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December 20, 2014

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Where I Stand:

The real effect of the election

Health care is an important issue this campaign season, and it goes beyond the rhetoric in the debate; it has real-life consequences. Unfortunately, the human cost is many times brushed aside, and people without insurance or in poor health too often have been vilified for their choices. Nicholas Kristof of The New York Times wrote a compelling column about what happened to a friend of his. The column took a full page in Tuesday’s Sun; if you haven’t read it, I would encourage you to do so. It’s a heartfelt story about how his friend made a few bad decisions and was without insurance when he was diagnosed with advanced prostate cancer. Here’s Kristof’s follow-up column, which is also a must-read. If nothing else comes out of this, we would all do well to reconsider the health care debate in light of the human cost many people pay. — Brian Greenspun

Nicholas Kristof

I wrote in my last column about my uninsured college roommate, Scott Androes, and his battle with Stage 4 prostate cancer — and a dysfunctional American health care system. I was taken aback by how many readers were savagely unsympathetic.

“Your friend made a foolish choice, and actions have consequences,” one reader said in a Twitter message.

As my column noted, Scott had a midlife crisis and left his job in the pension industry to read books and play poker, surviving on part-time work (last year, he earned $13,000). To save money, he skipped health insurance.

A year ago, he encountered difficulties urinating and didn’t see a doctor in part because of the cost. By the time the prostate cancer was detected, it had spread to his bones.

“I blew it,” Scott told me several times.

He repeatedly acknowledged that he should have bought insurance and should have seen a doctor as soon as his symptoms appeared.

Scott showed immense courage in telling his story. He worried that his legacy would be an unflattering article spotlighting his foolishness, yet he went ahead for two reasons. First, he said that readers might learn from his mistakes and call a doctor about that suspicious lump or mole. (If that’s you, do it now!) Second, he said he hoped that his story would help readers see the need for universal health care so that others wouldn’t suffer as he has.

That’s in part what this election is about. If President Barack Obama is re-elected, Obama-care will stay in place and health insurance will become close to universal in 2014. In contrast, Mitt Romney has promised if elected to work to repeal Obamacare — and any American who made a bad health care decision would continue to suffer.

To many of my readers, that’s fine.

“Not sure why I’m to feel guilty about your friend’s problem,” Terry from Oregon wrote on my blog. “I take care of myself and mine, and I am not responsible for anyone else.”

Bruce wrote that many people in hospitals are there because of their own poor choices: “Smoking, obesity, drugs, alcohol, noncompliance with medical advice. Extreme age and debility, patients so sick, old, demented, weak that if families had to pay one-tenth the cost of keeping the poor souls alive, they would instantly see that it was money wasted.”

That harsh view is gaining ground, particularly on the right. Pew Research Center polling has found that the proportion of Republicans who agree that “it is the responsibility of the government to take care of people who can’t take care of themselves” has slipped from 58 percent in 2007 to just 40 percent today.

Let me offer two counterarguments.

First, a civilized society compensates for the human propensity to screw up. That’s why we have single-payer firefighters and police officers. That’s why we require seat belts. When someone who has been speeding gets in a car accident, the 911 operator doesn’t sneer, “You were irresponsible, so figure out your own way to the hospital,” and hang up.

To err is human, but so is to forgive. Living in a community means being interconnected in myriad ways — including by empathy. To feel undiminished by the deaths of those around us isn’t heroic Ayn Rand individualism. It’s sociopathic. Compassion isn’t a sign of weakness but of civilization.

My second argument is that if you object to Obamacare because you don’t want to pay Scott’s medical bills, you’re a sucker. You’re already paying those bills. Because Scott wasn’t insured and didn’t get basic preventive care, he accumulated $550,000 in bills at Seattle’s Swedish Medical Center, which treated him as a charity case. We’re all paying for that.

Scott and I spoke Sunday morning about whether his story might move some critics of health care reform. He was weakening and mused that he probably didn’t have long. A few hours later, Scott slipped into a coma. He died Monday morning.

We can’t be certain that the cancer would have been found earlier, when it was more treatable, if Scott had been insured. But it’s a reasonable bet. Researchers have estimated that one American dies every 20 minutes for lack of health insurance.

In other countries, I’ve covered massacres, wars, famines and genocides, and they’re heart-rending because they’re so unnecessary and arbitrary. Those massacred in the Darfur genocide in Sudan might be alive if they had been born in Britain.

That’s how I feel about Scott. His death was also unnecessary and might not have occurred if he had lived in Britain or Canada or any other modern country where universal health care is standard and life expectancy is longer.

So Scott, old pal, rest in peace. Let’s pray that this presidential election will be a milestone in bringing to an end this squandering of American lives, including your own.

Nicholas Kristof writes for The New York Times.

Brian Greenspun is publisher and editor of the Las Vegas Sun.

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  1. Mr. Greenspan and Mr. Kristof, as I said before when the personal story of Scott Androes appeared, no medical community and health care guarantees can improve/save the life of a persons who forever reasons choose to forgoe both until death is near.

