Damon Winter/The New York Times
Nicholas D. Kristof
MY wife and I attended my 30-year college reunion a couple of weekends ago, but the partying was bittersweet. My freshman roommate, Scott Androes, was in a Seattle hospital bed, a victim in part of a broken health care system. Strip away the sound and fury of campaign ads and rival spinmeisters, and what’s at stake in this presidential election is, in part, lives like Scott’s.
Scott and I were both Oregon farm boys, friends through the Future Farmers of America, when Harvard sent us thick envelopes. We were exhilarated but nervous, for neither of us had ever actually visited Harvard, and we asked to room together for moral support among all those city slickers.
We were the country bumpkins of Harvard Yard. Yet if we amused our classmates more than we intended, we had our private jokes as well. We let slip (falsely) that we kept deer rifles under our beds and smiled as our friends gave them a wide berth.
Scott was there when I limped back from the Worst Date in History (quite regularly), and he and I together worked our way onto the Crimson, the student newspaper. He had an omnivorous mind: Scott may be the only champion judge of dairy cattle who enjoyed quoting Thomas Macaulay, the 19th-century British historian. Scott topped off his erudition with a crackling wit to deflate pretentiousness (which, at Harvard, kept him busy).
By nature, Scott was even-keeled, prudent and cautious, and he always looked like the mild-mannered financial consultant that he became. He never lost his temper, never drove too fast, never got drunk, never smoked marijuana.
Well, not that I remember. I don’t want to discredit his youth.
Yet for all his innate prudence, Scott now, at age 52, is suffering from Stage 4 prostate cancer, in part because he didn’t have health insurance. President Obama’s health care reform came just a bit too late to help Scott, but it will protect others like him — unless Mitt Romney repeals it.
If you favor gutting “Obamacare,” please listen to Scott’s story. He is willing to recount his embarrassing tale in part so that readers can learn from it.
I’ll let Scott take over the narrative:
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.
I didn’t buy health insurance because I knew it would be really expensive in the individual policy market, because many of the people in this market are high risk. I would have bought insurance if there had been any kind of fair-risk pooling. In 2005 I started working seasonally for H&R Block doing tax returns.
As seasonal work it of course doesn’t provide health benefits, but then lots of full-time jobs don’t either. I knew I was taking a big risk without insurance, but I was foolish.
In 2011 I began having greater difficulty peeing. I didn’t go see the doctor because that would have been several hundred dollars out of pocket — just enough disincentive to get me to make a bad decision.
Early this year, I began seeing blood in my urine, and then I got scared. I Googled “blood in urine” and turned up several possible explanations. I remember sitting at my computer and thinking, “Well, I can afford the cost of an infection, but cancer would probably bust my bank and take everything in my I.R.A. So I’m just going to bet on this being an infection.”
I was extremely busy at work since it was peak tax season, so I figured I’d go after April 15. Then I developed a 102-degree fever and went to one of those urgent care clinics in a strip mall. (I didn’t have a regular physician and hadn’t been getting annual physicals.)
The doctor there gave me a diagnosis of prostate infection and prescribed antibiotics. That seemed to help, but by April 15 it seemed to be getting worse again. On May 3 I saw a urologist, and he drew blood for tests, but the results weren’t back yet that weekend when my health degenerated rapidly.
A friend took me to the Swedish Medical Center Emergency Room near my home. Doctors ran blood labs immediately. A normal P.S.A. test for prostate cancer is below 4, and mine was 1,100. They also did a CT scan, which turned up possible signs of cancerous bone lesions. Prostate cancer likes to spread to bones.
I also had a blood disorder called disseminated intravascular coagulation, which is sometimes brought on by prostate cancer. It basically causes you to destroy your own blood cells, and it’s abbreviated as D.I.C. Medical students joke that it stands for “death is close.”
Let’s just stipulate up front that Scott blew it. Other people are sometimes too poor to buy health insurance or unschooled about the risks. Scott had no excuse. He could have afforded insurance, and while working in the pension industry he became expert on actuarial statistics; he knew precisely what risks he was taking. He’s the first to admit that he screwed up catastrophically and may die as a result.
