Covering the uninsured and the costs to society

by Lucas Restrepo, MD

Recently, the fire department of a small town in Tennessee called South Fulton ignored the call of a man who needed help quelling a fire near his house.

The firefighters declined lending a hand because the caller neglected to pay a $75 bill, the prerequisite for deserving assistance. The caller tried to put down the fire with a garden hose, but after two hours, his house caught on fire. When the property of a neighbor who had paid the $75 became threatened by the flames, the gallant firemen promptly answered the call of duty. The brave public servants prevented the flames from spreading to the property of their responsible contributor, carefully avoiding to suppress the conflagration’s source. Someone has to teach a lesson to the free-loaders in our society, explains a high-minded commentator.

Our health care system works exactly like South Fulton’s worthy fire department: we are entitled to health care only if we have money or qualify for Medicare or Medicaid. If you don’t have money, your health entirely depends on the charity of health care providers, who, as our admirable firefighters, may refuse to help.

I wish to argue that, besides being cruel and inhumane, the “South Fulton health care model” is a latent threat to society. The cost and effort of preventive medicine and basic primary care (fire prevention, putting down a small fire) is less than dealing with instances of end-organ failure (a house in flames). Moreover, having uninsured people (not aiming water to the fire source) creates a constant economic liability to responsible costumers (the neighborhood). On the other hand, why should someone become a doctor, nurse, or health insurance company founder (a firefighter) without being an altruist? Do firefighters dream of wealth and leisure?

The costs of not doing anything about a burning house are always paid in full by society ― and some costs are not immediately apparent. Who loves the sight and smell of a charred landscape? Where will the man live now that he has no house? Will he react violently to the inaction of the firemen? Will the reputation of the fire department (and the city’s) go up in smoke?

A single dispossessed is a liability to an entire society.

The Patient Protection and Affordable Care Act (PPACA) aims at controlling the “fire hazard” of the uninsured. But PPACA is being sued on behalf of a crowd of demagogues. They argue that, while Congress can regulate commercial activity, it “can’t regulate inactivity.” The pompous frivolity of such musings is not particularly persuasive. In fact, the inaction of someone who doesn’t purchase insurance generates a flurry of commercial activity elsewhere: health care companies losing money on the uninsured increase costs to their “active” costumers to make up for the loss. It’s like setting houses on fire, while asking firefighters to contain the flames without aiming their hoses to the fire source.

From a biological standpoint, if you’re “merely alive,” you are “active.” Cells proliferate beyond the reach of our volition, sustain physiological stress, micro-injury and repair; infections ensue and are fought off, while passers-by are in turn infected; some engage in unhealthy behaviors, many unbeknownst to themselves or their neighbors; heredity works its way silently toward phenotypes; furtive cells become antisocial; people grow old and forget. In other words, we are getting sick regardless of our economic activity or inactivity.

Folks suing PPACA ail from the worst kind of irresponsibility: that exhibited by those who lack solutions.

Good health is requisite for life, liberty and the pursuit of happiness. This is true for individuals, but also for societies, which are successful if their members are healthy and fair-minded.

PPACA tells us that we all have to pay the $75, but also that firefighters can’t just sit and play the lyre while our neighbor’s house burns.

Lucas Restrepo is a neurologist who blogs at Progress Notes.

Submit a guest post and be heard.

View 15 Comments >