Steady Footsteps

You’re going to die.

I don’t know where and I don’t know when. I’ve never seen your medical record, but I can say with complete assurance, “You’re going to die.”

It doesn’t matter whether you’re eligible for Medicare or Medicaid. It doesn’t matter if your insurance premiums are paid up or not. It doesn’t even matter if you’ve never been sick a day in your life.

You’re still going to die.

Although mutual fund managers caution that: “Past performance is no guarantee of future results,” I’m going to side with history and science on this one--everybody eventually dies.

Given that health insurance and medical care will not prevent one’s eventual death, what are people thinking when they say, “I would love to quit my job and live out my dreams—but I can’t, because I would lose my health insurance?”

I think their real concern is: Who will take care of me if I cannot care for myself? And my answer is—it’s sure not going to be your health insurance company!

Medical care in the US today is set up and run according to conditions dictated by Medicare and big private medical insurance companies. It’s very, very difficult to actually get admitted to a hospital. Hospitals admit only a small percentage of the sick and injured people who pass through their emergency room doors. Most surgery these days is done on an outpatient basis. Reimbursement issues pressure hospitals to discharge patients as quickly as possible. So, the fact of the matter is that, even if you become seriously sick or injured, you may be spending most, if not all, of your recovery time in a hospital bed set up in your dining room as, chances are, you’ll be discharged from the hospital long before you’re able to climb the stairs to your bedroom. If you do pay an ambulance crew to carry you upstairs, you’ll be stuck up there while your spouse scuttles up and down the stairs with your meals. If you’re lucky, Medicare or your insurance will pay for a home health agency to send a nurse out a few times a week to teach your spouse how to change your surgical dressing, and perhaps a therapist to teach you to hobble over to the potty chair and to bathe yourself. It’s going to be hard on your spouse, because she’ll feel guilty about leaving you unattended when she slips out to the pharmacy or grocery store. Maybe this time you’ll have a complete recovery, but at some point, you will enter into a decline that will culminate in your death. Who will care for poor old you?

Will it be your spouse, who is aging, just as you are? Will it be your children? (That’s the bet that most people in Third World countries make.) Even the most well-intentioned adult American children find themselves in a terrible bind when their parents need care, because the kids themselves are tied down with their own financial and family obligations. You could pay out of pocket for a private duty nursing aide. How long would your finances allow that?

When my husband and I decided to quit our jobs, leave the US, and move to Vietnam in order to do volunteer work, one of the decisions we made was to forgo health insurance. This was not a decision we made lightly; we had never before voluntarily opted be uninsured.

Here’s our thinking on the situation: We can afford the same health care that any Vietnamese person can afford. It’s not “top notch”—but it’s not bad. We would rather contribute to the Vietnamese health care system by paying directly for our care than to give any more money to private health insurers.

We chose to move to Vietnam while we were in our fifties and still fit enough to be able to do meaningful work here. We hope that, when we do decline to where we can no longer do so much, that a reservoir of good will and savings will enable us to find and financially support someone to take care of us. It’s a vague notion—and we don’t spend a lot of time thinking about it—but it’s allowed us envision a life in which “keeping our health insurance” is not the ultimate goal.

There’s no doubt that you will die.

The question is: Will you live?