The news noise about the rocky roll out of Obamacare has been so deafening that it has diverted our attention from the central importance of the Affordable Care Act (ACA). Amid the brouhaha about ACA website malfunctions, private insurance policy cancellations, and Obama Administration mismanagement, our collective attention has been redirected from the fact that the presence or absence of ACA can be a matter of life or death for millions of Americans. As a cancer patient these destabilizing diversions make me angry. As an anthropologist, they make me anxious about the future of our society.
When my oncologist told me in 2001 that I had Non-Hodgkin Lymphoma, a set of blood cancers most of which have no cure, the news turned my world upside down. My physician recommended an experimental course of treatment--a nine month course of chemotherapy, combined with the relatively new immunotherapy drug, rituximab, a genetically engineered medicine, cloned from mice, which would uniquely target and kill lymphoma cells. Prior to 2001 I had never had to worry about medical insurance coverage. After the cancer diagnosis, though, it was uncertain if Blue Cross/Blue Shield would cover what was then an "experimental" course of treatment. Prior to my first treatment I learned that I would need a good deal of rituximab and that each bag of the medicine would cost roughly $6000. With baited breath I went ahead with the treatment not knowing if it would be covered, not knowing if I'd be able to pay for it. When I learned that my insurance would, in fact, fully cover a very expensive long-term course of treatments, I could focus my attention on prognosis rather than payment. Indeed, those rituximab treatments, which took almost three years to complete, averted a premature death. They gave me time to travel, write new articles, craft new books,and reach out to a new generation of college students. They also gave me more time with children and grandchildren--a real new lease on life.
If I hadn't had superior health insurance, I would have died many years ago--a life cut short by a lack of access to health care. It makes me angry that millions of Americans cannot not share my good fortune. For any number of reasons--a work-related accident, a sudden debilitating illness, an unexpected job loss--a hardworking person can be rapidly thrown into poverty, which usually means living without health insurance.
Consider the case of Richard Streeter which is described in Nicholas Kristof's most recent New York Times column, "This is Why We Need Obamacare." Kristof wrote about what the lack of coverage has meant for the 47 year-old truck driver from Eugene, Oregon.
His problem isn't Obamacare, but a tumor in his colon that may kill him because Obamacare didn't come quite soon enough.
Streeter had health insurance for decades, but beginning in 2008 his employer no longer offered it as an option. He says he tried to buy individual health insurance but, as a lifelong smoker in his late 40s, couldn't find anything affordable -- so he took a terrible chance and did without. He now has advanced colon cancer--a candidate for a needless and premature death.
Streeter is one of 50 million Americans without health insurance, which means that more and more people are rolling the dice with their health and becoming, usually through no fault of their own, prime candidates for needless suffering and premature death.
In his column, Kristof calls for the opponents of the ACA , who have brought forward no alternative plans for health care, to demonstrate more empathy for the increasing population of poor Americans who lack health insurance.
...how about showing empathy also for a far larger and more desperate group: The nearly 50 million Americans without insurance who play health care Russian roulette as a result. FamiliesUSA, a health care advocacy group that supports Obamacare, estimated last year that an American dies every 20 minutes for lack of insurance.
As a cancer patient and a citizen, I am angry that politicians would want to deny 50 million Americans access to health insurance and quality medical care. As an anthropologist, I'm worried about what such mean-spirited advocacy means for our society. In anthropology we have a concept that attempts to explain, among other things, health care inequities. It is called structural violence. The anthropologist-physician Paul Farmer used the term to analyze health care in Haiti. Structural violence exists in societies marked by extreme social inequality, which means that your access to health care becomes a function of your rank in the social order. If you are caught in the web of structural violence it means that you and people like you will have little if any access to even minimal health care, which means, in turn, that your are likely to suffer from easily preventable diseases. Such a sorry state also means that you will probably die before their time. Indeed, structural violence not only triggers widespread physical and social suffering, but also ensures that a small percentage of rich people will continue to live lavishly and healthily, while a large percentage of poor people will have to endure the privation of living in unhealthy, squalid conditions--"the wretched of the earth" to borrow from Franz Fanon.
It is ironic that structural violence is increasingly raising its ugly head in America. If the case of Richard Streeter is indicative, then we can say that third world "wretched of the earth" conditions are spreading across an America that is marked by rapidly increasing social polarization. In the richest nation in the world, should poverty condemn you to an unhealthy life and/or a premature death? In the richest nation in the world, is quality health care a right or a privilege?
The answers to these questions will in large measure determine our future social course. One path leads us to increasing social inequity, structural violence and despair--a "wretched" social life. The other path, on which the ACA is a partial corrective, is likely to prompt the development of a more vibrant middle class, a greater degree of structural parity and a healthier, happier and more productive population.
What kind of land will our grandchildren inherit? Will it be "This land was made for you and me," to cite a line from Woody Guthrie's famous folk song? Or will it be This Land Was Made for You and Me (But Mostly Me): Billionaires in the Wild, to quote the title of Bruce McCall and David Letterman's new book.
The real news about Obamacare, then, is that its fate is likely to shape the world we bequeath to our children and grandchildren. What kind of world will that be?