A Health Care Disaster
By Nicholas D. Kristof
Kiln, Miss.
In the richest country in the world, a man named Eugene Johnson is going blind in a homeless shelter, because his eye medicine washed away in Hurricane Katrina and he can’t afford to buy more.
At one level, that’s an indictment of the official rescue effort: the authorities were sufficiently concerned about hurricanes that last year they pre-positioned 10,000 body bags in New Orleans, but they dozed as Katrina approached.
Yet at a deeper level, Mr. Johnson’s plight is a window into our broken health care system. Sure, we need to think about how to rebuild New Orleans, but we also need to reconstruct a sensible health care system.
And that task is urgent, for one study suggests that more than 18,000 Americans will die this year as a consequence of not having health insurance.
Barbara Bush thought that Hurricane Katrina worked out pretty well for the poor. (“Many of the people in the arena here, you know, were underprivileged anyway,” she said after touring the Astrodome, “so this is working very well for them.”) I’d like her to come here to the rural Mississippi town of Kiln, near the Louisiana line, and meet Mr. Johnson. A barrel-chested retired plumber, a white man of 57, Mr. Johnson suffers from diabetes that has already cost him two toes. Complications also threaten his eyesight, and so he must take nine prescription medicines, including two to preserve his vision.
But the hurricane destroyed Mr. Johnson’s house. Since then, he has been bouncing from one shelter to the next and is now sleeping on a cot in a school gymnasium, along with his wife and four of his five children (one is grown and has left home).
Once Mr. Johnson found a pharmacy that was open and had one of the medicines he needs. But it charged $119 for it, and he couldn’t afford that. So Mr. Johnson is slowly going blind.
“My eyes are starting to mess up,” Mr. Johnson explained. “I see little spots. And then sometimes they all move around, like a TV picture that’s gone bad.”
Finally, a first-rate aid group, Children’s Health Fund, brought doctors and a mobile clinic to Mr. Johnson’s shelter. One of the doctors, David Krol, examined Mr. Johnson, was horrified, and is working on obtaining the medications he needs. But as Dr. Krol described the mobile clinic: “We’re a stopgap. Nothing more.”
If Mr. Johnson were more mobile, more adept at working the system, and more of a complainer, he might have gotten help earlier. But the poor tend to be stuck in shelters, without vehicles, and many are busy looking after small children. And many, like Mr. Johnson, are disastrously polite, patient, deferential and even cheerful. Around here, if you have the patience of Job, you suffer like Job.
Nearly every medical worker I spoke to warned that there would be a surge in deaths from heart disease, strokes and other ailments, concentrated among the poor, because of the interruption in medicines. Dr. Jay Lemery told of treating a single mother in a shelter whose three children were bouncing off the walls because they had attention-deficit disorder and hadn’t had their medication. The mother herself was prone to depression and had run out of her own medicine as well – in an environment that would make Pangloss suicidal.
The shelter was hot and tempers were so frayed that two women were having a fistfight. Dr. Lemery added: “Even the Red Cross people, who have the patience of Mother Teresa, were in tears.”
Yet the reality is that our medical system failed this region long before Katrina arrived. One of the Children’s Health Fund doctors discovered a previously undetected hole in a 4-year-old boy’s heart. The mother said nobody had ever listened to the boy’s chest before.
In both Mississippi and Louisiana, infant mortality is worse (for every 1,000 babies born, 10 die in their first year of life) than in Costa Rica (8 die per 1,000). For black babies in either state, the picture is still more horrifying: 15 die per 1,000. In poor, war-torn Sri Lanka, where per capita medical spending is only $131, babies have better odds, with 13 dying per 1,000.
So let’s rebuild the levees, but let’s also construct a health care system that works. A dozen years after the last, failed attempt to reform health care, the system is more broken than ever. For the sake of Mr. Johnson, and for our children, it’s time to try again.