Yet remember also that while Scott was foolish, mostly he was unlucky. He is a bachelor, so he didn’t have a spouse whose insurance he could fall back on in his midlife crisis. In any case, we all take risks, and usually we get away with them. Scott is a usually prudent guy who took a chance, and then everything went wrong.
The Mitt Romney philosophy, as I understand it, is that this is a tragic but necessary byproduct of requiring Americans to take personal responsibility for their lives. They need to understand that mistakes have consequences. That’s why Romney would repeal Obamacare and leave people like Scott to pay the price for their irresponsibility.
To me, that seems ineffably harsh. We all make mistakes, and a humane government tries to compensate for our misjudgments. That’s why highways have guardrails, why drivers must wear seat belts, why police officers pull over speeders, why we have fire codes. In other modern countries, Scott would have been insured, and his cancer would have been much more likely to be detected in time for effective treatment.
Is that a nanny state? No, it’s a civilized one.
President Obama’s care plan addresses this problem inelegantly, by forcing people like Scott to buy insurance beginning in 2014. Some will grumble about the “mandate” and the insurance cost, but it will save lives.
Already, Obamacare is slowly reducing the number of people without health insurance, as young adults can now stay on their parents’ plans. But the Census Bureau reported last month that 48.6 million Americans are still uninsured — a travesty in a wealthy country. The Urban Institute calculated in 2008 that some 27,000 Americans between the ages of 25 and 65 die prematurely each year because they don’t have health insurance. Another estimate is even higher.
You want to put a face on those numbers? Look at Scott’s picture. One American like him dies every 20 minutes for lack of health insurance.
Back to Scott:
For seven weeks they kept me alive with daily blood transfusions. They also gave me chemotherapy, suppressing the cancer so that my blood could return to normal. I was released June 29, and since then have had more chemo and also hormone therapy to limit the cancer growth.
But the cancer has kept growing, and I went to the E.R. again on Sept. 17 when I found that I was losing all strength in my legs. They did an M.R.I. and saw that there were tumors pressing on my spinal cord. They have been treating me with radiation for three weeks now to shrink those tumors and will continue to do so for another week.
I submitted an application to the hospital for charity care and was approved. The bill is already north of $550,000. Based on the low income on my tax return they knocked it down to $1,339. Swedish Medical Center has treated me better than I ever deserved.
Some doctor bills are not covered by the charity application, and I expect to spend all of my I.R.A. assets before I’m done. Some doctors have been generously treating me without sending bills, and I am humbled by their ethic of service to the patient.
Some things I have to pay for, like $1,700 for the Lupron hormone therapy and $1,400 for an ambulance trip. It’s an arbitrary and haphazard system, and I’m just lucky to live in a city with a highly competent and generous hospital like Swedish.
In this respect, Scott is very lucky, and the system is now responding superbly and compassionately. But of course, his care is not exactly “free” — we’re all paying the bill.
Romney argues that Obamacare is economically inefficient. But where is the efficiency in a system that neglects routine physicals and preventive care, and then pays $550,000 in bills as a result? To me, this is repugnant economically as well as morally.
In the Romney system, people like Scott would remain uninsured. And they would be unable to buy insurance because of their cancer history.
Obamacare does address these problems, albeit in a complex and intrusive way, forcing people by a mandate to get insurance. Some will certainly fall through the cracks, and in any case the Obama plan does little to address the underlying problem of rising health costs. But do we really prefer the previous system in which one American in six was uninsured like Scott, all walking the tightrope, and sometimes falling off?
As my classmates and I celebrated our reunion and relived our triumphs — like spiking the punch during a visit by the governor — I kept thinking of Scott in his hospital bed. No amount of nostalgic laughter could fill the void of his absence.
Back to Scott:
This whole experience has made me feel like such a fool. I blew one that I really should have gotten right. You probably remember that my mother died of breast cancer the July before we started college. She watched my high school graduation from the back of an ambulance on the football field at our outdoor graduation. Six weeks later she was dead, and six weeks after that I was on an airplane that took me east of the Mississippi for the first time in my life.
