Scrooge, Tiny Tim and Universal Health Care  

(published December 12, 2007 in the Circleville Herald)


“ Of all the forms of inequality, injustice in health care is the most shocking and most inhuman.” Rev. Martin Luther King Jr.


This Christmas season many of us will watch one of the multiple versions of Charles Dickens’ The Christmas Carol. The 1984 version, directed by Clive Donner and starring George C. Scott as Scrooge best develops Dickens’ constant concern in all his works for the effects of poverty, social injustice and neglect on the less fortunate in Londons’ industrial revolution of the mid-nineteenth century. Director Donner has avoided producing the usual whitewashed and sentimental version we have of the novel as simply a heart warming tale of an old man’s overcoming his personal meanness,  like a Victorian era version of the Grinch.


Scrooge refuses alms for the London poor, commenting that “they should die and decrease the surplus population”, they may go to the debtor’s prisons, the workhouses. Scrooge is unmoved by the out of work family living on the streets, unmoved when the Ghost of Christmas Present shows him the children of Ignorance and Want that lie dangerously hidden in the alleys beyond the stock exchange. Like Marley, doomed to walk the earth enchained in death, Scrooge never walked in empathy with his fellow Londoner in need.


It is finally a personal encounter with the ailing child of his ill-used employee, Tiny Tim, who will die by next Christmas if his family’s economic situation, and therefore access to nutrition, medicine and healthcare do not improve that expands Scrooge’s sensibilities beyond the affairs of business alone. Once we also feel Bob Cratchit’s  pain for his son Tiny Tim we then also understand the heart, and the outrage, of so many of Dickens’ novels.


As an emergency physician, working in the overloaded safety net of a broken healthcare system, I have a personal encounter every day with the 47 million Tiny Tims of our nation with no health insurance , the twice that number who are underinsured and thus only one illness away from ruin and bankruptcy. 70% of the uninsured are working, often in two jobs trying to make ends meet. Emergency departments provide excellent pit-stop treatment, yet I know the patients I care for who will need ongoing care for their high blood pressure, their diabetes, ongoing care for their child’s asthma will not get it. They will live shorter, sicker, less productive lives. Those who go without care often include the insured, who have to choose between school fees, gasoline and insurance co-pays.


Ultimately, healthcare in our nation is a question of moral values, a question of who we are. Jesus himself , whose birth among the lowest of the lowly  we celebrate this month, reminded us that “whatever you did for the least of these brothers of mine, you did for me.” Matthew 25:40 NIV.  All of us need to feel Bob Cratchit’s pain,  feel the pain and then act. Dickens expected no less from his readers. As Americans, especially in this Christmas season, we should expect no less than compassionate, thoughtful action from ourselves to insure healthcare for all of us.


With the Herald’s forbearance I shall submit several columns on the sound medical and economic arguments for universal single-payer health care over the next several months. For further information I refer you to Physicians for a National Health Plan at and the Ohio Single Payer Action Network at A merry  and secure Christmas to all of us, not just the well-insured.


Brad Cotton

Emergency Physician