A middle-aged man is sitting, head drooped, on a portable stool in the middle of the pavement, with a makeshift cardboard sign on a string around his neck. Since my arrival in the US, it’s been such a common sight to see people — or “bums,” as they are dismissively called here — begging that I almost didn’t read the sign. But this one stopped me in my tracks.
Scrawled in crayon, it read: “Please Help. Colon cancer. Lost my job. Can’t afford the rest of my treatment.” The message was as simple as it was brutal. Here was a man, it turns out, who had until recently worked at a job that came with health insurance, but when the job went, his access to life-saving treatment went with it.
The fact is that it would be hard to swing the proverbial cat here without hitting someone with a tale to tell about healthcare. It’s ubiquitous. From dinner party conversations to the young campaigners in the street asking for a donation to help counteract the insurance company lobbyists in Washington, everyone wants to have their say.
Peter works in my local independent bookshop in Berkeley, California, and is keen to learn more about the British state-funded National Health Service (NHS), and to explain why getting sick in the US can be so perilous. Peter works part-time and earns a modest income. He has been without employer-based health insurance — something tens of millions of Americans rely on to pay for medical bills — since he became disabled, and is perplexed by people who want to retain a system that means millions of people like him are denied basic treatment.
“It has to work, it just has to,” he says of US President Barack Obama’s plans to reform healthcare so that the 40 million Americans currently without health insurance have access to some, and so that those depending on employers to provide it don’t end up denied life-saving treatment should they be unlucky enough to lose their job.
“The status quo is simply unacceptable. But whether we get the reform we desperately need ... well, that’s another thing altogether,” he said.
As we talk, other people browsing in the shop join in. It’s as if they are desperate to talk about it, to get their concerns off their chest.
“It’s a terrible situation this country is in and it can’t go on,” a slight, middle-aged woman proffers. “It shouldn’t be the case that a whole family ends up in dire straits because someone gets ill, but that’s what happens here.”
While still a teenager, the woman’s mother, who was the primary breadwinner, was suddenly seriously disabled and the family’s meager insurance coverage quickly ran out.
Their limited savings were swallowed up, as was any chance the children had of going to college, because the money set aside to pay for education was also consumed by healthcare costs.
“That’s what I don’t understand about the people who object to [state] healthcare provision,” the woman said. “Don’t they understand that anyone can get sick? Don’t they understand that it’s not that person’s fault? If someone gets ill, it can mean a whole family going under. What kind of society are we that we can let that happen?”
At times, it feels as if healthcare reform here is being steered, and possibly even derailed, by those who have the most money and lobby for insurance firms, or by those who shout the loudest.
As the British general election approaches, it’s expected that healthcare will be deployed, as ever, as a political football. There will be plenty of to-ing and fro-ing about quality of care, waiting lists, targets, privatization by the back door and curbing public expenditure.
What people won’t see, however, is politicians suggesting that there shouldn’t be a National Health Service.
What people in Britain won’t see is anyone seriously suggesting that if you don’t have money, then tough luck, the cancer will just have to get on with the business of killing you.
What they won’t see is the man or woman who lost their job in this recession sitting in the street asking for a few pennies to help pay for their cancer treatment.
Mary O’Hara, a Guardian social affairs writer, is the Alistair Cooke Fulbright Scholar at the University of California, Berkeley.
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