    CarmineD

  2. This is where logic escapes the conservatives. They choose not to think deep enough because they hang on to their ideology regardless of reasons:

    Would you rather pay for the $550,000 bill (and millions others)? Or would you support a health reform law that requires EVERYONE to have medical insurance.

    It is that simple. Conservatives preach about taking personal responsibility for oneself, which is the essence of the law, yet they do not support this? Go figure.

    A sign that society has evolved is measured by how its members treat the underprivileged.

  3. My thought is this...we don't need Obama care, we only need the mandate. Scott made $130,000 but was not responsible enough to buy insurance. Just require everyone to buy insurance. Problem solved, without the 3,000 pages.

  4. Right Mr. Henry. With all the 'smart' comments we all make in this forum, I wonder why they are not tapping us to run this country. Go figure! That just show they don't know nutin' huh?

  5. So much of the arguments about health care in the US is based on emotional ties to victims or the blind following of a particular train of thought. As a medical professional for about 40 years, let me give you all a few facts about our "business".
    First of all, the system was never, ever broken. That's so much pap from special interest groups.

    Years ago, anyone needing care either came into a doctor's office or went to the ER. Because of so much LESS paperwork, expenses, malpractice insurance premiums, and regulations, we all took car of many people who had no insurance or could not afford the regular fees for service. That ended with the government imposing gabage rules on all of us, over regulating us, and deciding how much to re-imburse us for these services.

    Secondly, while the concept of providing for the disadvantaged and idiotic is "noble" in nature, when you have tens of millions in that position, it becomes unsustainable for any country. When I started in family practice, I could see 20 patients a day and make a decent living. At the end, I was seeing about 45-50 a day and barely breaking even. The enormous costs involved in keeping up with all the garbage regulations from Uncle Sam is pushing out many of us in the profession.

    Third, there is a huge difference in helping those who make a mistake, such as the first unplanned pregnancy, or one who goes under because he tried to start his own business and failed, and the hopelessly stupid who do things that are known destroyers of health and life - smoking, drinking to excess, obesity from lifestyle (not genetics or a medical problem), dangerous hobbies or sports, etc. The first group I would always help. The second group not so much. As an adult, these is a point where you DO have to take responsibility for your actions, and to believe that others are responsible for your stupidity again and again, is nerve beyond belief.

    Finally, the argument about the uninsured and "we all pay for it anyway" is a silly one. With real universal health insurance, who do think pays for it? Right - the taxpayers. If the government forces less payments back to insurers or makes them insure everyone, what do you think they will do? Right again - raise rates for everyone. Insurance companies are businesses that need to make a profit to stay in business. As a final note. Dumping 30 million more people into health care, many of whom need care on an ongoing basis, will overwhelm the entire system. Who do you think will be there to provide such services? Not the overworked medical professionals - doctor's offices or ER's. That I can assure you. You will all wind up like socialized medicine countries where you will wait weeks to months to see a doctor. Then you'll whine about that.

  6. HOw about the human costs of those who do actually PAY for the health care/insurance of others? It is not only and just the wealthy who pay more--the family with few health problems who see their insurance go up 2500 or 5000 per year more because of Obamacare PAY as well. The get to retire later and live on less, go on fewer vactions (well-earned), have to borrow more to go to college, and pay more for everything else. What about them??
    You see if you make a bad choice and EXPECT to be able to FORCE strangers to take care of you--what does that make them? What does that make you?

    Yes, we SHOULD all get together and help our neighbor BUT should we be FORCED to help someone?

    If my neighbor needs a couple of bucks I have helped out, but what if they need a new liver because they drank themselves silly every night--should they expect me to go under the knife to give them some of mine??? How about YOU???? What if the secertary of health rules that you HAVE to give up part of your liver or a kidney for someone on the other side of the country, are you really no more than a piece of meat that can be used at the whim of those with the power? But you say taht it is YOUR body and that YOU have control over it? Really? How did you earn that money--was it not by using your muscles to move machinery or your mind to move an idea. Did not you earn your money with the use of your body? If you do not own the product of your mind and body, then I submit that you do not own your body!!!!!!!!!!!!!!

    I feel badly for my sister who died about a year ago of lung cancer she was a smoker from age 13. I would have done almost anything to keep her alive--operations, bone marrow transplants, money, and what not. But should I have been able to FORCE YOU to do all of that for my sister?? Should you have been compelled to under go an operation to save HER life. I do not think so. I beleive that everyone is so emotionally attached to those who need help they do not see that they are forcing sacrafices on those they do not own.
    We have gone from asking for help to demanding help. To quote someone who taught me better:
    It is not what you give, but what you share, for the gift without the giver's bare
    He that gives alms feeds three; himself, his hungry neighbor and ME.
    We should also judge a society by how much force it is willing to use against unarmed, peaceful civilians to obtain that which it wants. The initiation of the use of force, whether by a person or a government, is WRONG!