Am I My Brother's Keeper? Why pay for health care for the undeserving?

By Samuel Metz, MD. Samuel Metz is a private practice anesthesiologist, HCAO representative from the Portland chapter of Physicians for a National Health Program, and founding member of Mad As Hell Doctors.

My brother-in-law Max has smoked since he was 12 years old. Now he's turning 40 and hates the miserable habit. His many efforts to quit reduced his three-pack a day habit to one, but he still can't kick the addiction. Meanwhile, his many years of low-paying jobs, if they offered any benefits at all, provided him only with high-deductible health insurance he couldn't afford to use. He hadn't seen a physician in years. But last month he went to the emergency room with a hacking cough that kept him awake for two nights running. The ER people gave him three pieces of bad news: (1) he's got an advanced lung cancer requiring an operation he can't afford, (2) the only hospital that will admit him is the county hospital funded with tax dollars, and (3) the multi-hundred dollar emergency room bill is more than he can pay.

Question: Should we spend our hard-earned tax dollars on Max's operation? Or should Max go without health care because, after all, his bad decisions had allowed the disease to go undetected for so long and caused the cancer in the first place?

It's a question that goes to the heart of our health care crisis. Should we reduce health care costs by excluding the undeserving? If we don't squander dollars on them, we liberate billions for us solid citizens who earned our right to health care. Why should everyone have that right?

This bandwagon has powerful emotional and logical appeal, but it rumbles over the speed bumps of reality. Before we hop on board, consider these points.

First, perhaps our intuition tells us who deserves health care (i.e., we and our families) and who doesn't (people with self-inflicted illnesses). But ultimately, who can be entrusted to decide? What if people in charge exclude us and our families because we pay fewer taxes than they do, drink or smoke more than they do, or weigh more than they do? Who do we want to determine if our families get health care?

The bandwagon just headed down a very slippery slope.

Second, Oregonians already pay enough to provide comprehensive health care for every one of us, even the "undeserving." Our problem is not insufficient funds, but who handles our health care dollars.

Right now, Americans filter $850 billion through our private health insurance industry. Of that, at least $350 billion is lost to administration before it ever turns into health care. That's a lot of lost money. In fact, it's more than Americans spend on obesity and tobacco-related diseases combined. It's seven times what we spend on health care for all immigrants, documented or otherwise. It's more money than the US spends on all drugs and medications. And, importantly, it's more money than we need to extend comprehensive health care to every one of us.

Oregon is no different.

If Oregonians diverted what we currently spend on health care premiums and out-of-pocket payments into a statewide, publicly funded, universal care agency, we would recover enough administrative costs to pay for treatment for uninsured people like Max without spending more money. We need to regain our health care dollars from insurance companies, not from our neighbors (deserving or undeserving).

Universal health care is an essential tool to ensure each of us gets better care for less money. Who cares if freeloaders get care at our expense if by doing so the rest of us spend less and receive better care?

So hop on the bandwagon for quality health care for everyone. The campaign to create publicly funded universal health care in Oregon is underway, spearheaded by Health Care for All-Oregon. To provide Max with the care he needs while making your own care less expensive, visit www.hcao.org. Learn more about how to become a better advocate for your family's health care needs and play your own role in this vital process. Turning Oregon into a shining example of cost-effective comprehensive health care requires people like us looking after ourselves, our families, and our communities. Join us!