Tiny Tim, Scrooge and the Occupy movement

By Brad Cotton, M.D.
Circleville (Ohio) Herald, Dec. 12, 2011

Many of us were shocked and disgusted that for the second time in recent years Tennessee firefighters allowed a families’ home to burn to the ground. Seems the monthly premium for fire service had not been paid. I wonder if this family, like so many families today, was struggling deciding what bills to pay that month, choosing among their children’s prescription meds, school fees, car payments, certainly the chance of a fire seemed remote.

The television footage of flames crackling and the house collapsing, with the fire personnel standing idly by, rams home the brutal reality that 30 years of right-wing, market-worshiping, anti-government politics has brought upon us: in America today, you are on your own -- forget any notions of neighbors, community or any sense that we are in this together.

How quickly, one must ask, would we have universal single-payer healthcare, if scenes as vivid as the flames eating alive a families’ home, if the unbearable suffering of the 45,000 Americans dying from lack of health insurance could be similarly brought before our eyes?

What if the pain and bankruptcy of millions upon millions of us either uninsured or underinsured were felt by each of us every day? Note that underinsurance, or insurance in name only that will bankrupt your family if one ever tries to use it, is becoming the norm today.

The Patient Protection and Affordable Care Act (PPACA), as six years experience with “Romneycare” (PPACA by any other name) in Massachusetts has shown, allows for the proliferation of underinsurance. Underinsurance products are recognized by increased premiums, larger deductibles, lower actuarial rates, “health savings accounts” or as “defined contribution” coverage (this is what Republican Rep. Paul Ryan proposes to do with Medicare).

What it really means, get sick and you and your family are bankrupted while the health care “system,” like those Tennessee firefighters look on uselessly.

Thanks to the Occupy Wall Street movement for bringing into our national discourse the ever growing chasm in America between the “haves” and the “have nots.” One can’t be much more of a “have not” than to be one out of six of us without health insurance.

Sadly, as the Physicians for a National Health Program quotes the Stanford University study “Growth in the Residential Segregation of Families by Income 1970-2009”: "The increasing concentration of income and wealth, and therefore of resources such as schools, parks and public services in a small number of neighborhoods results in greater disadvantages for the remaining neighborhoods where low- and middle-income families live.”

Basically the study found that affluent folks no longer inhabit even the same physical space that we do, thus “out of sight, out of mind” and no sense of “we-ness" or responsibility for our fellow citizen’s plight.

Market forces maximize profit, not care. A recent study published in the Annals of Emergency Medicine academically titled “System-Level Health Disparities in California Emergency Departments: Minorities and Medicaid Patients are at Higher Risk of Losing Their Emergency Departments” in plain English arrived at the same conclusion as the above quoted Stanford study: Health care is available where there is profit to be made. In poorer neighborhoods, no profit means no hospital, no emergency department, no health care. We are literally dying to protect the profits of the Wall Street traded health insurers.

This Christmas season, watch Charles Dickens' “A Christmas Carol.” I recommend director Clive Donner’s 1984 version starring George C. Scott as Scrooge. The social justice message of Dickens’ Carol is so often sanitized into a sentimental story of Scrooge’s heart growing three sizes that day, like the Grinch’s. Donner’s version keeps much of the message intact about low wages, poverty, the unemployed living under a bridge, Tiny Tim’s likely death from lack of money and health care.

Especially powerful is the Ghost of Christmas Present showing Scrooge the hidden dangerous children “Ignorance” and “Want,” noting that simply because Scrooge chooses not to see them, as does the 1 percent in our segregated neighborhoods today, does not mean they aren’t there nor lessen their danger.

Dickens, social activist that he was, initially began “A Christmas Carol” as a political tract to be titled “An Appeal to the People of England on Behalf of the Poor Man’s Child.” Are we hearing Dickens’ appeal? If our political, economic and health care systems do not care for the Bob Cratchits and Tiny Tims among us, if we put right-wing ideology above reality, if we care more for profits than for care, then we are all Scrooges.

May the Ghosts of Marley and the Ghosts of Christmas Past, Present and Future speak to us through the “Occupy” movement.

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Dr. Brad Cotton resides in Circleville, Ohio, and is a member of Physicians for a National Health Program.