The Rabbit Hole

post by Paul Kelleher (@kelleher_)

This tragic NYT op-ed is a must-read, as is Harold Pollack's reflections on it. 

The author frames the story as one about healthy folks who forgo health insurance to make ends meet, but who are terribly unlucky and then face a horrendous medical and financial future. Pollack adds that in addition to ensuring that people don't (or don't have to) take such gambles, health reform is also about taking care of one another.

I want to add one layer to what the author and Pollack say. The author of the op-ed says that it was a car accident that ruined her sister-in-law's life. Perhaps it was somebody's fault. But perhaps not. I do not want to live in a society where I can be the cause--perhaps negligent, but perhaps innocent--of someone else's medical and financial ruin in the blink of an eye. And yet any one of us, at any time of the day, in the blink of an eye, can go from happy, reputable member of the community to the person who was involved in ending someone else's life as they knew it. We are not the only potential victims of our own missteps. And still I am certain that my liability insurance certainly would not have begun to help this woman if, heaven forbid, I had been a partial cause in what she now faces. That is one reason (among so many others) to ensure that no one in our society is left to fall down the rabbit hole.   

Comments

[Brad F]

Paul
I think the more intriguing discussion relates to whether, in a society where a Paul Starr type option exists (sans mandate), and a "rugged individualist" chooses to go bareback, what then?

Harold approaches the tragic case above in ACA default mode (with the mandate, "this would not happen"). Of course, he might be referring to the plight of individuals ONCE they are in a 2014+ Medicaid program--with or without pre-existing coverage.

Regardless, I think this is a sensible test case for folks with more conservative or libertarian leanings. Essentially, in the coverage environment you envision--the world of opt out--what do we do with this patient?

If the answer is not let them die, its time to rethink plan.

Brad