As the presidential debates get revved up, I have been scrutinizing their health care plans.  Both candidates rightly insist that something must be done to cover the ballooning and exploding population of uninsured in this country.  For both, the solution will likely include a hit to the pocketbook of Joe Public, whether through taxes, or through private insurance companies that we are required to purchase coverage from.  This has the standard libertarian masses quite upset.  One thing I am hearing more and more about in the argument against universal Health care coverage is “those people.”

Those people are the ones who sit at home and play video games on unemployment.  Those people are the ones who are on crack and meth, spending money on it instead of diapers or health insurance.  Those people are the ones who don’t exercise any responsibility for their own health and a fat, lazy, smokers all.  Those people are a drain on our economy and a blight on our society. 

      I have absolutely no question that taking responsibility for our own health is vitally important and is dying.  I do understand some of the worry about entitlement mentality.  I have on occasion seen some of “those people” in clinic who may be suffering the consequences of their choices and actions. 

     Here is the problem.  They are generally not my patients, they are the parents.  Often they are the absent parent, you know the stereotypic “deadbeat dads” we all rightly condemn.  You see, single mothers have a very difficult time getting jobs with health insurance.  Especially as businesses are hurting as they try to pay for it, cutting more and more benefits. 

    Here is another problem, epilepsy.  It turns out that anybody can have seizures.  They may strike at any point in someone’s life and are particularly common in childhood.  They commit you to at least two years of drug therapy.  They raise insurance prices for us all.  For people who are angry at rising health care and insurance costs, I fear too many will become those people.  Too many will be thought to have seizures from drugs because they don’t have insurance.  So what if premiums are five times what someone in good health’s might be.  It’s okay because they are “those people.”   

    Insurance companies have motive to charge or exclude the smokers and the obese.  It turns out they have the same motive to exclude those with Cerebral Palsy and Multiple Sclerosis.  This motive applies to any family with cystic fibrosis or sickle cell disease, or an entire host of genetic disorders.  They really need to get rid of those with type I diabetes and as we start to push against type II diabetes as caused by obesity and not taking care of yourself, Diabetes is diabetes, right?

   Wrong, they are completely different diseases, the former with no lifestyle factors, hitting people almost at random and committing them to a lifetime of expensive insulin and increasing risk for severe health problems as they age, the latter with lifestyle factors that have become alarmingly commonplace, even normal. 

“Those people” can be stretched to cover a variety of lifestyle choices.  “Those people” could include Sarah Palin and the like, for refusing to abort babies with down syndrome.  “Those people” could in the future include any parent who does not abort for any bad gene whatsoever.  Certainly, It must cost less to genetically engineer healthy children than care for “those babies.”    Eventually, “those people” could be anyone that is not part of the master race with the right hair, eye and skin color.  After all, we all know “those people” are no good.

   “Those people”  will quickly become anyone over a certain age in the ICU who does not make themselves DNR, regardless of their comorbidities.  After all, it will be much cheaper for us all if we could just let the elderly die in peace.  They may have compelling reasons to fight on for life, but they’re costing the rest of us money and that is unforgivable.  They don’t recover as well from surgery so they should just live with their gall stones and welcome a burst appendix as their release from the cares of this world.

     “Those people” could become those with Major Depression because we all “know” that making the wrong choices is what makes us depressed.  Mental Illness is “in your head,” after all.  We who live right could never have such misfortune.   Post traumatic stress only happens to gangbangers.  In fact, schizophrenia and autism must be bad parenting too, come to think of it.  That could save a whole lot of money and taxes if only it were true. 

   In fact, we would probably be much better off if we just got rid of medical care entirely.  Let nature kill off the weak the way it was intended in the first place.   We aren’t letting evolution work the way it is supposed too anymore.  Then we really will have a master race consisting only of the beautiful people, not “those people” who are just no good, inferior choices, inferior genes, inferior minds, just plain inferior.

     I hope I have exaggerated my point tongue in cheek enough to make it clear.  I don’t think blaming people for poor health will lead to anything good.  The financial incentive is there to demonize a whole bunch of people simply because they need help.  That is not a society that I want any part of.   Personally, I will gladly pay more taxes if it helps the weakest among us.  I don’t know if the private insurance thing will ever fly because there is just too much market incentive to cherry pick the healthy groups and leave out the unhealthy.  If we blame the patients, it will then become all too easy. 

   But that is the subject of a different post.  This post is about bigotry, hate, pride, and what lengths man will go to in order to feel okay about not helping the poor.  We have the potential to become true monsters.  If it’s all the same, I am going to do everything within my power to avoid becoming one of “these people.”  It pays to remember that there but for the grace of God, go we, in the case of both the chronically ill and the chronically prejudiced.  I firmly believe that there are no ”those people”  only people, only children of God.