sound miserable or squalid: it’s not. I’ve got most of what I need, and my life’s full of joy and laughter and light and love, mostly thanks to my wife, with special assists from my dog and cats, and the people in our music program at church.
But I’m not conspicuous for disposable income. Don’t be fooled by my political stature, good looks, and enormous cultural influence.
This isn’t a poor-me post. I’m not too badly off. I’ll see a dermatologist, of course, and make whatever inroads I can towards a long life. I’ll refuse a biopsy I can’t afford, or lab-work that will require extensive credit checks. The doctor and I will do that awkward dance usually reserved for car-salesmen after they’ve delivered the pitch and you start to explain you can’t afford the thing. They’re partly thinking, “What have we been doing this for if we’re not going to close the deal?”
With doctors, I always think the subtext there is, “But you need this. You could die.” Okay, then give it to me at a price I can afford or you’re complicit in my death, aren’t you.
Can’t do that. Market forces and all that.
My story isn’t the worst tale you’ll hear of healthcare in the U.S. But it’s not unusual and it’s a reminder of how upside down we’ve become when we profit off the desire of people to live, and we call that legitimate, even sacred, capitalism. Can’t touch the free market.
I’m basically a capitalist. I think that self-interest drives innovation far better than government does. And markets manage themselves a lot better than presidents do. A lot of the miraculous things we can do in a clinic are the result of profit-motive.
But much more than a capitalist, I’m a humanist, in the sense that I believe the desires that make us human are often far greater and more important than our economic potential. Long before I develop value in some economic sense, I’ve got a right, or at least a drive, to continue to exist, to connect to people, to love, to make beautiful things.
In other words, the statement “I desire not to die of preventable diseases” seems to me different than the statements “I would like to drive a manual-transmission Mustang,” or “I would like a softer toilet-paper experience.” One of those statements is a basic human need, the other two are preferences that depend on the first being fulfilled. (Make the joke of your choice about which is which in this space: ____________. Ha. Good one.)
Whatever I’ve got on my scalp (and for all I know, it’s sunburn where my hair used to be) can no doubt be easily identified and cured, or at least managed. I’ve got several friends that deal with skin-cancers that yielded to early detection and treatment, if it’s a worst-case scenario.
But it’s not cheap in America. It’s economically possible, no doubt, because free market capitalism created huge incentives to develop therapies and techniques for detection and management of those diseases. But it keeps people, especially the poor, on the string, reduces freedom and quality of life, and increases dependency on those who are already well-off.
Talk about a devil’s bargain: “Make it worth our while, and we’ll keep you from dying.”
Fair enough.
But if that’s where you stand, as a nation, as a movement, as a political perspective, you can stow the term “pro-life.”
David Wilcox.