Nicholas Kristof's Sunday New York Times column is about his Harvard freshman-year roommate, Scott Androes, who has cancer after going from the end of 2003 to 2012 without health insurance.
Mr. Kristof writes, "it would have made more sense to provide Scott with insurance and regular physicals. Catching the cancer earlier would have saved hundreds of thousands of dollars in radiation and chemo expenses — and maybe a life as well." He goes on to write that this is what the upcoming presidential election is about.
It's a moving, sad, and touching tale in a kind of there-but-for-the-grace-of-God-go-I way, and on Sunday night it was high on the list of most-emailed-articles on the Times Web site.
But the more I thought about it, the more I was troubled by some unanswered questions. Maybe Mr. Kristof can answer them in a follow-up column, or in the comments section below, or maybe Mr. Androes will — I hope his health recovers enough for him to engage in this debate.
1. Mr. Androes writes that "it all started in December of 2003 when I quit my job as a pension consultant…I didn't buy health insurance because I knew it would be really expensive in the individual policy market, because many of the people in this market are high risk. I would have bought insurance if there had been any kind of fair-risk pooling." Question: Why couldn't he have continued his health insurance from work for 18 months under the provisions of the Consolidated Omnibus Budget Reconciliation Act of 1985, or Cobra?
2. Mr. Androes writes that he "didn't have a regular physician and hadn't been getting annual physicals." Question: did he have a regular physician and get annual physicals back when he did have insurance? Because if he didn't, it's not really clear that the insurance mandate under ObamaCare would have meant that Mr. Androes's cancer would have been caught earlier. ObamaCare compels people either to buy insurance or to pay a tax that is smaller than the cost of the insurance. It doesn't compel anyone to submit to a physical examination or a urine or blood test annually or to have a regular physician.
3. Mr. Kristof writes that "while Scott was foolish, mostly he was unlucky. He is a bachelor, so he didn't have a spouse whose insurance he could fall back on in his midlife crisis." Isn't another way of looking it that he is lucky to be a bachelor, because insurance for one individual is a lot cheaper to buy that for a couple or a family, and because he didn't have a family to support so he had more disposable income that he could have used to buy himself health insurance if he had wanted to?
4. Mr. Kristof writes that "In the Romney system, people like Scott would remain uninsured. And they would be unable to buy insurance because of their cancer history." Doesn't this ignore the fact that as governor of Massachusetts, Mr. Romney decisively acted to address this exact issue of the uninsured, including those with pre-existing conditions? And doesn't it also ignore the fact that, as a recent Los Angeles Times dispatch put it, Mr. Romney "has repeatedly said that he would require insurance companies to cover people with preexisting conditions"?
5. Mr. Androes writes that earlier this year, with blood in his urine and a 102-degree fever, he "went to one of those urgent care clinics in a strip mall…The doctor there have me a diagnosis of prostate infection and prescribed antibiotics." Later, he saw a urologist and went to an emergency room where doctors discovered prostate cancer. Question: Why not name the doctor at the strip mall who missed the diagnosis, or at least the urgent care clinic? The column's point seems to be that ObamaCare would have detected the cancer earlier. Yet this whole episode involving the misdiagnosis and the urgent care clinic took place in 2012, two years after the Affordable Care Act was signed into law. Part of what Mr. Androes seems to have been a victim of is not only a country that allows individuals to go without health insurance, but also a system that, as the book Unaccountable argues, lacks basic transparency and accountability for errors — in part because of a medical malpractice law system that ObamaCare leaves largely untouched.
My point here is not to be unsympathetic to Mr. Kristof or to his friend with what sounds like a really grim medical situation, just to point out that the choice in the election isn't quite so simple as Mr. Kristof essentially frames it, with President Obama heroically preventing cancer and Mitt Romney callously condemning people to it. Maybe a more decentralized approach in which states like Mr. Romney's Massachusetts take the lead would yield better results than a top-down, bureacuracy-heavy national health overhaul. And maybe there are some things, like a bachelor who doesn't like going to the doctor, that no state or national law will solve short of one requiring twice-annual compulsory medical exams by physicians required by the same law never to miss a diagnosis.