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Plight of the Uninsured: What would it take to solve it?

First in a series Another death of another uninsured Minnesotan leads to provocative questions about why more than 7 percent of us lack insurance — questions Casey Selix will explore in an occasional series on health care, beginning

First in a series of occasional pieces on health-care policy.

My friend could have been a poster boy for the health-care industry. “Running is my health insurance,” he’d tell me as he set off for another run or signed up for a 10-K race. Another frequent refrain: “I’m in charge of my health.”

My friend died this month of colon cancer. He was 60.

He was self-employed and he was uninsured.

I’m not going to use his name because he wouldn’t want to be remembered for his lack of health insurance. He was not proud of it, but he was trying to make the best of it with a little bravado.

“My running is my health insurance. I’m in charge of my health.”

He just couldn’t afford the usual health insurance.

One among 374,000

Some might well say he couldn’t afford not to have it. Yet he was among the 374,000 Minnesotans who didn’t have health insurance in 2007, which statistically translates to 7.2 percent of the state’s population – reportedly among the lowest uninsured rates in the nation. Of that uninsured group, he was among the 20.6 percent called self-employed, the 3.7 percent with postgraduate degrees and the 68.3 percent who were unmarried. Though a Minnesota Department of Health Fact Sheet (PDF) has a lot of details, bar graphs and pie charts on the state’s comparatively good statistics, this fact stands out: My friend was 100 percent uninsured.

So, he ran, he played tennis, he swam, he lifted weights. He quit smoking decades ago. He appeared to be in great physical shape most of the time, though he liked to eat the foods we probably shouldn’t eat that often.

“Running is my health insurance. I’m in charge of my health.”

But because he didn’t have health insurance, he probably didn’t undergo the colonoscopy recommended at age 50 by the American Medical Association, the screening procedure covered by insurance. He ignored the symptoms until it was too late.

“I started feeling bad in March,” he told me a few days before he died, “but I didn’t do anything about it for a while.” 

Once diagnosed, little time
By the time he was diagnosed, he was given six weeks to live. The cancer had metastasized into his liver. He was turning yellow with jaundice, and his once-trim belly and muscular legs were bloated.

The discussion turned to whether chemotherapy would buy him time to settle his affairs and whether he had enough money on hand to pay for a round or two of treatment and how much he’d have to spend down what he had in the bank to qualify for Medical Assistance. He invested in prescriptions for morphine and diuretics instead.

I’m in charge of my health.”
He outlived the six-week, or 43-day, diagnosis by two days. Those 48 hours bought him enough time to enjoy a party in his honor, to see family, friends and clients gathered on a cool spring evening in a friend’s backyard, to let us wait on him hand and foot, to admire photos of him through his life, to listen to live Irish music once more with him, this time the plaintive wails wishing him farewell.   

When I share my friend’s story, people are visibly shaken. I’ve seen and heard enough reactions that I can confidently report the consensus: He didn’t have health insurance? What is wrong with our country’s health system?! Why don’t we as a nation, with all our wealth, have some form of universal health care for our citizens? Why is health care/insurance so expensive?

Looking for answers
Provocative questions. I’ll explore them in the coming weeks in a series of posts and stories.

Since 2001, I’ve been reading and collecting reports from various publications on our nation’s health-care issues, hoping somehow that I (an editor most of this time) could persuade others to report a public-service project asking these questions: What would it take to get universal health care in our state? What are the pros and cons? How would it work?

Trying to connect all those dots sounds daunting, doesn’t it? But now I must try to make sense of this predicament – for my friend and others like him. I have a lot of questions. I need some answers. 
A week after my friend’s death, presidential candidate John McCain was in St. Paul for a town hall meeting and I wondered if he might have some answers as I read MinnPost writer G.R. Anderson Jr.’s report on the event:

“The second question came from a woman whose son has a ‘chronic disease’ and the family’s health insurance can’t keep up with the bills. McCain looked positively morose, but offered nothing concrete on health care, other than saying to people who want socialized medicine, ‘I suggest you go to Canada or England.’ “

If only my friend had thought of that option.

Next: Minnesota’s 374,000 uninsured people could fill a city close to the size of Minneapolis. Who are the people in this population? Please feel free to pose some of your own questions for our ongoing series in the comments section below.