Occam's Razor

Sometimes you want to cheer and shake your fist at the same time. That was my reaction to this Washington Post article that curiously arrived on my birthday, Saturday, when I turned 57:

Nine days into the new year, the 41-year-old call-center worker headed to the health clinic on Highway 15. She saw a doctor about her chronic stomach ulcers, had her blood drawn for tests and collected referrals for all the specialists she had been told she needed but could never afford.

Health insurance finally came last month to Breathitt County, Kentucky and a lady named Mary Combs. Previously, like many of the people in this part of Appalachia, she saw a doctor irregularly if ever. She could not afford health insurance or even to see a doctor most of the time. She could occasionally afford to see a doctor at the local clinic, which at least had a sliding scale of payment based on her meager income. But even twenty dollars came hard to her and many of those who form the working poor of this country. Seeing specialists was simply out of the question. She was uninsured and in the eyes of many, principally Republicans, she did not deserve health insurance. Let them be miserable. C’est la vie.

Of course because she was working, albeit at starvation wages, she made too “much” money to qualify for Medicaid. At least that was the case until the Affordable Care Act finally caught up with her, which made it possible for her to enroll in Kentucky’s version of Medicaid, thanks to a healthy subsidy from the federal government. Mary Combs, like many of the people documented in this article, finally could do something to heal herself. Finally, at last, government gave a damn.

So many people like Mary Combs live in a world of hurt, always a paycheck or less away from losing all they have, and rarely with enough cash to see a doctor, even one with a sliding payment fee. Life for them is mostly suffering, something that is largely endured. Sometimes it ends abruptly and prematurely with a stroke, but often it means slow declines and frequent hospitalization for bills they cannot pay, but which simply adds to their indebtedness and drive overall health care costs higher. Often they come home from the hospital without a job. It left them when they couldn’t show up for their shift for a week. The hurdles just to stay alive simply grow higher every day for people like Mary Combs.

However, now she can afford to see a doctor, and specialists, and maybe start treating one of her many medical conditions. She can do so without going bankrupt, and by avoiding the hospital perhaps without losing her job as well. She had a chance not just to live, but to get better and maybe eke out some modest enjoyment from life again. It’s still a very long road and with her chronic conditions the odds are still against her. But she is getting some relief: psychological as well as medical.

Elsewhere in the article:

“Yeah, sometimes his face will get real red like he’s going to blow up?” Terri said. “Then he gets sick.”

“Okay,” Freeman said, pressing a stethoscope to his chest. “Big breaths.”

“Sometimes my heart hurts,” her new patient said as she listened to his stomach. “All I know is when you get 30, you start falling apart.”

No, at fifty you start falling apart. You don’t start falling apart at thirty unless you simply cannot afford to get treated and your job and environment stress you like a professional football player. At thirty you should be able to go three years without a physical. You should not have crushed discs in your back, suffer from sleep apnea and have already filed for bankruptcy. But if you live in Appalachia like John Wagers profiled in the article, and repair heaters for a living and never had health insurance before, then maybe you do fall apart at age thirty. This is what happened to our ancestors a few centuries back when medicine was more black art than science and most people never escaped a poverty they were born into.

Having affordable health insurance is something I have taken for granted. I can spend most of my life out of pain. I can enjoy most days. I can look forward (I hope) to an active and happy retirement. Now perhaps can the John Wagers and Mary Combs of the country too. Maybe as their health improves they will be able to compete for better paying jobs, because they are healthier and can be productive but also maybe because the minimum wage is raised, as us Democrats want to do. Maybe they will be able to attend a community college when they are healthy and have a few more dollars in their pockets. Just maybe they will get a real chance at the American dream, which needlessly denied them by tactics like only allowing those who can afford it to see a doctor.

The Affordable Care Act is hardly perfect, but it is a start. It warms my heart that in our fractured way we are finally moving people like John Wagers and Mary Combs out of misery and into health. They are being treated like human beings now instead of someone in a lower caste. It’s why elections matter and it’s why I am a Democrat and progressive.