February 29, 2020

The Health of a Nation

By Isiah Smith | June 17, 2017

It’s an early hot, sultry Virginia morning, and I’m drenched with sweat. A pressure that feels like a two-ton elephant is crushing my chest, and I’m slipping into the darkness.

A sharp pain cuts through my chest. So, this is what it’s like to die.

My voice is heavy with fear. I shake my wife, Marlene. “I’m going to the emergency room,” I gasp. 

“Call me when you get there,” she says, yawning. “It’s 2 o’clock in the morning.”

“No, we are going to the emergency room. I think I’m having a heart attack.”

We are soon on our way to Arlington Hospital. 

“Do you have your insurance card?” Marlene asks.

I nod. Insurance is the farthest thing from my mind. I want to live.

Middle-aged African American men with chest pains have priority in emergency rooms. An army of nurses and attendants wheel me into a room, rip off my shirt, and attach electrodes to my chest.

But first I must hand over my insurance card to assure the hospital that even if I don’t survive, my medical bills will be paid.

First things first.

America has long wrestled with the issue of providing universal health care for all Americans. Indeed, it is the political Sisyphean rock of American politics that never gets over the top of the mountain.

One of the earliest federal health care proposals was the 1854 Bill for the Indigent Insane, which would have established asylums for indigent citizens with mental and emotional disabilities, as well as for the blind and deaf, through federal land grants to the states. 

But President Franklin Pierce vetoed the bill, arguing that the federal government should not commit itself to social welfare, which he believed was the states’ responsibility.

Throughout the 1900s, the federal government attempted to establish compulsory government run or voluntary health care programs. 

Following World War II, President Truman called for universal health care as part of his fair deal; strong opposition stopped it. In 1970, three proposals for universal national health insurance, each of which would be financed by payroll taxes and general federal revenues, were introduced in Congress. None came to fruition. 

Likewise, the Clinton “Health Security Express” bus never left the station. Throughout the 1990s and early 2000s, universal health care became a political football kicked around by both parties. Neither party could score, and each successive proposal fell short of the goal line.

Under President Obama, the scale at long last began to tilt in favor of the American people.

In 2010, the U.S. House passed the Patient Protection and Affordable Care Act (ACA). President Obama signed the bill the same day. The following day, Republicans introduced legislation to repeal the ACA but never offered alternatives. 

Members of the House attempted this stunt more than 50 times. Their main objection to the statute seemed rooted in their personal distain for the president who signed it into law, derisively labeling it “Obamacare.” The “people’s care” might have been a more suitable sobriquet.

Nonpartisan data gathered after the enactment of the ACA showed a significant drop in the number of Americans without coverage. Some estimates report that the ACA covered at least 22 million people who previously had been without insurance. 

On May 4, 2017, the Republican-led House of Representatives passed, on its second attempt, the American Health Care Act. The nonpartisan Congressional Budget Office estimates that upward of 24 million people will lose coverage under this act. Millions might die. The Republican response? “We said we would repeal Obamacare, and we did it!”  

During the first 10–15 years of the 20th century, European countries began passing their first social welfare acts, ultimately forming the basis for compulsory government-run or voluntary subsidized-health-care programs. The United States did not follow their lead.

A unique American history of decentralization of and limits to government, and a blind but foolish adherence to classical liberalism might help explain the aversion to compulsory government insurance.

I wonder. Congress has had little difficulty exempting itself from the punishing and mean-spirited impact of the AHA — presumably because its members recognize a bad bill when they see it. Consequently, any congressman who suffers a heart attack at 2am can expect to receive the same exemplary care I received.

But will you?


The hospital staff found I needed emergency heart surgery that would cost as much as a small house. As a retired federal employee, I have the great fortune of being covered by the same insurance plan that covers every member of Congress. Unlike millions of Americans who struggle to pay their health care cost, my surgery was fully covered.

Additionally, my recovery, and the medications I must take for the rest of my life, were largely covered by my insurance policy. I am responsible for a reasonable co-pay, but without the insurance, I might not be here writing this column.

Rep. Raúl R. Labrador (R-Idaho) defended the GOP health care bill at a town hall in on May 5. His assertion: “Nobody dies because they don’t have access to health care.”Spoken like a man who enjoys the best health care in the world.

Isiah Smith Jr. is a former newspaper columnist for the Miami Times. He worked as a psychotherapist before attending the University of Miami Law School, where he also received a master’s degree in psychology. In December 2013, he retired from the Department of Energy’s Office of General Counsel, where he served as a deputy assistant general counsel for administrative litigation and information law. Isiah lives in Traverse City with his wife, Marlene.


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