I met Randy a little over 4 years ago. He was living down the road from my church and started coming in every Sunday morning for the service. Every once in a while he would ask for help with something – a ride, or a little bit of food. One day he came in and told me that he was getting kicked out of his house and would be homeless by the end of the day. Randy had a pretty rough go of things as an adult. After a stint in the Army he found himself a drifter, moving from shelter to shelter across the country trying to find a home. He worked along the way and picked up skills in construction. He ended up back in Indiana because both his parents lived there, within an hour of each other.
A few years before I met him he was living in a homeless shelter in Grant County. He would pick up odd jobs during the day, sometimes just volunteering his time and talents. One day he was helping another resident move a refrigerator up some stairs for an elderly lady. The stairs gave out from under Randy and he fell through with the fridge on top of him. He broke his back. He mounted up somewhere between $30k-$60k in medical bills and went through multiple surgeries. Randy couldn’t afford medical insurance so these bills just mounted. He found a free clinic that would see him and prescribe pain meds but he soon became addicted to the pills. It was his addiction that led him to me. He was being accused of stealing pills. I don’t doubt that he stole them. When Randy was high he didn’t have much awareness of his actions. Without the pills he lived in severe pain, but with them he was a mess.
Had Randy been able to afford a primary care physician he may have had the chance to try other medicines that could control his pain without the addictive side-effects. He might have had regular checkups that would put him on a path towards healing rather than towards a destructive cycle of addiction and homelessness. Because he was poor his primary care was the emergency room. With each painful visit his bills mounted. I worked with Randy for a number of years. I took him to disability trials, doctor appointments, and helped him find a place to live. He found odd jobs to pay his rent but they always landed him in the hospital. He was disabled, plain and simple, rendering his manual labor skills moot. Through a program at a local social service agency he was able to find permanent housing and after years of waiting finally started receiving SSI so he could afford it. He even got his meds mostly under control.
Randy’s girlfriend came to my office this morning. She can be pretty dramatic so I wasn’t surprised to see her a bit flustered. She was looking at me through her periphery. Her voice was quick and desperate when she told me, “This isn’t good. Randy died last night.” She thinks he may have died because of a tumor he had on his head, but she wasn’t sure.
This morning the United States Supreme Court heard arguments against the Affordable Care Act passed by Congress in 2010. Though this is a complicated issue the basic question is whether or not Congress has the power to require people to buy insurance. The counter is that everybody participates in the healthcare system at some point. If a person without insurance has to access healthcare and cannot afford it those costs get passed on to others through rising healthcare costs and through taxes. The Affordable Care Act also expands coverage for low-income folks. As I mentioned earlier, Randy’s primary care was the emergency room. In 2009 the average cost for a visit to the ER was $1,318 (Medical Expenditure Panel Survey). When folks like Randy can’t pay their bills these costs get passed on to others, which doesn’t make the bill go away. An average visit to my doctor costs me $167. One 2010 study shows that ¼ of all regular doctor visits (non-emergency) are made in the ER rather than with a primary care physician (http://content.healthaffairs.org/content/29/9/1620.abstract). That’s 88,500,000 ER visits a year. Of those, more than half are made by patients who have no insurance. That’s over 44,250,000 visits a year, with an average cost of $1,318 per visit, that gets passed on to other people and to our government amounting to a total cost of around $58,321,500,000 a year to care for the uninsured. These numbers are a gross simplification but demonstrate the cost of health care in our current system. And none of these costs go to preventative measures which would keep people healthy, ultimately saving more money.
But right now, these numbers mean squat to me. A friend of mine died because our society didn’t take care of him. He wasn’t deemed worthy of having adequate health care in a society that thrives on gluttonous consumption. We failed Randy and, I’m afraid, millions of people like him. This isn’t about conservative vs liberal. This isn’t about ousting a president or towing a party-line. This is about human dignity. What will history say of a society that has more money and resources than any society before it but who won’t feed, clothe, and protect the most vulnerable of its citizens? It will say that we failed. I’m sorry, Randy.