I was going to write a screed here on the American health care system. On how we take care (or fail to take care) of our most vulnerable citizens, those who are unable, for one reason or another, to take care of themselves. On the 'compassion' that lets us write off our employees (and therefore remove their health care) the moment they become too ill to work, and force those who have recently become disabled to jump through an often-humiliating and always ridiculously difficult series of hoops in order to receive what should be a human right.
But you know what? As I think about it, the story I have to tell is really a story of 'it could have been worse'. At every single point, it really could have been, and for tens of thousands of Americans every year, it was. So maybe I'll just tell that story, instead, and let the screed sort of stand, mostly unspoken.
This is a story of a man named Jim (note: name has been changed to at least somewhat protect his privacy), who had an accident. Well, sort of an accident. Just remember: unless you happen to be independently wealthy, it probably could just as easily have been you. And unless you were pretty lucky, it could have been worse. Much worse.
Jim lives in San Francisco. Up until recently, he had, if not a normal life, at least one that wasn't too astonishing. He was a bartender by trade, and worked several pubs of various sorts in San Francisco. He lived in one of the 'less desirable' neighborhoods of San Francisco, by which I mean one where the median income is not roughly ten times the US average. It is a higher-than-average area in terms of crime, but not alarmingly so. And practically everything else about it is just fine, if you like living in a city.
Jim was also a musician — a fiddle player — and an well-known member of San Francisco's quite active Irish music community. He had a few other hobbies (motorcycles among them). Mostly, though, his work and his music were his life.
And then that changed.
One day Jim was at home, in his apartment, and noticed someone on his balcony, apparently trying to break in. Jim, who has in some of his bartender gigs doubled as a bouncer, decided to try to fend off this intruder, who didn't seem to be armed. After a struggle, the intruder shoved Jim into the railing of his balcony, which, rather than support his weight, simply broke off. Jim fell a story onto concrete. And, as luck would have it, his assailant fell on top of him, at which time Jim lost consciousness. (His assailant got away clean, as far as I know.)
I guess this is the first point at which it could have been worse. What if his assailant had had a gun? (One could ask, 'what if Jim had one', but that invites the question of 'what if they both had had them'. If they both had had guns, Jim would not have survived to fetch his, because it would have been somewhere other than the middle of his living room.)
He awoke some time later, in an intensive care facility. He had extensive nerve damage. He had a concussion and a fractured skull. He had quite a lot of internal bleeding. And he had a lot of less life-threatening but still nasty injuries. He stayed in the ICU for several more days, and in the hospital for a while longer.
And here's another 'it could have been worse': Jim was found quickly, and he lived in a city with good public infrastructure (ambulances), and within two miles of one of the few hospitals in the country to be certified as a traumatic brain injury center. (Indeed, San Francisco General Hospital was the first to be so certified, in 2011.) How many people can say the same thing?
Despite his world-class care, Jim's injuries, it quickly became clear, were going to have some lasting effects. Specifically, the nervous system damage led to difficulty walking, and made it nearly impossible for him to pick up things: one hand is completely unable to close, and the other has no strength. The cranial fractures and concussion have lead to persistent dizziness and memory issues. He can hardly hold a teacup. He certainly can't tend bar, or play music. Or drive. Or do many of the things that most of us take for granted. Without extensive (expensive) rehabilitation, it is clear that these things would be impossible forever. Even with it, it is not clear how much of a recovery he can make.
Nevertheless, he was eventually discharged, and sent home. And here is another 'it could have been worse': Jim still had his apartment, and had enough money saved to pay his rent, at least for the time that he was in the hospital. Many people living paycheck-to-paycheck would have lost their housing while they were in the hospital, at least in less tenant-friendly cities than San Francisco. And in San Francisco, with the limited rent control and we have, and with housing prices having gone from awful to ludicrous over the last three years, he never could have afforded to find a new place, even had it been possible for him to do so in his state.
Of course, in theory, Social Security and/or SSI would have been able to step in and save him from losing his apartment. Needless to say, Jim is still fighting to get classified as disabled, months later. For him, at least, no lawyer is necessary: it's absolutely clear cut. But it still takes months to get through the process, and in the mean time no assistance is forthcoming. Especially for someone who can hardly hold a telephone, and certainly can't hold a pen. Or use a mouse. Or always remember the things he needs to fill in on the forms. So in practice, Jim ran out of money long before it kicked in. (It still hasn't, mind you.) And even in San Francisco, if you're in an apartment for several months without paying rent, you can get kicked out.
So here's yet another 'it could have been worse': Jim is a member of San Francisco's Irish music community, a close-knit, good-sized group. One that, whatever its other faults, takes care of its own. A couple of members stepped up to loan him enough money to keep him from being kicked out of his apartment, and some others are holding a benefit concert for him.
How many people have a group of friends willing to organize a night-long musical celebration, a venue owner willing to donate his space, and ten or so different musical acts willing to donate their talents towards helping them? If you're lucky, you may have a family who is close enough and prosperous enough to fall back on, but if you're not, you might not fare as well as Jim.
Finally, there's one more 'it could have been worse,' and it's a big one. When Jim went to check out of the hospital, all he had to say was 'I'm part of Healthy San Francisco'. He didn't have health insurance (how many bartenders do?), but at least in one place in the US, that doesn't matter. If you're signed up for Healthy San Francisco, you pay what you can (as determined by those terrible bureaucrats, naturally) and San Francisco picks up the rest of the tab. Whatever else might happen to Jim, he won't be going bankrupt from medical bills. Not even after several days in intensive care, several surgeries, and significantly longer (I'm not sure exactly how long) in the hospital.
What's more, now that he's out of the hospital, he can get rehabilitative care. He doesn't have to sell off all his worldly possessions (including his fiddle) to qualify for Medi-Cal (aka Medicaid), nor does he have to worry about the benefit concert making him ineligible for Medicaid. He can access the health care he needs. Whatever else he has to worry about, and there's plenty, that's at least one thing that will not be an issue.
So sure. It could have been worse, much worse. Jim has advantages that the vast majority of Americans don't: world-class health care within a couple miles, a supportive community, and no need to worry about medical bills. Let's face it: a lot of Americans, had they been in his shoes, would not be alive today, for one reason or another. A lot more would have hundreds of thousands in medical bills facing them, no income, and an uncertain future of possible eviction... to where, exactly?
I can't help but think, though, that there's something wrong with this viewpoint. Think about it: what we're saying here is, 'This man had his body severely damaged, nearly to death, by a criminal. Gee, it's an awfully good thing that he wasn't thrown out on the street or financially ruined immediately afterward!' A society where you even have to think that for a second is a pretty fucked up place to live.
NOTE: If there's anyone here from the San Francisco Bay area who has the slightest interest in Irish music, I'd like to invite you to the benefit concert, which is on Saturday night, at 9 PM, in San Francisco. Please send me a private message for the details. (Also, yes, with a fair bit of dedicated effort, you can probably figure out the real name of the person who I am referring to. I WOULD REALLY PREFER IT IF YOU DID NOT DO SO. If someone should refer to his name in the comments, I'll delete the damn diary. I feel like I'm borderline intruding on his privacy as it is.)
10:49 AM PT: Thanks for the rescue! I was watching my diary last night, which came out at juuuust about the time that the I-5 collapse broke, and thinking, 'well, that was some pretty impressive timing right there.'