First responders

Two first-responder stories highlight the need for health reform.

I saw three news stories yesterday that add up to one message that seems right for this season.

The first was Jonathan Cohn’s New Republic/Kaiser Health News piece noting Republicans’ basic plan for poor people is to cut Medicaid and other programs that provide health care for them. During the health reform debate, Congressional Budget Office analyses of Republican proposals consistently found that these would only cover a miniscule fraction of the uninsured. Beneath a thin rhetorical veneer, Republicans unapologetically argue that we should just leave tens of millions of people uninsured.

The second was Jon Stewart’s evisceration of those same Republicans for filibustering legislation providing health benefits to 9/11 first responders. Stewart focused on the target-rich environment of Republican hypocrisy. For those who fell asleep under a tree during the Clinton administration, FOX news has spent the last nine years honing its partisan 9/11 rage machine, trotting out first responders to attack opponents of the Iraq war and torture, not to mention the “Ground Zero Mosque” as soft on terrorism and unpatriotic. Yet FOX was oddly silent when Republicans blocked the James Zadroga 9/11 Health and Compensation Act to help those same first responders pay for their lung diseases, cancers, and other serious health difficulties.

Yet watch that clip and read up on these providers’ real problems.

First-responders face strange and specific health problems because they spent weeks, sometimes months, working in charred wreckage. Yet the financial and insurance problems they face are similar to those faced by hundreds of thousands of other very sick people: Their insurance imposes punishing copayments for costly therapies. They require costly treatments and medications. They need money because they cannot work. Responders with ambiguous ailments watch their insurers and employers bicker over who should pay for what, since it is hard to tell whether their specific illness was work-related. Their insurers may require some reinsurance, too, if 9/11 caused many of their customers to have unpredictable, huge needs.

These are all standard-issue matters in health reform. Four years from now, many of these responders will have access to health insurance exchanges which would provide better protection against medical bankruptcy. They will enjoy legal protections against insurer discrimination based on their preexisting conditions. They will have access to financial help if they can’t afford their insurance coverage and better access to Medicaid. Millions of others who are not first responders but who face the same deadly ailments need these protections, too. For them, 2015 can’t come too soon—assuming Republicans don’t find ways to undermine ACA or to delay things even further.

2015 is also far away for another first responder: Chicago musician Matthew Leone. As the always-hip Chicago Tribune describes things: “Leone, a rock musician with tattoos and spike hair who stands 5-foot-6 and weighs 118 pounds, seems an unlikely hero.” Last summer, Leone interceded when a woman cried out for help as she was being beaten and choked by her husband Justin Pivec. According to the Tribune, Leone pushed Pivec off her, and tried to calm things down. Pivec (six inches taller and sixty pounds heavier) beat Leone severely.

Leone needed brain surgery. One-third of his skull was removed to relieve the brain pressure. He left the hospital with forty staples in his skull, a broken nose, dislocated jaw, and a partially paralyzed face. He’s needed extensive rehab. He can’t tour. He has $300,000 in medical bills. I don’t know his insurance details. Like many musicians and freelance professionals, Leone was uninsured–added 12/19. Given his profession, even if he had purchased insurance, it’s virtually certain that he would have held crappy coverage through the individual or small-group market that wouldn’t handle something of this magnitude. In short, he’s exactly the kind of person who needs the protections of a health insurance exchange and the affordability credits provided through health reform.

His twin brother Nathan is helping him. Other musicians—Lady Gaga, Gene Simmons, Billy Corgan among them—have been helping, too. That’s great, but they shouldn’t have to do this, any more than people should have to hold bake sales and raffles to finance liver transplants for friends and loved-ones.

Republicans claim a midterm mandate for lower taxes and limited government. That’s pretty rich when so much of their 2010 margin of victory was provided by angry Medicare recipients. Paul Starr rightly notes the “psychology of self-exemption” at the heart of this.

The obvious hypocrisy is really the least of it. This morning, hundreds of thousands of Americans struggle with really serious injuries and illnesses and with really serious medical bills. Some are injured or sick because they heroically helped others. Most simply drew a bad ticket in life’s lottery. One might be hypocritical or one might be logically consistent in supporting policies which abandon them to their fate. Whatever. If you don’t believe we as a nation should respond to help them now, then you really shouldn’t expect Matthew Leone or those 9/11 EMTs, cops, and firefighters to respond for you if you really need it.

