Liberian national Thomas Eric Duncan travelled to the US on a tourist visa, arriving September 20. He came to visit his companion, Louise Troh, and their son. Many suspect Duncan lied when leaving Monrovia (Liberia’s capital) on September 19, claiming on a governmental health form issued at the airport that he had not had contact with someone stricken with Ebola. Multiple reports claim that a few days earlier in Liberia, Duncan had helped carry a seriously ill pregnant woman to the hospital (Duncan’s nephew, Josephus Weeks, denies these reports.) Whether Duncan suspected the woman of having Ebola or malaria remains undetermined. The woman later died of Ebola. Most likely, Duncan contracted the disease from the woman. Duncan himself died in a Dallas hospital on October 8; he was originally sent home on September 25 from the same hospital with significant pain and a 103* fever. Two days later, September 27, he returned to the hospital via ambulance – this time to stay – eventually diagnosed with the disease that would kill him. Back to the fateful day, September 25, when Duncan originally came to Dallas’s Texas Health Presbyterian Hospital: a man of color with no health insurance sent home, after a few hours at the hospital, to fend for himself. Yes, Duncan was a foreigner, but it wasn’t the first time a patient without insurance was sent away in such a fashion.
T.R. Reid, in his book The Healing of America (Penguin, 2009), says that the US health care system doesn’t work for everybody because the American health care is more so a market than a system. In a market, people with money are able to buy what they want; others are left out. Reid does a superb job of making the case that the principle of health insurance and the pursuit of profit, in today’s world, are inherently conflicted. Many US citizens are unaware that its country is the only one of the developed nations that doesn’t offer universal coverage to its citizens. The U.K., France, Japan, Germany, Canada, and Australia are among those nations that care for all of its citizens, regardless of income and wealth status. What do to about foreigners – in the country legally or not – with no means to pay for treatment, like Duncan, is a crucial question that has implications for every one of us.
Reid documents the US health care system’s unfortunate inefficiencies and wastes in comparison with other countries: we spend the most on health care per capita and per GDP (significantly so), spend more on administration costs, and our fragmented system lacks the decisive incentive to encourage long-term preventative care. Whereas some 700,000 US citizens annually declare bankruptcy due to health care costs, other countries (Britain, France, Germany, Japan) have none who are forced to do so.
For those under the impression that the “free market” is the mechanism to cure all of our ills (pun intended), Reid’s presentation strongly argues to the contrary. Reid encourages (and I agree) that America go forward in health care by doing what it has done many times before: to pragmatically look around (in this case, to other nations) to see what works best and to incorporate those traits and practices to make our own system – which is the best in the world for a minority of us – much better for all Americans. These mentioned nations use market principles within their systems, but in a controlled manner. We can certainly do the same. Reid says fixing our fragmented system is a moral and ethical obligation, and reminds us that we are better off when all of us – not just some – have access to good care.
At first glance, some of us might not feel responsible for the health of a foreigner visiting on a tourist visa, but inaction or neglect can be deadly for the rest of the population. And it’s not only that Ebola or some other deadly disease might proliferate, as horrific as that would be in itself. We are weaker, more fragmented, and more vulnerable to social ills (violence, depression, higher rates of incarceration, teen pregnancy, obesity, shorter life spans) when social inequalities escalate. My book, Just a Little Bit More: The Culture of Excess and the Fate of the Common Good, establishes and develops this argument in detail.
Thank God for brave public servants – from military personnel going to the front lines of the Ebola breakout in Africa to nurses and doctors fighting the disease in our hospitals here. More so than ever – in this age of modern globalization – we are interconnected and have a shared responsibility for the good health and well-being of all.
Just a Little Bit More is available at the Blue Ocotillo Publishing website and through Amazon (paperback and ebook) and other booksellers and retailers.