“Jenny,” as I’ll call her, came in for a follow-up appointment the other day. You probably don’t know Jenny personally, but you read about her all the time. That’s because Jenny is a statistic, a faceless number.
Jenny is an outgoing, always smiling 40-year-old who has been badly crippled with rheumatoid arthritis since her early 20s. Despite gnarled, twisted hands, crooked feet, and such neck pain that she often can’t sit up for more than a few minutes at a time, she has made it clear that her disease is not going to control her life. She simply refuses to give up, and her spirit is a source of great inspiration to her friends as well as to her doctors and nurses. I always look forward to seeing her. Besides, for the past couple of years she has finally begun to respond to some new medicines, and at her last visit three months ago she was feeling better than she had in years. However, when she returned last week, it was quickly apparent that something was terribly wrong.
After a smile and a feeble “hello,” she suddenly began crying, and through her tears she told me about her unrelenting pain and about the humiliation of having to rely on her friends to help her eat, bathe, and tend to her bathroom needs. After she partially regained her composure, Jenny told me that a couple of months ago, she had been unceremoniously dumped from TennCare, the state of Tennessee’s health-care insurance program, because she was no longer Medicaid eligible. She had previously qualified for TennCare because she was medically uninsurable, but the fact that she has a few meager assets like an old car got her kicked out of the program.
Jenny is a college graduate and has held a number of responsible jobs in the past, but her only income now is her disability check. The drug regimen that had finally brought a measure of relief costs almost a thousand dollars per month, so when she was dropped from TennCare, she literally had to choose between food and medicine. She stopped her medicines, and within a couple of weeks her disease roared back.
We pride ourselves on our health care in this country, and it is true that our technology outstrips the rest of the world. However, people like Jenny would be better off if they lived in any other Western-style democracy because all the countries of Western Europe plus Canada, Australia, Japan and many others have decided that access to decent health care is a right of citizenship.
Among the world’s industrialized democracies, we alone have huge numbers of people without health insurance. That number is now around 46 million and probably growing as states struggle with budget shortfalls. It is sometimes difficult to put things in perspective while history is being written. I remember one of my daughters studying segregation in the South when she was in junior high school. One night she looked up at me and asked, “Why did people let it happen?” I had no answer.
As one who grew up in the segregated South, I realized at a pretty early age that black people were treated unfairly, that “separate but equal” was a sham, and that no moral justification existed for the status quo. Yet I, and nearly all white people, went about our daily lives giving little thought to the situation.
The fact is that contact between blacks and whites was minimal, and what little there was almost always had the black person in a subservient role. Later on, when I was in college at Vanderbilt, I had late-night dorm discussions with friends from the Deep South. They insisted that they “knew” black people because they had been around them all their lives, unlike me. But when I questioned my friends further, I learned the black people they were talking about were almost always children of domestic workers or the like. Meaningful relationships were rare.
So, despite the fact that millions of people were suffering from our laws, we whites managed to live with ourselves by the usual techniques or rationalizations. We dehumanized black people by using ugly words to describe them. We joked about them, with the jokes usually ending up with the black person looking stupid. We told stories that blamed blacks for their situation by implying a poor work ethic, dishonesty or other faults. I can even remember my grandmother, a devout Christian, telling me that if God had wanted the races to mix, He would have made us all the same.
Today’s young people just don’t buy all that. They look at me and ask how in the world we allowed segregation to exist for so long. And in reality, I have no acceptable answer. However, I sometimes ask if they can think of an analogous situation in America today. Are there people who are suffering unjustly because of our current public policies, similar to how blacks suffered under segregation?
They usually stare blankly, smugly confident that their generation would not tolerate such injustice. And then I remind them of an ugly, uniquely American fact: Alone among industrialized countries, the United States allows a huge proportion of its people to go without health insurance. More than 15 percent of the population—46 million people including as many as 10 million children—do not have access to adequate health care. And the consequences are very real, resulting in poorer care for children with asthma, diabetes and other conditions, much less the lack of preventive care, higher death rates and even financial ruin.
That’s when the conversation gets interesting. “That’s just not the same,” they say, or, “We just can’t afford it” or, “How can we insure them if they won’t take care of themselves?” I point out that the answers remind me of the things white people said in the 1950s. By implying that the problem is just too big to solve, and even worse, by implying that the uninsured are somehow responsible for their predicament, we deflect the conversation from the real issue.
In many ways the problem of the uninsured is even more complex than segregation. While most of the time meaningful contact between blacks and whites was rare, we knew who they were. With the uninsured, we can’t even see them. When we go to the grocery, chances are huge that some of the people checking out in front of us are terrified of their next illness, or are being denied good preventive care for their high blood pressure or diabetes, or face bankruptcy because of medical bills, and we don’t know who they are. They are truly invisible. An invisible nation of 46 million people lives within our borders, and we don’t even know who they are.
Maybe part of the problem is statistics. Numbers, even big numbers, don’t tell the whole story. In fact, they may actually blur the fact that every number represents one individual, and by focusing on statistics we don’t clearly portray the degree of pain and suffering these individuals are experiencing. In fact, we may even be pleased when we read that removing people like Jenny “cleans up” the TennCare rolls.
Like segregation, the issue of health care for the uninsured is fundamentally a moral one. We can argue this and that about the details, but one thing is certain: Just as our children don’t understand how we tolerated segregation, our grandchildren will wonder how we could have allowed this to happen. What will we tell them?
© 2013 Vanderbilt University
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Dr. John Sergent, BA’63, MD’66, is a professor of medicine at Vanderbilt who also serves as vice chair for education for the Department of Medicine and is director of the internal medicine residency program. This essay is adapted from his recent book, Healing Words (2009, Cold Tree Press), a collection of writings that first appeared in The Tennessean newspaper.