Plight of 'The Uninsured' Nearly Hits Home

John Commins, for HealthLeaders Media, April 8, 2009

Two weeks ago, I was in my backyard here in semi-rural Vero Beach, FL, armed with a pellet spreader and locked in mortal combat with fire ants, when I heard the impact of a crash in my front yard. I ran around the corner of the house and found a young woman sprawled on her back in my front yard, conscious, but clearly frightened and in pain. A few feet away lay a Harley-Davidson motorcycle, wedged against an electrical transformer that had been knocked off its concrete foundation.

I yelled for my wife inside the house to call 9-1-1, and ran to the woman's side, told her not to move, told her that an ambulance was on its way. The first words out of her mouth were "Don't call an ambulance. I don't have insurance. I can't go to the hospital. I can't pay for it." That may not be an exact quote but it was pretty close.

The woman had been learning to ride the motorcycle on our quiet side street when she reached the corner, panicked, and hit the throttle instead of the brake. Fortunately for her, she wasn't going too fast when the motorcycle hit the transformer, throwing her over the green, three-feet-high, steel box. Otherwise, she would have hit the side of my house and sustained very serious injuries against a less-forgiving brick wall. The ambulance arrived about 10 minutes later and she was transported on a stretcher, her neck in a brace. I saw her a few days later hobbling around on crutches, her leg in a full splint.

Once the ambulance left and the neighborhood settled down, I had a chance to reflect on what that young woman said as I picked blue metallic Harley paint chips off my lawn. I was angry. I thought "what does it say about our nation if a frightened and injured accident victim's first thoughts are about her inability to pay for care?" What if I had honored her request and cancelled the ambulance? Would she have dragged herself home?

Later, upon further review, I realized the issue was more complicated. It's easy to pull a Michael Moore, shake your fist at an unjust system, and demand "free" healthcare. But I also had to wonder why the young woman didn't have health insurance. She wasn't yet 20 years old, so maybe she thought she was invincible. Maybe she couldn't get a health plan through her work, or maybe she was unemployed, or maybe she believed she couldn't afford a health plan, regardless of her job status. Here in Florida, however, they have a new, low-cost health insurance plan called Cover Florida that's received extensive publicity. Why hadn't she enrolled? Why was she riding a motorcycle if she wasn't properly insured? Turns out, she didn't have a motorcycle operating license, or auto insurance, either. Florida Power & Light Co. will send her a bill for the damaged transformer.

I thought about that minor accident and the circumstances, and extrapolated for the 47 million or so uninsured people in this country. The questions quickly overwhelmed the answers. How many Americans are uninsured because they either can't afford it or can't get it because of a dreaded "pre-existing condition?" How many are uninsured because they don't think they'll need it, or because they have no assets to protect? Can we have universal healthcare without mandatory premiums? How will those premiums be collected? Who will set the rates? Will they be deducted from paychecks like the payroll tax for Social Security? Can a deeply divided Congress reach a consensus for such reforms? Would we the people make it work?

There are larger philosophical questions too. Where does society's responsibility for the health of the individual begin? Shouldn't the individual also have a share of the responsibility to maintain his health? We talk about healthcare being a right. Shouldn't it also be a responsibility? Are we doing everything in our means to give people the tools to take care of themselves? Does universal coverage mean universal care?

Healthcare leaders themselves are divided on this question. In overall results from the HealthLeaders Media Industry Survey 2009, respondents vary on which model offers the best hope for healthcare: government-mandate universal health insurance, 25%; government-funded universal healthcare, 22%; consumer-directed healthcare, 34%; employer-sponsored healthcare, 11%; and other, 9%.

So, in that very small episode that near-literally hit home, I got an up-close-and-personal tutorial on the incredible complexities hidden in a simple term like "healthcare reform." It's a lesson that hospitals and healthcare providers review every hour of the day, and usually in far more dire circumstances.

As a columnist, you can pick an ideology on healthcare reform that suits you and run above the fray without getting your shoes bloody. It gets a lot more complicated when "the uninsured" are real people, lying on the ground in front of your house, injured and scared, broken, and broke.

John Commins is the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached at
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