Recently, on the "Dr. America" show, I reported on the now-viral story of Luis Lang, a 49-year-old man from South Carolina who initially opposed Obamacare, and is now facing financial ruin as he suffers some dire health problems, including possible blindness. I made a small donation on his GoFundMe online fundraiser, as did many progressives who have long supported the Affordable Care Act. After sharing that I made a donation to help Mr. Lang, I received mixed responses from fellow progressives, and I want to clarify my position and offer some advice.
1. Health Justice for All means ALL.
When many of us advocate for health justice, we intend for it to be available, accessible, and used by everyone -- not just those who please us. If we have to pass perfection tests on our principles before we can have basic human rights like health care, then we are doomed. As a physician, I know just how flawed and vulnerable we are as human beings. No one deserves to be shamed or ridiculed for their personal politics when they are facing health problems even when those problems, when looked at very broadly, have connections to misguided political ideologies. For example, Mr. Lang is a smoker, and perhaps his conservative politics may run anathema to public health campaigns like anti-tobacco regulations. However, his personal politics are not an excuse to deny him care or let him go blind.
2. The Tortoise Did Not Win Bragging Rights Over The Hare.
One rebuttal I heard to my decision to donate to Mr. Lang's fundraiser was that we should make him live with the consequences of his choices. To me, this is petty and more importantly, unnecessary. The moral of Mr. Lang's story has been made: he opposed Obamacare on flawed political reasoning and then finds himself in a dire situation where universal healthcare could have saved his health without costing his personal wealth. The irony is illustrative enough, and for Mr. Lang to suffer further in the richest country on earth when treatment is possible is cruel and unusual. When Aesop wrote "The Tortoise and the Hare," the moral was simply "Slow and steady wins the race." There is no sequel that says the winner gets to be a jerk about it.
3. Talk the Talk, but Do It While Walking the Walk.
Another rebuttal I heard regarding my donation to Mr. Lang is that it was unsustainable. What about everyone else who needs care but lives in places like South Carolina that refuse to expand Medicaid and create obstacles to Obamacare implementation? Is it sustainable to set up fundraising websites for the 4 million Americans in the coverage gap (194,000 of whom live in South Carolina)? These are perfectly valid questions, and merit discussions about implementing and improving upon the Affordable Care Act. However, as those discussions continue, let us not lose focus on the urgency of now. We must provide care right now for those who need help right now. As much as I enjoy debates about health policy that get deep into the weeds, I am glad my clinical experiences remind me that patients often can not wait for perfect policies, and we are obligated as children of God to care for one another -- by any means necessary in the present, while building more sustainable systems.
4. Where to Stick That Wagging Finger.
Ultimately, if we are so compelled to blame or shame someone, then let's redirect frustration away from Mr. Lang and towards those with the power to change his (and our) circumstances. Living in South Carolina should not be a danger to anyone's health, but by refusing to expand Medicaid and criminalizing the implementation of Obamacare, Governor Nikki Haley and the South Carolina legislature are making health care a privilege, not a right in their state. Political leaders who continue to oppose Obamacare should take a good hard look at the substantial track record of Republican-majority states that have expanded Medicaid and facilitated other provisions of the Affordable Care Act. There are 25 million insured Americans, better functioning hospitals, and improving state budgets, all of which justify implementing the Affordable Care Act.
Mr. Lang's story has gone viral in the world of health news because it takes place in a state where politicians punish people for being flawed and vulnerable -- in other words, for being people. None of us should be expected to have perfect personal choices in politics or healthy behaviors before we are deemed worthy of health care. Mr. Lang's story is not about his personal responsibility as much as it is about our collective responsibilities to each other. No one should go blind and broke in the richest country on earth. Let's realize a vision of health care working hand-in-hand with social justice.