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Updated on September 26, 2009

Can you afford to stay alive?

By Dr Robert Sprackland

America is wrestling with one of the most important issues that ever faced the nation, healthcare reform. Typical of the American system of government, the specifics of the issue have become largely divorced from facts and our best interests and wed to politics and bumper-sticker slogans. This is especially peculiar, though, when we consider that mutual care of ourselves is a subject specifically stated by the Founding Father in a document called the Constitution, way back in 1787. In fact, it rates mention up front in the very first sentence of that document:

“We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”

How the question of whether universal healthcare should be considered a right or a privilege became politicized is not so important, for America has a government that is famous for trying legislate everything from recognition of a winning football team by Congress to requiring a president to go on record about his personal sexual habits. But healthcare is an issue that truly is universal; the health of one person very directly affects that of many others, and in several important – not trivial – ways. I am going to provide some examples.


Let me start with the dollars-and-cents of healthcare, because all political arguments ultimately fall back on cost/benefit analyses. According to a 2005 report published by the prestigious Commonwealth Fund (1), American businesses lose about 485 million workdays due to illness and disabilities. That represents a loss of about $260 billion in earnings, taxes, and productivity, or about the equivalent of the annual budgets for the states of California and Florida combined. (2) I don’t see how such losses become the sole concern of one political party over another; these lost hours led directly to increased costs for all consumers.

Now add another fact to this loss of productivity. According to the Commonwealth Fund report, “workers without paid time off to see a physician are more likely to report missing work or being unable to concentrate at their job.” (1) That means uninsured workers represent a majority of those lost work hours. Employers have long claimed that providing health benefits to workers is too great an expense, but if the covered workers took less sick time, wouldn’t the expense be eliminated?


The state of California passed a law in 1994 that barred illegal immigrants from receiving government-funded healthcare. Specifically, Proposition 187 required publicly funded health care facilities to denycare to illegal immigrants and to report them to governmentofficials. (3) Perhaps the most well-known tragedy that followed passage (but not enactment) of Proposition 187 was that of 12-year-old Julio Cano, a child of illegal immigrants. Julio was denied non-emergency medical care when his father brought him to a clinic. His father thought Proposition 187 was already in force.

“We went instead to a clinic, but they said there was no emergency,” said the boy’s father. “We waited until Friday, pay day, so we had $60 for an examination. They said there was something wrong and gave him antibiotics. Next morning, my Julio died." Julio’s death resulted from acute leukemia and a secondary infection; antibiotic treatment alone was completely inadequate. Incidentally, Mr. Cano took the day off from work after he got his $60. (4)

Leukemia, though, is not contagious, and it is contagion that most strongly provides the essential need for universal health care. Tuberculosis, swine flu, West Nile virus, and so many other potentially fatal illnesses are highly contagious, are not unable to breach gated communities, and do not attack only legal residents. To think otherwise is beyond foolish; it is, truly, stupid and a threat to all of us. In 1994, citizens who supported Prop 187 refused to understand that as immigrants begin to  avoid seeking medical care and immunizing their children, the likelihood for all of us contracting infectious diseases increases to dangerous high levels. According to the Los Angeles Times, “prenatal examinations at the Community Health Foundation of East L.A. have dropped by 60 percent since just before the (1994) election. Immunizations against infectious childhood diseases such as the measles, polio, and diphtheria have nose-dived sharply. At Clinica Oscar Romero in Pico-Union, patient visits declined by more than 50 percent during the first five days after elections. On a recent weeknight, the usually bustling Free Clinic in Simi Valley was empty.” (5)

The proposition was ruled largely unconstitutional in 1998, but the fact that such an issue can win voter support shows the likelihood that Americans will value dollars over health. It is rarely explicitly stated that the health (or lack thereof) of one of us has direct affects on all of us. With international travel and the speed at which we move from one locality to another, it is foolish to believe that any contagion will be contained to one place or ethnic group. Failure to establish a universal healthcare program that will actually promote the public welfare will leave us in a situation where only those who can afford healthcare will get it; for the rest of us, it will still be a case, often, of “go ahead and die.” (6) Perhaps if Americans had been as circumspect about starting a war in Iraq as they are about establishing healthcare reform, funding universal coverage would be a far less difficult problem. Getting back some of those 485 million workdays certainly can’t hurt!

References –

(1) Health and Productivity Among U.S. Workers. Karen Davis, Sara R. Collins, Michelle M. Doty, Alice Ho, and Alyssa L. Holmgren. August 2005;

(2) 2007 State Expenditure Report. National Association of State Budget Officers, 2008;

(3) Denial of Care to Illegal Immigrants — Proposition 187 in California. The New England Journal of Medicine, Volume 332(16):1095-1098, 1995;

(4) Boy Whose Parents Feared Deportation Had Leukemia. Lee Romney and Jeff Brazil, Los Angeles Times November 24, 1994.

(5) The Aftermath of Prop 187; Licensing Human Rights Abuses Against Racial Minorities. Sarah Song. 1995;

(6) Go Ahead and Die (Pirates of the Health Care-ibean).

Dr Sprackland has taught anatomy and physiology to pre-medical and nursing students for nearly two decades.


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      Tina Gardner, MD 8 years ago

      A government sponsored health care insurance option for people who would rather buy it instead of overpriced private health care insurance is a very sensible option. It might even force private insurance companies to curb their greed in order to compete successfully with it. The resistance to implementing such a system seems to me to be the height of selfishness by more-fortunate Americans.

      Tina M. Gardner, MD