The Community Mandate

Really, I don’t understand how the professional commentariat does it; how do you express your opinions on an issue over and over again? Once it’s said, it’s said, isn’t it? (Maybe that’s why they  always seem to be writing and saying things that are more and more silly.)

Anyway, I’ve been reading about this week’s arguments before the Supreme Court about the Affordable Care Act, and I just keep getting more and more frustrated at how much of the country just keeps missing the central issue about healthcare policy. I would like to explain this in the simplest possible terms, but I already did, back in January, 2008, long before Barack Obama was even nominated to run for president. This op-ed column was originally published in The Record, a prominent New Jersey regional newspaper, under the title, “The Moral Price of Cancer”. I never liked or wanted that title, and I hereby republish it on Something Entirely Different as “The Community Mandate”:


When I found out that I had esophageal cancer last July, many worries came to me. Will I die? Am I going to be very sick?  Am I going to be disabled? How will I tell my children? My mother? The one thing I didn’t have to worry about was how I would pay for my treatments. As a retired civil servant, I have excellent health insurance.

Esophageal cancer is a very aggressive, very dangerous cancer; surviving it requires very aggressive, very expensive treatments. Since beginning my treatments on August 1, I have had twenty-five radiation treatments, six chemotherapy infusions, and two major surgeries involving more than three weeks in the hospital and six days in critical care units. I have also undergone two CT scans, two PET scans, four endoscopy procedures, and four weeks of IV nutrition with visiting nurses. Next week, I begin another four months of chemotherapy. If I am very lucky, that, plus five years of frequent CT and PET scans, will conclude my treatments and my insurer’s expenses. If I am a little less lucky, there will be more treatments and surgeries over the years to cope with metastases.

Since being told I have cancer, I have spent more money at Starbucks than I have spent on health care, even with having been unable to drink coffee for two months of my treatments. (Now that it is a new year, I will have out-of pocket costs again, until I have laid out one thousand dollars during the year.)

Rick Grimes, who lives in a small town in Texas, found out he has esophageal cancer last September. He is forty-nine years old, with a two-year old child, and was disabled by an on-the-job back injury. He has no health insurance because insuring his small family would have cost almost as much as his wife earns at her part-time job. Yet, the Grimes family is too well-off to qualify for Medicaid.

Consequently, nearly four months after his diagnosis, and eight months after his alarming symptoms first appeared, Rick Grimes has not yet received any treatment for his cancer. (As of this writing, he does have an appointment to see an oncologist for charity care.) The tumor in his esophagus has now gotten large enough to seriously interfere with swallowing. Rick, who used to be muscular and active, now weighs 116 pounds, and has been to the emergency room for IV hydration.

If Rick Grimes dies, his death certificate should list his cause of death as “lack of health care.”

If I die, I don’t want to have to explain to St. Peter why I stood by quietly and let people like Rick Grimes suffer and die.

We don’t need our religious leaders or texts to tell us that the first imperative of a moral life is to take care of the poor and the sick. We know this, in our souls, our hearts, our bones, our guts, or wherever it is that we recognize incontrovertible truth. And our religious leaders and texts do all tell us this, very, very clearly. Isn’t it ironic that the United States, which in every measurable way is the most religious of the developed nations, is the only developed nation that does not guarantee everyone within its borders adequate health care?

Because we will be the last of the developed nations to provide universal health care, it shouldn’t be hard to get it right. All we have to do is look at what the other countries are doing, and see what works and what doesn’t. Most of Europe has efficient and effective health care; we can do it too.

There is no political or economic ideal that can compare in importance to the great moral imperative to care for the poor and the sick. We cannot excuse ourselves with appeals for limited government or economic self-determination; if we continue to fail in this most basic human responsibility, we fail as human beings.

Cancer still kills a lot of people, some cancers more than others. If I live and someone else dies, or I die and someone else lives…OK, that’s the way it is. But when people are dying because we failed in our duty to care, it shows the cancer we have allowed to grow in our hearts.


(Less than three months after this article was first published, Rick Grimes died of esophageal cancer with metastatic spread to his brain.)

5 responses to “The Community Mandate

  1. Thank you so much for this, Paul!
    Our natural inclination to love one another, reinforced by our deep knowledge that it’s also a commandment from God, must bear fruit in institutions that provide for the common good and leave no one deprived of necessities — food, shelter, education, health care, and a meaningful livelihood within a sustainable way of collective life. If and when our political and economic institutions fail to do that — and they seem to be failing big-time in addressing the big problems of our time — something else must take their place. I find myself wondering what it will look like: monasteries or ashrams of charity? consumer cooperatives with credit unions and not-for-profit health-care plans? an underground railroad to off-the-grid organic collective farms? I simply can’t guess. But I know that God is Love, and is continuing to create us in His/Her own image in spite of our resistances, and is almighty. Love will create its own institutions of mutual care, eventually giving us a safety net with a heart that will not fail the Rick Grimeses of the next century, provided that we don’t cook ourselves in the meantime. Faith tells me that it must be so.

  2. This Friend speaks my heart and my mind…..

  3. Even though I signed a petition in favor of Obamacare I believe Hamellcare is properly focused.

  4. Now that we’ve been living in Canada for a while, the idea of NOT having universal health care just seems nuts. Would you have police or fire departments only for those who can pay in your community? Wouldn’t that hurt the entire community? Allowing people to live in fear of illness, with all the attendant distortions that has on their own lives and their community’s well-being, because they don’t have “enough” money makes no sense, economically or morally.

  5. A close relative of mine was diagnosed w/ late stage ec & we are so lucky we changed health plans last year to BC/BS personal choice (he is also an employee of our small family biz). Altho he has a hi deductible plan of $3000, he hit his limit within days of being diagnosed. Since that point in time he has racked up a fortune, but all has been covered with out a hiccup. Needless to say the plan we have costs a small fortune. We have continued to pay for his BC/BS even tho he is eligible for medicaid due to his disability because we know it covers everything & worry there will be gaps in medicaid coverage. I can not even begin to imagine the horror the Grimes family faced in not being able to obtain proper treatment. They were given a death sentence due to their unfortunate situation. Our family sacrifices a lot to pay for our medical coverage & sacrifices even more to continue paying for our long term employee/relative because we want him to have good care. Altho we may be successful by other’s terms, we don’t have new cars, don’t go on fancy vacations, we work like dogs & we spent about $25,000 on my family alone last year for med insurance, deductilbes & dental care. I do see many people who can’t “afford” health care but are able to afford luxuries that our family goes without. I do think health care should be mandatory because if everyone who was truly able to pay for insurance did, people like the Grimes family who were in real need would be able to be provided for by the system. I believe if many of the people abusing the system were forced to pay for their own care, costs would decrease & we all could get better coverage. It is a matter of priorities for many people. Can’t afford health insurance? Maybe people could if they stopped buying new cars, cut out expensive cable tv, cell phone plans, eating out constantly, etc.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s