What to do about the health care invincibles?

  • Article by: MIKE MEYERS
  • Updated: January 4, 2014 - 4:10 PM

Currently, they don’t buy insurance and get bailed out if ill or injured. We must reverse the incentives. Here’s how.



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In the heat of a softball game last spring, a runner was dashing to score. He slammed into both home plate and the catcher. The umpire called him safe.

Safe was the wrong word. Shattered was more like it. Mike’s ankle had snapped, leaving his foot hanging at a right angle to his leg.

Until that day, Mike, a sturdy, vigorous 31-year-old, had been an “invincible” — part of a generation of young, healthy people with every expectation of well-being and little prospect of occupying a hospital bed.

What happened next to Mike, the son of my old college roommate, is the tale of a brand of charity that must be abandoned if the transformation of American medicine, called the Affordable Care Act, is to succeed.

After surgery and weeks of physical therapy, Mike had run up medical bills of more than $35,000. But he was lucky enough to find himself in a Raleigh, N.C., hospital that made a deal with him — a patient with two part-time jobs, no health insurance, no savings and no prospect of paying so large a bill.

Mike ended up owing less than $5,000, a third of his annual income. His parents paid that tab. The hospital wrote off the other $30,000.

With the arrival of the new year, Mike may not be so fortunate next time. And if Obamacare is to succeed, his luck should run out.

One of the great mysteries in the introduction of Obamacare centers on how hospitals will handle patients like Mike. Let’s hope it’s less kindly, at least from an economic point of view.

The Affordable Care Act should change the way hospitals collect from patients — imposing financial consequences not written into the law.

Mike is one of millions of young people who have made a habit of living day by day, giving no more than a passing thought to health coverage.

Republican saboteurs, trying to undercut the rollout of Obamacare, have been taking out surreal TV ads (featuring a grotesque “Uncle Sam” alternately playing gynecologist and urologist) aiming to convince young people that they don’t need insurance.

They’ve even flitted around the country holding pizza parties to preach against what is supposed to be a conservative’s North Star — personal responsibility.

In a perverse way, Mike’s nearly free ride makes the right-wingers’ case.

Like many young people, his access to health care came through a visit to the emergency room. Republican presidential nominee Mitt Romney famously endorsed that way of providing care to the uninsured during the 2012 campaign.

Never mind that emergency rooms don’t have help for people with chronic conditions, such as diabetics in need of daily insulin shots, Parkinson’s patients who depend on drugs to curb symptoms of their disease, cancer patients who require chemotherapy or any of countless other people with illnesses that are grave but don’t fit the description of an emergency. And forget that the emergency room represents the highest cost of any routine health care — a cost absorbed by everyone else when the visitor to the emergency room cannot pay for the care.

Hospitals soon will have to reexamine an important question. How much care should a uninsured patient receive?

The apparent answer of Republicans, who have no health care plan to call their own, appears to be whatever it takes to fix the immediate problem. Concentrate on now, not on tomorrow.

In Mike’s case, that might mean straightening the ankle and applying a cast. But surgery? Let him limp.

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