Southern Views

As a healthcare social worker I have strong opinions about the importance of equal access to medical care. My focus has been on “equal access” because I am an advocate for those with expensive health conditions – the people traditionally shunned by for-profit insurance companies. I admit that I have been less attentive to that aspect of health reform that aims to make all Americans carry some form of health insurance. It has never seemed particularly wrong to me. After all, we are now required to have auto insurance and those who do not comply come across as irresponsible or even criminal. But then again, I do not run a small business and I don’t have to worry about payrolls and the bottom line.

We all have our worries that keep us awake at night. I represent people with chronic health conditions, most of them born with a diagnosis that will challenge them all of their lives. There are many such conditions and many advocates such as myself working to help them get life-saving medicine when they cannot get insurance. Hundreds of thousands of Americans with hemophilia, diabetes and asthma, for example, have felt the sting of rejection by insurance companies. That includes many children as well as adults. To some insurance companies, even a pregnancy is considered a “pre-existing condition.” If you have insurance you might be stunned to know how many have been left out in the cold.

Government dollars have historically had to pick up the slack left by insurance companies not wanting to sell their products to those with actual health needs. In that sense, our system already had a strong public base of support long before health insurance reform. Unfortunately, much of this taxpayer-funded support has had to focus on extremely expensive emergency room visits when prevention and as-needed medication can be so much cheaper. It’s a bad business model as well as being inhumane.

The uninsured in America have traditionally included small business owners, job-seeking young adults who have dropped off their parents’ insurance, construction workers, shop employees, independent contractors — even those who work for gigantic, wealthy, international businesses such as McDonald’s, which doesn’t offer any kind of insurance option to many employees. These Americans don‘t qualify for Medicaid or Medicare and many would not take it if they could. They simply want the chance to buy private health insurance like the rest of us. And like the rest of us they want to pay premiums that are not so outrageous they make it impossible to pay other bills. This is another focus of health insurance reform.

The uninsured in America include many with pre-existing medical conditions who now cheer for changes brought about by the Affordable Care Act.  I know. As a social worker I’m often there when they are cheering. Finally, they can buy insurance, too. So why do others in our country act like this change in policy is un-American?

For a while now, television has occasionally sent me into a tailspin. I know that most people are good. So why do the passions of a large number of Americans lead them to believe that all of this change is a dangerous thing? To many President Obama’s healthcare initiatives even smack of socialism and evil. I am a student of human psychology and behavior and yet it has been hard for me to put all of the pieces together. I have wondered if the world is going completely mad.

Then I started really listening to what really bothers so many who are shouting for the repeal of healthcare reform. It is not, thank goodness, that these folks want their fellow Americans to go without medicine and suffer. The real thorn for many Americans is the mandate that ALL citizens should have some form of health insurance whether they want it or not. This change appears to shake them on a primal level that is not completely about the wallet. For them, it feels like a threat to personal freedom to have government mandating what seems like a personal decision. This is a separate issue from the fears of small business owners, a concern I do readily understand and support.

So let us get back to the car insurance thing. Americans are now required to have it. If you do not, you can be in big trouble with a branch of government called the police force. I would like to point out that healthcare insurance is very similar. If you choose not to carry it and you get in a car accident, for example — or maybe you get diagnosed with cancer — you cannot go back after the fact and buy insurance to cover the costs. Your choices are to pay for it all of pocket, which in many cases is simply impossible, or pass along the responsibility of your care to other taxpayers. That’s right, tax dollars will be spent to take care of you because you did not acknowledge that your health fortunes could change. That is a fact that will continue if we are not required to carry insurance for our bodies in the same way that we carry insurance for our cars. There is no free lunch and no free medical care. The latter is particularly true.

So think about it, you who want to exercise your so-called right to avoid paying for health insurance. (And I don’t mean those who have tried but can’t get it or can’t afford it because of outrageously inflated costs.) Those same taxpayers whom many healthcare opponents seem to care so much about will pay the doctors, nurses and other professionals who took care of you. What — do you expect them to work for free? Hospitals are businesses, too, and they cannot survive that type of mentality.

I have not seen anyone offering to sign a statement saying that this exercise of personal freedom means he or she is opting out of any type of medical care should there be an accident or serious illness.  And doctors’ professional oaths prevent them from honoring such a statement should they be presented with one.

No, our lives are simply too intertwined to make decisions without having an impact on others. Even a decision not to wear a seatbelt means that you might end up on a public disability program when a simple strap across your body could have prevented it and saved the country a great deal of money. We are in this together. Like it or not, our choices can pull money out of other people’s wallets. You might not want to pay for someone else’s Medicaid, but maybe I’m not particularly excited about paying for your medical care, either. Still, we rise above such things and pool our resources to run a nation that is as healthy as possible. And nothing about that sounds even remotely un-American.

Cathleen Hulbert

Cathleen Hulbert

Cathleen Hulbert, MSW, LCSW, is a free-lance journalist and clinical social worker who spent six years living in New York City where she earned her graduate degree from Columbia University School of Social Work and worked in the neighborhoods of Brooklyn. During that time, unexpected teachers began to emerge who would set the stage for the writing of  the novel, “The First Lamp — A Story of Cosmic Illumination,” a time-travel tale about original innocence. For more information about the book go to She later traveled to Hawaii to answer the call of Kalah and to embrace the healing power of Aloha. She returned with a renewed dedication to sea turtle conservation, a burning love for the Hawaiian culture and a deeper respect for the needs of Mother Earth. She now lives in Roswell, Georgia, where she works in the healthcare field and continues to write. In November 2008 Cathleen was a co-recipient of the National Hemophilia Foundation's "Distinction in Communication Award" for helping teens with chronic bleeding disorders create their own camp newspapers. Her current project is a sequel to "The First Lamp."