Helaine’s Blog

Boston highlights healthcare’s lost promise: it’s charity now, policy later

April 25th, 2013 | via The Guardian

Charitable donations have been rolling in fast for Boston victims – but wouldn’t better healthcare policies help them more?

It’s a little more than a week since the bombing of the Boston Marathon, and the charitable donations are rolling in fast.

“Our hearts are broken, we are outraged, and we are looking for connection and meaning,” says Richard Audsley, a former United Way official who has worked with fundraising efforts to assist victims of everything from the Columbine to the Aurora shootings. “The easiest way for us to respond is to reach for our checkbook and make a donation.”

This is true for the rich among us as well as the poor. The money piles up fast in a wave of sympathy.

It’s already visible in Boston. The One Fund for Boston, set up by Boston mayor Tom Menino and Massachusetts governor Deval Patrick within a day of the attack, will be distributing more than $20m under the guidance of former 9/11 Victim Compensation Fund manager Kenneth Feinberg.

Numerous friends and families of victims of the attack have also mounted impressive fundraising campaigns to help victims with future expenses ranging from medical bills to housing to rehabilitation for the suddenly handicapped.

These sorts of efforts are now so common they even have their own foundation to help guide them, the recently established Center for Disaster Philanthropy.

“To give to causes we care about including people and communities impacted by disaster has become a way of life for us over the past decade,” says Bob Ottenhoff, the organization’s president. “We expect government to play a major role in disaster recovery but we also look to individuals, corporations and foundations.”

The private sector has been generous. The Celeste and Sydney Recovery Fund, set up to benefit severely injured mother and daughter Celeste and Sydney Corcoran, has $648,000 from donors.

Jeffrey Bauman, the young Costco employee who lost both legs and was instrumental in identifying the alleged bombers, has received more than $676,000 from donors.

This generosity is a sign that something is right with us, when we hear about so much that is wrong. But our willingness to donate also raises questions about the long-term: is our kindness, and our willingness to help, substituting for greater policy changes? Charity is lovely, but perhaps universal health coverage would help too?

I know this sounds churlish, so bear with me.

Let’s travel back through time, to the Aurora shootings nine months ago. Many of the disaster’s twentysomething victims lacked health insurance. Public pressure quickly led many hospitals treating the wounded to announce they would provide care gratis to uninsured victims.

No such statements have followed in the wake of the Boston bombing, where we still do not know how many of the over 264 victims lacked health insurance. Massachusetts is the rare state that makes health coverage mandatory, but the Marathon attracts a crowd from around the nation and many live in other states.

For the rest of us, there are flaws even in the fixes. The new government healthcare plan – known as Obamacare – is yet to be fully rolled out and is prohibitively expensive for some with lower salaries. That’s true even for those young aides who work in Congress, who are now trying to avoid signing up for it.

Ezra Klein of the Washington Post noted Wednesday that Obamacare is often sabotaged along party lines as well, with Republicans trying to torpedo any penny allotted to improving the program: “They’ve refused to sign off on any budget that includes the necessary money for implementation,” Klein wrote of Republicans and Obamacare, and it doesn’t take a genius to realize that the rest of us will suffer – literally – while Congress enjoys an ideological battle. Publications that lean to the right have crowed that nearly 24 million people who would be eligible for healthcare under the new law wouldn’t even want it.

Americans are pragmatic. We don’t wait for legislation to do the right thing. These crises are so common after disasters that of course we jump in with charity. It doesn’t, after all, take a lot of imagination to wonder why we need to raise money so people like Ericka Brannock, 29, can afford to pay their health insurance bills. Brannock’s left leg needed to be amputated at the knee after the blast and her health coverage is currently set to end in June.

There’s another side to this, though. We shouldn’t give up so easily on changing the law. It’s not that the government can’t handle a better plan. In fact, we can look to one universal health insurance outfit that has quite a bit of experience dealing with traumatic amputations.

I am, of course, talking about the Veterans Administration. If you lose a limb in Iraq or Afghanistan you can receive a state-of-the-art replacement, one that might cost as much as $50,000. If you’re looking for a special prosthesis so you can participate in athletics, the VA is likely to help you there too. And they will provide all the physical therapy you need.

Those options are less available to civilians. If you’re not in the military and you get wounded, your options for physical therapy are limited. The available prosthetics are usually of low quality. One health insurer, Aetna, said last year that it considers foot and leg replacements “experimental and investigational” in many cases, and judges whether the wounded is “motivated to ambulate.” Imagine insurance adjusters, after a major trauma, chewing on their pencils trying to decide whether the wounded ever really want to walk again.

It’s also worth noting that prosthetics need to be replaced every so often, and attention and charitable donations don’t last forever.

The vast majority of coverage of the event just seems to take this rather dubious state of affairs for granted. There have been debates, among some senators, as to whether the suspected bombers are enemy combatants. Yet no one, to the best of my knowledge, is suggesting we allow the victims of the Boston attacks to seek coverage from the VA. Instead you get headlines like Politico’s “Coverage limits are a harsh reality for amputees.”

Even Kenneth Feinberg, who has built a second career around managing these funds for disaster victims, is warning the amount raised for the victims of the Boston bombing, while seemingly fantastic, is probably inadequate. “It’s not a lot of money, when you look at the nature of the injuries, the number of injuries,” he said during a Tuesday news conference. “How you are going to divide this money?”

The victims of the attack will live with the consequences of it for the rest of their lives. Yet, for the rest of us, attention fades. We all but stop giving money – Audsley claims that 85% of disaster funds raised are received within 90 days of the tragedy.

A better health policy could last a lot longer.

Comments are closed.