HEALTH CARE/Joan Retsinas

Congress Flunks the Jimmy Kimmel Test, or The Deserving Sick

On late-night television, Jimmy Kimmel launched his test. Should a child born with a severe anomaly be denied treatment because an insurer says “no, it was a pre-existing condition”?

Budget Director Mick Mulvaney responded “No, But.” In that “But,” Mr. Mulvaney, on behalf of the Administration, added his spin to the test. He injected the distinction between the “Deserving” and the “Undeserving” sick. He agreed that health insurance should pay to treat the infant Billy Kimmel, but elaborated:

“The question is, who is responsible for your ordinary healthcare? You or somebody else…That doesn’t mean we should take care of the person who sits at home, eats poorly and gets diabetes. Is that the same thing as Jimmy Kimmel’s kid? I don’t think that it is.”

We have given a 21st century twist to the distinction between “deserving” and “undeserving.”

Here is a primer into this linguistic nuance. A patient who has not contributed to the malady is considered “undeserving” in terms of illness: s/he did not bring it on. Consequently, that patient “deserves” treatment. So, for Billy Kimmel, born with a condition that required open heart surgery, insurers absolutely should pay. The baby was not responsible. (Happily, the baby had the surgery.)

On the other hand, an overweight, sedentary, alcoholic who sky dives (you fill in the contributing “bad” behavior) “deserves” his illness, and, hence, is “undeserving” of subsidized (whether by taxpayers or by others in his “pool”) health care.

The notion of the deserving sick evokes the Victorian distinction between the deserving poor (those who through no fault of their industrious selves did not deserve their poverty, hence deserved subsistence, if only poor farms) and the undeserving sluggards who deserved their Dickensian squalor.

But the blame for illness is difficult to parse. The question becomes: what did the patient do? Or not do? To contribute to the malady?

The test is ludicrous. While behaviors contribute to many illnesses, so do environmental pollutants, genes, and luck. Solomon would despair at judging. A bicyclist riding without a helmet is injured when a driver, drunk, hits him. Do we allot 50% “cause” to the cyclist? What if engineers established that a helmet wouldn’t have helped? A thin man who runs marathons gets diabetes – no blame there. What about a thin sedentary man? A child living in a tenement infected with mold has asthma. Are the renter-parents to blame? The landlord? If the apartment is part of a public housing complex, should the government pay for the child’s medical care? What about the child who goes to a public school infected with mold? (Rhode Island has a few schools that meet that sad criterion.)

The reality is that insurers want to keep costs down – which means excluding expensive treatments. Before Obamacare, insurers routinely invoked “pre-existing” exclusions, the codicil that let insurers carve out whatever conditions the new enrollee had – and refuse to cover them. An enrollee who enrolled with a diagnosis of cancer would wait up to a year before the insurer would cover chemotherapy (though the insurer would cover surgery for a broken leg, unrelated to the cancer, right away). Insurers, though, did not cloak those exclusions under the guise of personal failure.

Understandably, the public loathed those exclusions. Most people as they age develop some condition. Obamacare abolished those much-loathed codicils; and, in the election-time debates over health insurance, the voters, Republicans and Democrats alike, made it clear that they wanted that abolition to stand.

This administration, however, wants to let insurers bring back this reason to say “no.” “Pre-existing condition” exclusions are on the bargaining table, part of the embryonic American Health Care Act.

The Kaiser Family Foundation estimates that 6.3 million Americans (77% of the total number of Americans with a “gap” in coverage) have a “declinable pre-existing condition.” That represents a major savings for insurers.

Conservative legislators cloak the exclusion in blame: we won’t insure whatever you have if you were responsible.

Congress, and the Administration, should look in their mirrors. If the American public voted them out of office, and they applied for health insurance, would they have a “declinable” pre-existing condition? If yes, are they overweight? Sedentary? Do they exercise too little? Drink too much? Smoke? Eat the required number of fruits and vegetables? Do they pass the Jimmy Kimmel test?

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, July 1-15, 2017

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