The pain of being ill and uncovered

July 5, 2009 

— This year, we have been granted government-subsidized converter boxes -- two $40 coupons per household! -- for our televisions. These coupons ensure, I suppose, that the un-cabled don't drop off the advertisers' grid. Whatever the reason for our leaders' generosity, it is so interesting to learn just when the government is prepared to intervene, and how far it will go, to shape our lives.

Apparently, Washington does want us to carry on watching -- and is willing to incur at least some trouble and expense to make sure that we do.

But with health care, government intervention isn't such a sure thing. Even Kay Hagan, the junior senator from North Carolina, and a Democrat, isn't sure about the virtues of a government-funded health insurance program. She must think it's a bridge too far for the government's road into our lives, and, of course, it sticks an oar in the waters of free-market activity.

Since immigrating to the United States 30 years ago, I have become more sympathetic to the distaste many Americans feel for government "interference." Now, when I hear my English sister's incredulous response to the news that, No, not everyone in the USA is required to have a G.P. and that old people here don't have to be periodically visited by a health worker to check on their well-being, I bite back a "Nanny State" retort. But old National Health Service habits from my English upbringing die hard.

In the end, I would argue that we in the United States now have to accept just that degree of government action and funding that will end the truly uncivilized and inhumane deprivation suffered by millions of uninsured fellow-citizens. There is no ideological queasiness on Earth that can justify such a huge gap in the social network that most of us profess to believe in.

When the Labor government came to power in the U.K. in 1945, after the country had kicked out Prime Minister Winston Churchill and the Tories, a brave new world seemed, and in a way was, about to be born. Government grants sent thousands and then millions of working- and middle-class children to universities, previously the province of only the rich, plus the occasional low-born scholarship winner. Government-run health care came in 1948 and the gnawing worries of -- mainly -- the middle-classes over the crippling price of serious illness were ended, at a stroke.

Before 1948, in the U.K., as now in the U.S.A., the very poor and the very rich had some medical security; but the huge middle class lived, and died, under the sword of Damocles.

This middle-class anxiety is voiced for us in a March 1945 letter written by an English woman named Eileen Blair. We still have the letter, because it happens to be from a member of a now-famous family: she was the wife of Eric Blair, a k a George Orwell, author of "1984" and "Animal Farm."

Mrs. Blair knows she is seriously ill, but she is worried about the cost of treatment. Orwell biographer Bernard Crick shows us that she writes thus to her husband, who is in Europe reporting on the end of the Allied push towards Germany:

"They want me to go in for this operation at once. This is all a bit difficult. It is going to cost a terrible lot of money. A bed in a kind of ward costs seven guineas a week and [the] operation fee is forty guineas . . . . But what worries me is that I really don't think I'm worth the money. On the other hand, of course, this thing will take a longish time to kill me if left alone and it will be costing some money the whole time. "

Eileen Blair's references to "guineas" have a Dickensian sound. But her words are only too relevant and familiar to us today in their layering of the pain and fear of ill health with oppressive financial anxiety.

How many of these same brittle dramas play out across the United States every day?

We cannot know, because the leading characteristics of the uninsured are silence and invisibility. They, or we, are the people who do not go for routine check-ups, for screenings or for the early treatment of those symptoms which presage disaster. Inaction is the key; such people are hidden from view until the curtain goes up on the inevitable Fifth Act in the Emergency Room.

In this season of political energy, we can end this particular type of home-grown human suffering and repair the tears in our social fabric. But if we want change to occur, now is the time to move. I hope Senator Hagan is listening.

Rosemary Haskell teaches English at Elon University and lives in Chapel Hill.

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