A few days ago, I got one of those calls no parent wants to get. “Dad, I am at the emergency room.” Our elder daughter, Mary, channeled her father’s innate clumsiness and broke her leg.
Thankfully, all will be well. She was seen in the ER, then by a specialist; she had X-rays and tests run and a cast put on her leg, with plenty of good follow-on care already scheduled. All this was possible, without the dark specter of life-altering medical debt, because we are blessed with really good socialized medical care, thanks to my service in the military. I, like the politicians who vilify socialized medicine at every turn, am a grateful beneficiary of it.
But what if that weren’t the case? What if I and my family, like so many Americans, had no health insurance, or were underinsured to the extent the co-pays and deductibles would bankrupt us? What then might a broken leg have to say about our society?
Margaret Mead, a renowned anthropologist of the 1960s-70s, answered this very question one day when a student asked what Mead considered to be the first sign of civilization. Author Remy Blumenfeld recounted the story in a March issue of Forbes.
The student, as we might, expected Mead to say the first sign of civilization is a certain tool, or form of pottery or perhaps religion. But, no — Mead said the first sign of civilization can be seen in a broken femur that has healed. Mead explained that in pre-civilization, if your femur breaks, you are dead. You will be eaten or starve long before it heals. But, a healed femur means other people stayed with you and cared for you, protected you — put your life above their own self-interest — long enough for the bone to heal.
Civilization, then, exists when and only when people care enough to put others’ welfare above their own self-interest — at least enough to keep others from suffering excruciating and utterly preventable deaths. In anthropological terms, then, how does the United States measure up?
Let’s review a few facts, with the premise up-front that wonderful health care does exist in this country, practiced and taught by many fine men and women. But, how accessible is that care?
Today, America is the only industrialized nation in the world without universal access to health care, despite spending more per capita than any other industrialized nation on health care, according to data from the Organisation for Economic Co-operation and Development.
According to a Census Bureau report, 27.5 million people, 8.5% of the population, went without health insurance in 2018 — an increase for the first time since Obamacare took effect, including a sharp increase in the uninsured rate for children. The worst uninsured rates were in states that bucked Medicaid expansion: Florida, 13%; Georgia, 13.7%; Oklahoma 14.2%; and Texas, 17.7%. So, we beat Texas. At least we have that.
But, even worse than the uninsured rate is the huge swath of Americans who have health insurance, but who can’t afford to use it. A 2018 study by New York-based nonprofit Commonwealth Fund found almost a third of Americans who have insurance are underinsured — meaning their insurance can’t cover a major medical event, or they don’t have the money to pay for co-pays and deductibles if they have an emergency.
The report found 41% of underinsured adults delayed needed medical care because of cost, and almost half reported debt problems because of medical bills or uncompensated loss of work. A separate 2018 study published in the American Journal of Public Health found two-thirds of all bankruptcies in the United States are tied to medical issues — again, due to either uninsured costs of care or unpaid time out of work.
So, going back to Mead’s assessment of civilization — how do we stand up? Well, for some, we are a civilization to be envied. Excellent health care by top-notch professionals is available. The broken femur of Mead’s litmus test can be healed. That is, of course, as long as you have the key to the American version of civilization — money. Lots of money.
But, if you don’t have that key, well, then, you are effectively not a part of what passes for civilization in America. Without money, something as simple as a broken bone can mean the loss of home and stability. Without insurance or the means to buy it, Americans are passing up needed medical care, skipping insulin doses and leaving diabetes, heart disease and other ailments untreated.
And these are not people who lack the key to civilization because of lack of effort. According to the Kaiser Family Foundation, more than 80% of uninsured Americans and virtually all underinsured Americans are in working households. They simply don’t earn enough from their labor to buy their way into what has become of civilization in America.
So, are we civilized in this country? Sure we are — if you can afford to buy your way in. But, those who don’t have the key of wealth are increasingly left behind to die preventable deaths, just as much as a pre-civilization victim with a broken femur. For them, life outside the select realm of wealth remains, as Thomas Hobbes put it, “solitary, poor, nasty, brutish, and short.” And that, by any standard, is not a civilization that deserves to be called great.