Her death at 53 permanently darkened my view of life. It also made me feel that I was at high risk for cancer because in my amateur opinion I was genetically very similar to her, just based on appearance and personality. And much of my career has been in actuarial work, where the whole point is to identify risks.
I read Nassim Taleb’s book “The Black Swan” and imbibed his idea that you should keep an eye out for low-probability events that have potentially big consequences, both positive and negative. You insure against the potentially negative ones, like prostate cancer.
So why didn’t I get physicals? Why didn’t I get P.S.A. tests? Why didn’t I get examined when I started having trouble urinating? Partly because of the traditional male delinquency about seeing doctors. I had no regular family doctor; typical bachelor guy behavior.
I had plenty of warning signs, and that’s why I feel like a damned fool. I would give anything to have gone to a doctor in, say, October 2011. It fills me with regret. Now I’m struggling with all my might to walk 30 feet down the hallway with the physical therapists holding on to me so I don’t fall. I’ve got all my chips bet on the hope that the radiation treatments that I’m getting daily are going to shrink the tumors that are pressing on my spinal cord so that someday soon I can be back out on the sidewalk enjoying a walk in my neighborhood. That would be the height of joy for me.
When I make mistakes, my wife and friends forgive me. We need a health care system that is equally forgiving.
That means getting all Americans insured, and then emphasizing preventive care like cancer screenings. Presidents since Franklin D. Roosevelt have sought to create universal health insurance, and Obama finally saw it achieved in his first term. It will gradually come into effect, with 2014 the pivotal year — if Romney does not repeal it.
In some ways, of course, America’s health care system is superb. It is masterly in pioneering new techniques, and its top-level care for those with insurance is unrivaled. Sometimes even those without insurance, like Scott, get superb care as charity cases, and I salute the doctors at Swedish Medical Center in Seattle for their professionalism and compassion toward my old friend.
But it would have made more sense to provide Scott with insurance and regular physicals. Catching the cancer early might have saved hundreds of thousands of dollars in radiation and chemo expenses — and maybe a life as well.
So as you watch the presidential debates, as you listen to those campaign ads, remember that what is at stake is not so much the success of one politician or another. The real impact of the election will be felt in the lives of men and women around the country, in spheres as intimate as our gut-wrenching fear when we spot blood in our urine.
Our choices this election come too late for Scott, although I hope that my friend from tiny Silverton, Ore., who somehow beat the odds so many times already in his life, will also beat this cancer. The election has the potential to help save the lives of many others who don’t have insurance.
In his hospital room, my old pal is gallantly fighting his cancer — and battling a gnawing uncertainty that he should never have had to face, that no American should so needlessly endure. This is all heartbreakingly unnecessary. I’ll give Scott the final word.
From my 12th floor room I have a panoramic view looking east from downtown Seattle toward the suburbs to the Cascade Mountains. My visitors are often struck by the view.
Through my window I watch a succession of gloriously sunny days and I wonder if this will be my last Indian summer on earth. I still have hope and I tell myself that medical science has come a long way in the 34 years since my mother died, but I can’t help feeling that I’m walking in her footsteps.
A Possibly Fatal Mistake 10/16/2012 09:47
I mentioned before that cost of individual plan is very expensive. At least eight years ago, blue cross quoted $850/month. For Scott got treatment from emergence room, we tax payer foot the bill. Well， Bush once said 'we have medical system cares poor, the poor could go emergence room...' Romey had same idea.
Mayrain at 10/16/2012 15:08
Good point. I can't say health insurance premium in other states. But In MA, when Scott works for HR Block with lowered income, insurance premium can be very affordable with Commonwealth Care. If there is no insurance mandate, many people would still take a chance.
|I mentioned before that cost of individual plan is very expensive. At least eight years ago, blue cross quoted $850/month. For Scott got treatment from emergence room, we tax payer foot the bill. Well， Bush once said 'we have medical system cares poor, the poor could go emergence room...' Romey had same idea.|
花溪 at 10/16/2012 19:51