We are our brothers’ (and sisters’) keepers. Whatever happened in the midterms, I bet the American people will realize there is no other way to live.

Postscript: Yes this is also an argument for the individual mandate. You never know what might happen when you go uninsured, and it’s not right to run the risk that you will impose on others.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect,, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

11 thoughts on “First responders”

  1. Under the imprimatur of "austerity" the goals going forward for Fox News & Company are twofold:

    1) Convince people that we can't afford to take care of the poor.

    2) Convince people that we shouldn't tax our "billionaire Galts" because without their guidance, our poor people would be a lot poorer.

    These are the two overarching themes I sense the right-wing noise machine amping up.

    And if the left hopes to ever win tax hikes for the rich again, they'd better start hammering about the need for it right now.

    Along these lines: These four minutes of Malcolm Gladwell video are a good start.

    If you watch it, pay attention to the commercial you are forced to watch at the start. It is a quite interesting juxtaposition:

  2. Given his profession, even if he had purchased insurance, it’s virtually certain that he would have held crappy coverage through the individual or small-group market that wouldn’t handle something of this magnitude.

    I'm not wishing to disagree with your larger point, but this is not actually true. This case is exactly the size where existing insurance works pretty well. (Speaking from recent experience–my son was in the hospital for 5 weeks and had major surgery while we had standard high-deductible individual coverage this spring.) For $100/month or so, it will take a bill down from $500,000 to $7500–which is an amount that can be plausible raised or financed.

  3. For those who fell asleep under a tree during the Clinton administration, FOX news has spent the last nine years honing its partisan 9/11 rage machine

    Pretty sure you mean Bush, not Clinton.

  4. SamChevre,

    $100 a month? I'm a lot older than Leone, probably, and I pay more than five times that for a high-deductible individual policy. I also live in a state, MA, that has a heavily regulated health insurance industry (and did even before RomneyCare) including mandatory issue and no individualized underwriting (that has a name I can't think of right now).

    I'd be surprised if he could get something sensible for $100/mo.

  5. Community rating.

    $100/month would be about right for an under-30 male here in VA. Insurance for me, wife, and 3 children was $250/month this spring.

    Community rating makes insurance MUCH more expensive for the reasonably healthy, but makes it possible to insure the less healthy.

  6. SamChevre, you seem to be implying that sick and old people don't belong in your insurance pool.

    Why not just come out and say it?

  7. I just added the postscript. This case is also an argument for the importance of the mandate.

  8. Yet more untold suffering because we don't have universal health care, something most (every?) other 1st world country is able to do just fine. Do those complaining about not getting to pick their doctor not cringe when they hear these stories?

    Can't we all just admit that in an advanced civilization such as ours, health care should be a right?

    In a recent Colbert broadcast, he played a clip of Bill O'Reilly apparently sorting out the good poor from the bad poor. I guess this goes to koreyel's Galts: behind every health insurance tragedy there's a value judgment about the "deserving". Talk about "death panels"… today's conservative wears that black cloak well. In AZ, medicaid transplants have been revoked. But those patients were just "moochers" anyway, right?

  9. SamChevre,

    Yes. Community rating. Thanks.

    I take it VA doesn't have that, and that insurers are also free to turn down applicants? Is that right?

  10. I take it VA doesn’t have that, and that insurers are also free to turn down applicants? Is that right?

    I'm not sure. I know how my insurance worked and what it cost. I know that insurers can charge more depending on health history. I'm not certain whether they have to offer insurance at some price or not. And I know that the state has a high-risk poool, but I'm not certain how that works either.

    Sorry I can't be more help.

  11. Wow. In our state the standard family plan bought on the open market has a $7500 out-of-pocket limit. For the high-deductible plan it's $25K. (And no, unless you're absolutely healthy for about 10 years, the difference doesn't pay off.) Also, of course, you need to have just the right condition, treated by the right physicians, otherwise some of the cost simply isn't covered regardless of limits. At this point if ACA simply stops things from getting massively worse every year it will be a big deal.

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