Dentistry, Health Care, and Bildad the Shuhite

I am ill tonight. I am sick to my soul.

Twelve-year-old Deamonte Driver died of a toothache Sunday.

A routine, $80 tooth extraction might have saved him.

If his mother had been insured.

This is not, in and of itself, an unusual story. In 2003, nearly 16 percent of the US population was without health insurance. In the US, health insurance is inextricably linked to employment. If you have a job with good benefits, you’ll have relatively low-cost health insurance. If you have a job without medical benefits, or if you are unemployed, you will pay tremendously for health insurance, assuming you can afford it. If you can’t afford it, you’ll pay more for basic health care than the insured plus their insurance company pays.

Let me say that again. If you do not have health insurance, doctors and hospitals will charge you more than they charge insurance companies. Chances are, you’re like me: you have health insurance. Have you ever looked at the claim reports your insurance company sends you? I happen to have received one today. In the itemization section, there’s the following:

Services Submitted Charges Eligible Charges Benefits Paid
LAB-PATHOLOGY $30.00 $6.971 $6.97

1YOUR BLUE CROSS PREFERRED CARE PROVIDER HAS AGREED TO ACCCEPT THE AMOUNT LISTED IN THE ‘ELIGIBLE CHARGE’ COLUMN AS TOTAL PAYMENT FOR SERVICES RENDERED.

Did you catch the footnote there? Our doctor normally charges $30.00 for labwork, but for our insurance company they’re willing to take $6.97.

This leads to a nasty spiral. If you’re employed in low-wage jobs or unemployed, you can’t afford health insurance. That drives up the cost of your health care, to the point that you start playing Russian Roulette with your ailments. You have to guess whether a given illness is bad enough to warrant going to the doctor. That leads to more health problems, which in turn cost more, and soon you’re circling the drain financially.

Insurance companies aren’t helping. They are notoriously optimized for short-term gains over long-term benefits. They’re public companies, and are driven by market forces that reward immediate cost savings. For instance, my insurance company will not pay for physicals, despite the lower cost of early treatment of diseases and cancers.

Deamonte Driver’s case is illustrative. Look back at the article.

Deamonte’s death and the ultimate cost of his care, which could total more than $250,000, underscore an often-overlooked concern in the debate over universal health coverage: dental care.

$250,000 to care for a condition that could have been solved at the beginning for some $80. In 2004, the uninsured cost an estimated $125 billion. That’s out of $1.9 trillion spent on health care costs overall. Roughly ten percent of health care costs are already spent on the uninsured.

We spend more on health care than any other country. Switzerland insures everyone at a cost of some 11% of GDP. Canada does it for 9.7%. Despite our higher rate of spending, our longevity ranks behind all other industrialized countries.

Even if you’re insured now, there’s no guarantee that a life-threatening illness won’t take all of your money and then some. In 2001, half of all personal bankruptcies were due to illness and medical bills. More than 75% of those driven into bankruptcy by medical issues had health insurance when their illnesses began.

There is an overwhelming financial incentive to fix how we pay for medical care. But for me there’s a strong moral component. Why are we willing to let the poor die from easily-preventable diseases?

Among many of my fellow Christians, there is the idea that the poor deserve what they get. If they are poor, it is because of choices they have made.

“Does God pervert justice? Does the Almighty pervert what is right? When your children sinned against him, he gave them over to the penalty of their sin.”

Job 8:3-4

Those are the words of Bildad the Shuhite to his friend Job. The story of Job is a troubling one. God takes away Job’s family, his wealth, and his health. Job and his friends then argue about why God did this to Job. The safe view of the story is that it explains suffering and pain. It doesn’t, really. You can’t turn to the end of the story and get a pat answer to why, in the words of Harold Kushner, bad things happen to good people.

What we do see is a portrait of how people deal with the problem of suffering. I find Job’s friends’ responses extremely enlightening. Their approach to comforting Job is to tell him to repent. “This is your fault,” they say. “Go back to living a righteous life and all will be well.”

This flies in the face of our experience. Ten-year olds realize that bad people prosper. Good people suffer. “Why do the wicked live on, growing old and increasing in power?” Job cries to his friends. And yet, so many of us cling to the idea that luck and circumstance play no role in people’s situations.

If you’re poor, it’s your fault. And that absolves us of our obligation to help.

“They also will answer, ‘Lord, when did we seen you hungry or thirsty or a stranger or needing clothes or sick or in prison, and did not help you?’

“He will reply, ‘I tell you the truth, whatever you did not do for one of the least of these, you did not do for me.'”

Matthew 26:44-45

I don’t have a solution to the health care crisis. I don’t even know what I personally can do to begin fixing the problem. But that doesn’t mean I should shrug my shoulders and accept the situation as it is. If this is the best we can do for the least of these, then surely we are all damned.

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