I just read a very touching Nicholas Kristof article in the New York Times about a really nice guy in Seattle who may be dying of prostate cancer and doesn't have insurance. The story almost suggests that this guy may be dying of prostate cancer because he didn't have insurance, the assumption being that maybe he'd have gone to the doctor regularly and been diagnosed sooner if he had insurance.
The subject of the story sounds like the kind of guy I would truly like. The author's description of him makes him sound like just the sort of guy I'd have wanted for a college roommate. (He told his uptight Harvard school-mates that he kept a deer rifle under his bed!) So, it's very hard for me to not feel sorry for him. I don't want him to die. I really don't wish death or cancer on anyone. But, this guy I like. His friend, the author of the article, also sounds like a great guy. I'd probably like him, too.
But, as likeable as these guys are and as tragic as the story is, I'm having a little trouble getting over this one little thing: The guy pretty much did this to himself.
He admits this. He didn't go to the doctor regularly and he decided to play the odds and not buy health insurance on his own. I commend him for owning his decision. But, for me, it goes beyond that. The article quotes the dying man directly:
It all started in December 2003 when I quit my job as a pension consultant in a fit of midlife crisis. For the next year I did little besides read books I’d always wanted to read and play poker in the local card rooms.
He quit his job? I don't blame him for opting not to buy medical insurance as an individual. The price is ridiculous. I know. I've done it for short periods of time. But, the reason he had no insurance is ultimately because he quit his job - a job which presumably made insurance available and at least arguably affordable for him.
I have a problem with that. It keeps me from being completely empathetic towards this guy, and here's why.
I don't particularly love my job. I could do other things that I like much better. In fact, if I didn't have a significant chunk of change coming out of my check every payday for health care (medical insurance, dental insurance, and a flexible spending account to cover copays and deductibles and miscellaneous expenses), I could take a noticeable pay cut and still come out even. I'd love to take a year or two off and play guitar and maybe finish painting my house.
But, one of the primary reasons I get up every morning and go to work at a job I don't hate but hardly love is because, at my age ... barely younger than the guy in the story, I don't dare let my health insurance lapse. I make enough to pay bills and spend a little money, but probably the number one reason I hold a job is because I want to make damn sure I have health insurance in case I wake up one morning and discover that my own ever-growing prostate has gone cancerous on me. (Never mind that I have a wife and kids depending on me for medical care, something the subject of the other article didn't have to worry about.)
[Male millenial friends take note: your prostate, like your ears and nose, never stops growing. It's a design flaw but not one that's likely to generate a recall notice. One day you'll notice that it has taken a little time and effort to start peeing. Then you'll notice that even after you think you're done peeing you maybe aren't quite. Lesson: when you turn 40-ish, start having your doctor keep an eye on your prostate. Unlike a testicle exam, you couldn't really do this one yourself even if you wanted to. And, though you may be happy to help her out with at-home breast exams, I really wouldn't ask your girlfriend to do this for you, either. But, back to the story.]
I'd have to say that I resent this guy just up and quitting his job. Fair enough, he probably had money put away to feed himself, so it's not like he was asking us to provide him with free food simply because he chose not to work for a year or so. Hey, if you can afford to hang out reading books and playing poker for a year, more power to you! But, if you can't afford health insurance, I'm not sure you can afford to quit working.
Perhaps I'd be more sympathetic if the author of the article had argued that health insurance should be cheaper so that maybe we could afford to lay out of work for a year or two and pay monthly premiums out of a modest savings account. Or, so people who make minimum wage or less could buy health insurance even if their employer deliberately schedules them for 39 hours a week to avoid providing health insurance benefits. Or, so people could afford COBRA payments for three months before their insurance kicks in at a new employer. Reducing the cost of health insurance is an idea I could get behind.
Health care and health insurance are artificially expensive. I happen to believe that health insurance itself has driven the cost of health care to absurd heights and that insurance companies in general are little better than the Mafia's protection rackets. But, I don't believe that forcing people to buy insurance will fix any of that. Mandating health insurance might have prevented the subject of the story I read from making a foolish choice, but it couldn't force him into a doctor's office and it won't make insurance itself affordable.
To me, the cost of insurance is the real problem we should be addressing. Whether you buy it or not is up to you. Just don't expect to be bailed out of a bad bet if you choose to roll the dice. The guy in this story was a Harvard-educated pension planner, for pete's sake! He knew he was making a bad bet. We can't force people to act on their own behalf and we shouldn't act for them. But, to the extent that we can make it possible for people to act on their own behalf when they want to, we should.