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For the uninsured, a ray of hope in an imperfect health-care bill

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By Richard Cohen
Tuesday, December 22, 2009

From the 14th floor of New York-Presbyterian Hospital, I could look across the East River to much of Brooklyn and Queens. Behind me in the hospital bed was the woman I love, who was sick, very sick. She was attended by some remarkable doctors (including her own indomitable daughter), and I would sometimes drift to the window and look out over a city with several million people and wonder: What do they do? What do they do if they have no health insurance?

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That question has stuck with me. There have been several more hospital stays and many more visits to the doctor, and so I am, in a very painful way, an expert of sorts on the American health-care system. It is an inelegant monstrosity, a beast that consumes lives and money and makes some people rich and many more poor.

It is a quintessentially American operation, created out of pragmatism and prejudice -- a belief in what works and as deep a belief that the government can make nothing work. It is the product of tiny minds, some of them in Congress, and they have now set about improving the system in a way that exhausts Washington's store of cliches -- herding cats, making sausage and the rest.

But the reason cliches endure is that they are true. Ben Nelson did get special privileges for Nebraska, and Mary Landrieu got goodies for Louisiana. Carl Levin got a little something for Michigan; and New York, Pennsylvania and Vermont all found something under the Senate's Christmas tree. There are mysterious provisions in the bill to favor this state or that, this hospital or that -- but no money went into the pockets of members of Congress, so this is not corruption as we know it. It just smells the same.

The public option is gone, and lowering the age for Medicare is gone, and the insurance companies will make out like bandits -- another cliche, pardon me -- which is why their stocks are taking off. This made for wonderful graphics on "Morning Joe" and, I confess, ruined my morning, if not Joe's.

The bill has turned out to be a mosh pit of selfishness. It has managed to reduce even further Congress's standing with the public and has turned some senators into pygmies of principle. This is particularly true of the Republicans who have had nothing constructive to say about this bill or, for that matter, the economy, and who, if they had had their way, would surely have turned a banking crisis into a financial catastrophe.

But the bill does extend insurance coverage to the uninsured. This is the only economically advanced nation where people can go bankrupt from medical bills. This is the only rich nation where people can die from lack of medical care -- because they can't afford it or because it's not available.

T.R. Reid, my former Post colleague, went around the world asking people what they paid for various medical procedures and whether it was possible to become medically bankrupt. He then wrote a book about what he found, "The Healing of America." Only in America can sickness send you to the poorhouse. This cannot be what's meant by American exceptionalism.

I read the newspaper columns and listen to the television commentary of people who want to kill the health-care bill -- and often I nod in agreement at some of the points they make. But the liberals who insist on a perfect bill or nothing, the ones who are so bereaved over the death of the public option or so furious that abortion will not be covered that they would prefer no bill at all, ought to come to the window with me.

Behold the uninsured. Look at them in their terror. See their faces as they are denied coverage for preexisting conditions or their looks of despair because they cannot afford insurance at all. Watch them ignore symptoms of sickness, pass up examinations or wait, often for hours and hours, for free medical services. Being sick, really sick -- as the woman I love recently was -- is indescribably awful. To be both poor and sick -- is there anything worse?

This health-care bill is far from perfect. In some respects it is truly ugly. But from my old perch on the 14th floor of New York-Presbyterian Hospital, as I recall the terrible fright of a terrible illness, this bill looks as pretty as hope. It is a start.

cohenr@washpost.com


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