One of trends I’ve watched through my lifetime is lengthening life expectancy. When I was young, life expectancy was around 70. Now in the U.S, it is 78.8 years. Both of my parents lived into their nineties. A significant reason is treatments for cancer and heart disease, and, in general, advances in both preventive care, and treatments for many diseases, that if not curative, allow for longer life. Both of my parents recovered from illnesses from which they might have died in earlier times. My wife is a cancer survivor. I’ve recovered from an infection from which I might have died. My son had a heart procedure that cured an arrythmia that might have killed him.
All this was possible not only because of research advances and access to good medical care, but health insurance that allowed us to contribute to our health care costs without bankrupting us or exceeding our means. For many years, we and our employers paid health premiums, and my parents had medicare and supplemental coverage. In the case of my family, a job loss during one of these health crises might have led to very different outcomes.
Might we be facing the possibility of declining life expectancy, and the possibility that we might die sooner? Will it be the fate, at least for some of us in the U.S. to have life expectancies much more like those of the past? Will families see more deaths of infants and children (in my own city, infant mortality already is a function of zip code, with those in more prosperous zip codes seeing fewer deaths)? Will middle age people with treatable cancers die because they lack the coverage to afford the needed treatments, or bankrupt themselves trying to pay for it themselves, at higher rates than insurers pay?
It appears to me that as a country we are saying that it is morally acceptable to contemplate the possibility that some of our citizens, those whose employers don’t provide health coverage and cannot afford it, those with pre-existing conditions, those who have exceeded or cannot afford COBRA coverage, and perhaps the aged, may die earlier, simply because they cannot afford the health care and medications available to the more prosperous, that would extend their lives.
Truthfully, we’ve been saying that for a long time, and the latest health care measures only seem to enlarge the number of people who may not be able to afford treatments that may save or extend their lives. And I think it is likely that more of our citizens will need to face the sobering reality that death will come to them or those they love earlier than it might have. What will it do to the fabric of our society when the prosperous few receive care for which the rest can only hope?
I think part of how this happens is the illusion that “it can’t happen to me.” Yet for many, they may be one job loss, family crisis, accident, or illness, or chronic condition from facing this reality. The truth of it is that, no matter how much you feel in control, no matter how much money you have (for most of us), you are vulnerable.
Yes, health care is complicated. I’m glad our president finally figured this out. I’ll admit that I’m not an expert on this, but it seems we need to have a national conversation and solutions that are not partisan efforts if we are truly going to address the issues of health coverage in our country. It seems we need to talk about:
- Whether we consider it morally acceptable to have the inequities that exist in our health care system, particularly when these impact the most vulnerable–children, the unemployed, the aged.
- What good health care for all costs and how we will pay for it. It is true that we have been asking government to provide more than we are willing to pay for and this cannot continue indefinitely.
- Ensuring that those who provide health care services and products and insurance receive a reasonable return for their work or investment allowing them to sustain their efforts without exorbitant profits.
- What responsibility we have for our health choices — diet, exercise, preventive care, lifestyle.
- A better understanding and compassionate stewardship of good end of life care that neither hastens nor prolongs dying.
If we can’t figure out how to have that conversation, then it seems that we need to figure out how to talk about the fact that many of us may be dying sooner. It may be that we have to face the reality of dying sooner ourselves, or desperately using all our resources to save our lives. It may be that we have to figure out how we are going to remain one people when some receive care denied to others. Are we ready for that?