RALL: A Case for Socialized Medicine
I wasn't going that fast, but West End Avenue was slick from a light drizzle when I hit the monster pothole. The taxi I was driving while moonlighting skidded into the median strip. I heard the tires explode and felt the axle snap, then the car flipped over into the opposing direction of traffic and rolled over twice before slamming into an '86 Alliance so hard that the parked car's trunk popped open, broke off, cleared a fence and came to rest 20 feet away.
My cab slammed into a second automobile, totaling it as well, before finally coming to rest on top of its hood. Finally, the engine block fell off its support, pushing the accelerator to the floor. I stopped the ignition and climbed out the window -- since the door wouldn't open. Smoke was everywhere. Flames danced over my windshield.
The cops arrived in seconds. "Where's the driver? Where's the body?" an officer asked me repeatedly, refusing to believe that anyone could have survived such devastation.
After they finally accepted that I indeed was the driver, one of them told me: "Look behind the wheel. Notice anything?"
"Yeah -- the steering wheel is about six inches too high," I replied.
"We see that in fatal car wrecks," he explained. "The driver instinctively pushes the steering wheel shaft up, away from the body. You lifted over 2,000 pounds."
A New York City EMS ambulance pulled up. I was in shock; I felt great except for a dull throb in my right wrist. The ambulance guys offered to drive me to the nearest hospital, but warned: "The ambulance ride costs $195. Then there's $100 for the emergency room, plus whatever they do for you there."
At the time, which was 1985, I was working full-time as a trader-trainee at the Bear Stearns brokerage firm. I earned $10,000; my check for two weeks salary came to $315.29 after payroll deductions. Since my rent was $283 (for a two-bedroom apartment in Harlem with two roommates), I worked two or three nights a week as a taxi driver, making anywhere between $80 and $140 per 12-hour shift.
Bear Stearns deducted $8 from every other paycheck to pay for medical insurance, my deductible was $200 a year and the rest was only payable up to 80 percent, so the most my insurance would have covered was $80.
I had to make an on-the-spot decision and choose between the $300-plus hospital bill or the next month's rent. I had no savings -- only massive piles of student loans -- and I didn't know anyone who could lend me the money. So I refused the ambulance, walked to the subway and went home, considering myself lucky to still be alive.
After the accident, my wrist occasionally felt sore, and I sometimes felt light-headed. A year later, when I got a better job and could afford a complete physical exam, my doctor told me that the accident had broken my wrist (perhaps when I lifted that steering column), but that it had healed itself fairly well. I also had suffered a serious concussion -- from smacking into the bullet-proof divider in the cab -- which explained my recent spaceyness but that too would dissipate eventually. Finally, I had fractured my left knee. It hadn't set properly, and it would bother me more and more over time. "You should have gone to the hospital," he scolded me. "Your knee will never be the same."
He was right. At 33, I can't run stairs or sit in a cramped airplane seat without a lot of pain.
All this came to mind while I watched President Clinton at the Democratic National Convention brag about allowing fired workers to keep their insurance after they lose their jobs. And then again last week, as he formed a committee to take, as an anonymous administration official put it, "a more temperate, cautious approach" to health care reform.
When it comes to health care, the last thing we need is more caution or temperance. If someone like me -- who had the best medical insurance an American worker can get -- has to refuse care because of its cost, something is very wrong with the system.
Since Clinton came to office in 1993, seven million more Americans have lost their coverage. Nearly half of all people who do have health insurance are stuck in the K-Mart of medical care: HMOs that tell doctors which tests to order and which drugs to prescribe. It's a scandal that residents of the wealthiest country in recorded history should have to consider a visit to the doctor of their choice a luxury.
Ten years after my taxi accident, I make more money but I still don't go to the doctor unless I'm sick as a dog. It's just too expensive. I'm still fighting off the remnants of bronchitis I caught over a month ago -- because I'm self-employed and don't have insurance. The self-employed are the fastest-growing segment of the workforce, but none of our so-called leaders have taken time out of golfing to address the problem of insuring those who work for themselves.
Recently, while traveling in Mexico, my eye became badly irritated. It was a Sunday. If I had been in New York, both the offices of my regular physician and my ophthalmologist would have been closed. In the U.S., a hospital emergency room would not have seen me unless I was bleeding all over the floor.
As it happened, the government clinic I visited in the city of Chetumal in southeastern Mexico was clean, well-maintained, empty of patients and staffed with every conceivable specialist. A friendly, efficient ophthalmologist, fluent in several languages including English, treated me immediately and simply handed me the drugs I needed -- all gratis. Mexican citizens don't have to choose between medical treatment and the rent. In this incredibly poor and desperate country, quality care is available quickly, conveniently and without charge.
President Clinton's 1993 attempt to reform the health care system failed, not because it went too far but because it didn't do enough. Americans have plenty of experience with insurers and HMOs that limit their options and don't adequately compensate their expenses, and the Clinton plan promised more of the same. Every day, Americans are going untreated -- even dying! -- because they don't have the same access to a simple, humane, socialized medical system as nearly every other industrialized nation.
Americans deserve the same quality of medical care as their Mexican and Canadian neighbors. Like firemen and police officers, physicians provide an essential public service that can't be entrusted to a capricious free market; it's only normal that doctors become government employees. If, as now seems likely, President Clinton is reelected, he should take advantage of a second term to propose -- and fight for -- true health care reform that guarantees that no American ever again has to think about money before visiting a doctor.
Of course, the cabal of insanely overpaid doctors and their insurance company leeches will howl, but every ride comes to an end eventually -- sometimes at four in the morning in the rain, with a thundering crash.