My friend, Frank, has big problems – financial problems. Like so many people today, his youth was consumed with self gratification. I remember those days – living like there is no tomorrow. Now he is fifty years old, has marginal labor skills, and the financial shock of an encounter with modern health care.
He has always worked. But with only a high school education and no vocational training he has never had anything resembling a career. Over the years he has worked in a variety of service industries, like dishwasher, waiter, busboy, housekeeper, and a short stint collecting garbage. Like other young fools, he married right out of high school and quickly had three children. Sometimes he had to work two shifts, one as a daytime dishwasher and the evening or night shift as a housekeeper at a local retail store. He divorced in his mid thirties and lived frugally while making his child support payments.
His children are now grown. He has a nice rental and his own furniture. He thinks of himself as a “professional dishwasher.” His gross income is about twenty thousand dollars a year, he has about $5,000 in credit card debt, but manages to make his payments. He thinks of himself as a responsible person, paying his taxes, paying his own way, not causing trouble for anyone. He is proud of his children and his two new grandchildren. His car is old but functional, he has no car payments and maintains liability insurance on his vehicle. He has never been arrested, never run afoul of the law.
But Frank is beginning to age. At forty-nine years old Frank suffered some pains in his chest. He debated through the day – is this just gas, indigestion, or something much worse? By evening he decided he had better find out for sure. He drove his old car to the local hospital emergency room and reported some ‘pressure’ in his chest. We in America are blessed and cursed with modern health care. Frank was given a battery of tests through the late evening hours – nothing was found to be out of whack. But with the given symptoms the E.R. doctor felt that Frank should have a Cardiac Cath – they would send the remote camera through his arteries and look at his heart. Frank was given a room for the night and in the morning was tested by the most modern technology available. The result – a pulled muscle in his chest, no problem, Frank was discharged.
I had the same experience about five years ago – but I had health insurance. I paid the five hundred dollar deductible and went on my way. Frank received a bill for $19,500. He applied for financial aid with the hospital, but he made too much money to qualify. Frank has a history of always paying his bills, maybe a little late sometimes, but always paid. He had to make some choices. Frank dropped his telephone service, but kept his cable television . He ate less chicken and more macaroni and cheese and sent $50 a month to the hospital. Frank was on the 32 year payment plan. Frank has never been one to think in terms of 32 years – he thought of fifty dollars a month as a bunch of money.
This sort of arrangement is not acceptable to health care financial auditors. The hospital needs to maintain their bond rating for future projects – so they moved Frank’s account to ‘bad debt’ – they transferred his account to a collection agency. The hospitals use the ‘bad debt’ figures to justify the rising charges to insurance companies. They boast in their annual report that they give 15% of their services to the needy.
Those collection folks are ruthless. Unable to reach Frank at home, the collection agency found him at work. He was called away from his dishwasher station to go to the manager’s office for debt consultation. The collection agency demanded he refinance his house – ‘don’t have one’ – refinance his car -‘only worth $500″ – cash in his 401K – “What is that?” – use credit cards – “already maxed out” – give them his tax refund – “I can do that.” The assault was unforgiving and relentless. They settled for $150 a month, to be renegotiated after he surrendered his tax refund.
Frank tried to pay the $150. He was down to macaroni with no cheese and walking to work; he could not pay his auto insurance. He dropped his cable vision service. He could not buy birthday presents for his grandchildren. His $5,000 credit card debt was manageable – but his debt now totaled $25,000. Frank’s total assets, including his coffee pot and toaster, totaled around $2,500.
OK – so Frank has not been the poster child of responsible financial management. Frank would tell you himself that he regrets not getting better job training. He regrets getting married so young and having children when he could not really afford them. He regrets decisions made in his youth. Franks sits alone in his apartment, pondering what might have been – and wondering what is to be.
The manager of the restaurant at the truck stop suggested to Frank that he file for bankruptcy. “What are you talking about? I always pay my bills. I am no loser,” was the shocked response by the beleaguered Frank. The manager explained that Frank had his back to the wall, his options limited. Frank shuddered at the thought of failure. Bankruptcy would be his seminal life achievement. Devastated and broken, Frank called a lawyer. He will never recover his self dignity.
Many people are like Frank. Individual circumstances vary – but many are in their fifties, pondering what might have been and wondering what is to be. They have been responsible in the sense that they have always paid their way. They have not taken government handouts. They see themselves in that light. But one encounter with modern health care can dramatically change circumstances with the simple rise of a full moon. The monster of financial ruin is awakened.
What are we to do? It is not as simple as saying, “He should have thought of his future.” We are not arguing that he was future oriented – but the people who praise the virtues of Jesus are often the first to discount the virtues of Frank. None of us wants to shoulder the burden of our neighbor. The ideal is for each to carry his own weight. The reality is difficult to fathom.
The ethics of human society stare us in the face again.
In 1936 our government recognized that many people had not prepared for aging. Unwilling to simply discard old people as being irresponsible, they invented Social Security – a method of forcing workers to invest in their future. Social Security is not perfect – and with constant tinkering by Congress it is laboring to be self sustaining. In 1967 the government recognized that 15 out of 16 elderly people did not receive adequate health care – so they began Medicare – again forcing people to invest in more their future.Social Security and Medicare are not perfect in their application – but in concept address some of the fundamental ethical dilemmas of modern life.
We are next stage of civil evolution – that process by which we, as a society, gradually accept the virtues of Jesus and incorporate these virtues into our life. I am not arguing for a theocracy – I am merely being sarcastic. I can not help myself. The point is this – as we progress in the civil harmony of man living with man we must become more sensitive to others. We are no longer cave men. We no longer live by the rule of the biggest club wielded by the strongest arm.
We must accept the reality that man, living in harmony with man, bears some responsibility for our neighbor. We are not arguing for ‘nationalized health care.’ We are only submitting that our system of health care finance is not working. We are suggesting that we are at a place in civil evolution where we can recognize the problems. We can recognize that we have responsibility to others – as we have done in the past.
We will never reach the ideal harmony. But we can make progress.