My response to Dr. Roger Starner Jones

It all started with Facebook, as most of my recent irritations do. A Friend of a Friend posted a letter to the editor—supposedly written by a Mississippi ER doctor—expressing annoyance with a cigarette-smoking, beer-drinking, spendthrift Medicaid patient. He was against the health care bill and concluded that taxpayers shouldn’t have to pony up for this woman’s health care if she refuses to put down the beer and cigarettes and pitch in.

While there was plenty to hate about this doctor’s poorly-reasoned diatribe, I was perhaps more disturbed that the letter had gone viral. Among my high school classmates and third cousins, there was plenty to “Like”: “Couldn’t agree more!” rang out.

The doctor wrote:

During my last night’s shift in the ER, I had the pleasure of evaluating a patient with a shiny new gold tooth, multiple elaborate tattoos, a very expensive brand of tennis shoes and a new cellular telephone equipped with her favorite R&B tune for a ring tone.

Glancing over the chart, one could not help noticing her payer status: Medicaid.

She smokes more than one costly pack of cigarettes every day and, somehow, still has money to buy beer. And our President expects me to pay for this woman’s health care?

Our nation’s health care crisis is not a shortage of quality hospitals, doctors or nurses. It is a crisis of culture – a culture in which it is perfectly acceptable to spend money on vices while refusing to take care of one’s self or, heaven forbid, purchase health insurance.

A culture that thinks I can do whatever I want to because someone else will always take care of me.

Life is really not that hard. Most of us reap what we sow.

Starner Jones, MD Jackson, MS

My first instinct was to verify that the letter was correctly attributed, because the story rang false to me. I couldn’t believe that a health care professional would publicly describe and then vilify his patient. But Roger Starner Jones, M.D., is indeed an ER doctor at the University of Mississippi Medical Center, and his letter was published August 23, 2009, in the Jackson Clarion Ledger.

While it seems clear that Dr. Jones is a real person and the words are in fact his, something is fishy here. For example, while it’s true that a patient’s chart often lists health history and habits such as smoking, I doubt that a busy emergency room doctor had time to discover that this woman—let’s call her Sharon—was on Medicaid while he recognized her R&B ring tone and elaborate tattoos.

Instead, Sharon seems rather like a caricature—Mississippi welfare queen, child of the entitlement culture, spending her government checks on beer, cigarettes, gold tooth.

No, I suspect that Sharon is an amalgamation of many of Dr. Jones’ patients—perhaps mixed with some of his own frustrations and politics. It seems like a logical fallacy, as in: I know this to be true, and I’m going to prove it by offering some unverifiable facts blended with a bit of Great Society folklore. If that’s the case, then it’s especially disturbing that his letter has resonated with so many people across the Internet—many of whom are my friends, or at least Friends.

But forget about Sharon for now. Dr. Jones’ larger point (“most of us reap what we sow”) seems to be that, rather than allow the federal government to meddle in health care, those who lack access to health care should first help themselves. He seems to suggest a two-part solution: 1) Make healthy lifestyle choices and therefore avoid illness and 2) Buy health insurance instead of tattoos and ring tones.

Those of us who do not rest in the “life is not that hard” camp recognize that it’s not that simple. It’s really hard to get a job right now. It’s especially hard to get a job that offers health insurance. You can try to buy an individual policy, but assuming you can find someone to insure you (key words: young, healthy, non-smoker, no pre-existing condition, etc.), it’s still pretty expensive. The multi-page application is complicated—even for the educated and experienced—and if you make a mistake and leave something out (even if it’s irrelevant to your current claim) the insurance company will rescind your policy. In other words, because you weren’t completely forthcoming, your policy is cancelled and you’re on the hook.

I know all of this, both because I’m a lawyer who has handled health care issues every day for the past two years AND because I’m one of the under-insured. While I work more than 40 hours per week, I’m not eligible for benefits because I’m considered an independent contractor. Fortunately, I’m a healthy 40-year-old non-smoker, and after much research and paperwork, I managed to secure a high-deductible ($7,500) bare-bones policy for $85 per month. Another lawyer in my office chose a similar policy with a lower deductible, and he pays $190 per month.

If Sharon gives up her cigarettes and beer and manages to navigate the application process, will she be able to afford these premiums, the deductible, the co-pay, and the various health care costs that are left uncovered? If she can’t, is it still all her fault?

Blaming the afflicted for their affliction is nothing new, of course. Simply stated, the party line goes like this: If you lived a healthy lifestyle, you wouldn’t get sick. If you worked for a living, you wouldn’t be poor. If you refrained from unsafe sex, you wouldn’t get AIDS.

It’s tempting to embrace this philosophy, because we can comfort ourselves by saying: I’m not that kind of person, so that won’t happen to me. Plus, Sharon got herself into this mess, so it’s not my problem if she can’t get herself out of it.

This reasoning has fatal flaws, though: It ignores the non-smoker who gets lung cancer, the hemophiliac who gets a bad blood transfusion, the person who wants a job with benefits, but can’t find one.

More importantly, we’re all human, and all of us—every single one of us—is prone to a stupid mistake here and a dumb choice there. Sure, we all have to pay for our mistakes, but we’re all in this together. If each one of us can’t afford to be adequately insured against loss (even if some of it is our damn fault), can we decide as a group to have a safety net so some of us don’t sink?

I have found that, while it’s imminently worth it, life can be pretty hard. Lately, so many of us have been struggling. Some days, I come home and make myself a nice cocktail. Please don’t tell my insurance company.

--Robin Littlefield