The thing is rather amazing. My fellow liberals have been violently reforming our policy for years, yet in the area of health care an inequity of immense visibility endures. The pundits never mention it. The pols utter not a word of reproach. What manner of people have we become? We spend 9 percent of our GNP on health care (almost two-thirds as much as our Russian friends spend on their military), yet within our borders the class that contributes most to the GNP receives health care that is inadequate and, in some cases, downright dangerous. Of course I am thinking of the rich and powerful.
Surely the rich deserve equal protection of the law. If the egalitarian ethic, espoused by idealists like the celebrated Rev. Dr. William Sloane Coffin, means nothing else, it means that the super-rich deserve the same fine health care provided for the middle Americano. Possibly that is why this venerated cleric has labored all his days in plush purlieus like Yale University and the Riverside Baptist Church, an edifice built by the Rockefellers and embracing parishioners whose physiques are under constant assault from cholesterol, nicotine, psychoanalysis and other poisonous fruits of luxury.
In this joyous Christmas season, devote a few moments of compassionate meditation to the rich. Think of how they suffer, preyed upon by quacks, haunted by specialists and driven by the widely held American myth that health can be ensured by spending money. No store clerk in the land has died more squalidly than did billionaire Howard Hughes. What does it all mean? The unfortunate fellow had a string of easily treatable afflictions, and was finally done in by an untreated kidney disease. Visit any public health clinic; the janitor will tell you that kidney disease is easily spotted and takes a very long time before it becomes terminal. Moreover, the Howard Hughes Research Institute has, with 20 years of research, removed kidney failure from the list of untreatable diseases. Hughes might be alive today had he been poor, albeit the Howard Hughes Research Institute might need another patron.
The list of elite who died after dubious treatment is long and memorable. Think of George Washington and the bleeders and leeches who did him in. Remember the afflictions of Andrew Jackson. Harding's end was abrupt and remains a mystery. Barbara Hutton's was worse.
The catalog of the nation's centenarians is replete with one-time slaves and others of modest means. How many of the super-rich can be found on it? Rarely does a year pass that one of the rich and powerful does not perish, a victim of neglect or simple quackery. How many beloved rock artists have gone under with hepatitis or some other treatable or avoidable affliction? Our most devastating cultural tragedy, of course, was the loss of Elvis Presley. Precisely how he died remains obscured by those who would keep the memory of his life hallowed and profitable, but we do know that he died with medical problems that very few other Americans would fail to overcome.
Even the shah of Iran could not count on adequate care. Imagine two and one-half hours on an operating table and the attendant sawbones missed a gallstone! Was ever a mullah in far-off Qom so ill-treated? I am no physician, but I have studied the healing arts in this country and I am conversant with many of the nation's fine physicians. It is my studied opinion that Pahlavi has every reason to return to this country and file for malpractice against whoever perpetrated such an atrocity.
Every student of American medicine knows that the only Americans who receive worse medical care than the very rich are the very poor. Of the two, the poor are better off. Given a constant state of medical technology and other health-related variables, there is little that added medical expenditures can do to improve health. If the poor will avail themselves of the vaccinations and antibiotics that have improved the health of the middle class, and if they will practice proper health habits, their health will improve. The requisite health facilitites are increasingly available to the poor, especially in our cities. If we can motivate them to use these facilities and to avoid excessive drink, unwise diets and cigarettes, their lives will be healthier.
No such optimistic forecast can be made for the super-rich. Their problem is far more complicated. Time and again one sees the tragedy repeated. A fat cat discovers himself in a hell of a condition and so he calls in the most famous specialist in the world. The specialist knows an enormous amount about the disease, but has not seen a patient in years. The specialist is a genius at research, lecturing and collecting awards. His clinical exposure is meager. The fat cat perishes. Other times the fat cat calls in a dozen specialists but has no personal physician with overall responsibility for the patient; the patient becomes a premature corpse. Then, too, there is the tendency of the fat cat to fall for a simple quack. Tales of the famous frequenting high-priced maestros of the hypodermic are well known.
The story is a sad one. Our pols whoop for a greater expenditure of money, on the premise that this means improved health care. The premise is false. In modern societies, money does not buy corporeal bloom. After a certain level of technology -- a level available to most Americans today -- health is only purchased by prudent ways.
Tonight millions of Americans will, with joy in their hearts, go out and do thunderous violence to their systems. They will wake up in the morning feeling as though they had lived through catastrophe. They will feel malaise. They will feel depressed. In short, they will feel like many a rock star feels every morning of his life.
Yet it is the good fortune of the middle Americano that he is restrained by modest means. He will have available to him the ordinary docs of the American medical system -- a system that, notwithstanding the pols' assaults on it, remains about the best in the world. He will be given an aspirin, and he will recover. Meanwhile, the rich and powerful suffer horribly. Thank God someone finally found the guts to say it.