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Last Monday night, the NewsHour with Jim Lehrer devoted air time to an exchange between two former secretaries of Health and Human ServicesâDonna Shalala, who served in the Clinton cabinet, and Michael Leavitt, who served under George W. Bush. One of Leavittâs comments was particularly striking:
This debate started out about 50 million people who didnât have insurance. Itâs now become about the 250 million who do and the things that will occur to their insurance when we essentially put the entire system under the guidance of the federal government and increase the cost to everyone. The debate has shifted away from just how do we care for those who donât have insurance to the impact that this law could have on those who do?
Itâs a point that the media, for the most part, have missed. Health reform coverage has mostly revolved around what the president and other pols have been saying, and theyâve spent a lot of time promising that the price of coverage will come downâa proposition experts believe at best is debatableâand that insurance reforms will make the big bad insurance companies behave themselvesâperhaps another debatable point. What they havenât talked much about are the health care needs of the poor. Not surprising, I guess, since middle class folks with insurance vote; those begging in the subway donât.
Which brings me to a subway incident the other day, which suggested another group of missing persons the press has yet to write aboutâthose at the very bottom of the income ladder. A crippled man, legs bowed out, his bent arms clutching to walking sticks, fought to open the heavy door that separates the subway carsâa difficult task even for those whose body works. âCan someone please help me open the door,â he cried out. No one at his end of the car got up to helpânot even the tall young fellow standing next to the door, apparently so absorbed with sounds from his iPod that he couldnât lend a hand.
The man was thin and gaunt, and pleaded for food. âCan someone give me some food,â be begged. He was hungry, and his shaky hand held an empty carton that once contained Tropicana orange juiceâhis tin cup. I thrust a few dollars into the carton, and he held out his wrinkled hand in thanks.
I saw this manâs predicament in terms of the health care debate and the point Leavitt made on the NewsHour. Where does this man fit in? Or does he? Even if Medicaidâabout to expand under reform–catches him and offers a medical olive branch, what about the other things which make a person healthy? Like housing, money for food, and nutritious food itself. If you donât have good nutrition, you donât have good healthâa point that has surfaced in the debate only as it relates to obesity and the amount that obesity-related illnesses will cost the health care system down the road. Damn those fat people!
Interest groups have linked illness prevention to obesity, playing the blame-the-victim game. But what about the thin man in the subway who is possibly starving? Millions more are like him. What were his health problems? Who was connecting him to services?Where are the reporters who are trained to connect all these dots? Who so far in the health debate has shown the courage to do whatâs right for everyone? And what was it that kept New Yorkers in the subway car from holding a door open for a crippled old man?
Some questions to ponder on the day before Thanksgiving.
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