Nathan Wilkes’ story is heartbreaking. His son, Thomas, is an adorable three-year-old who was born with severe hemophilia, and a year later developed a resistance to treatment. The Wilkes family is now in a situation that should scare the hell out of anyone who’s covered by private health insurance. Basically, Thomas needs treatments that can blow through a $1 million policy in as little as a few days or as long as a year. Nathan’s employer provides health insurance, but because of the claims history, the insurance company has raised the rates and implemented a $1 million cap – which Thomas will meet sometime this spring.
Nathan works for a Colorado company with more than 50 employees, so group health insurance is not guaranteed issue for his company (as it would be with a group of 2 – 50 employees). Once Thomas meets the $1 million cap, the Wilkes family has few options. Thomas could get coverage through Cover Colorado, the state’s high-risk pool – but that also has a $1 million cap, so they would be in the same boat a year from now. Nathan earns too much money to qualify for Medicaid, although he has even been advised to divorce his wife so that she and the children could qualify (not a very pleasant proposal, and it also carries all sorts of other legal ramifications…)
Nathan recently traveled to Washington DC to meet with lawmakers and press for a universal health care system. If the Wilkes family lived in any other developed country in the world, private health insurance caps and medical underwriting would not be an issue for Thomas’ treatment. Since his condition is life-threatening, he would receive care immediately, without his parents having to worry about how to pay for it. Even though Nathan makes a good living, it’s unreasonable to expect any middle class family to come up with $1 million a year for medical care.
The problem that the Wilkes family is facing is created by the fact that in the US, health care is a for-profit venture. Health insurance companies, pharmaceutical companies and hospitals are often publicly traded, which means that their CEOs have an obligation to the shareholders to increase profits. Obviously we have to pay medical personnel and researchers, and pay for the raw materials used in medical care. But health care should not be for-profit. The issue that arises is where do we get the money to fund health care if we no longer allow public trading and ownership of the companies that comprise the health care system? The obvious answer is the government – which gets money from taxpayers. Every other developed country has figured out a way. It’s just a matter of priorities.
It’s easy to point fingers at people who “choose” not to have health insurance, or are irresponsible with their health. But the Wilkes’ have done everything right. Their son was born with a genetic abnormality, and they have health insurance – it’s just not enough. This family has been through a medical nightmare for the past three years – one that only luck has spared the majority of us. They already have to contend with the constant threat of even the smallest bump or scrape – the last thing they need to be worrying about is how to pay for their son’s treatment. Yet with the current health care system, that’s exactly what they have to worry about. So for everyone who is opposed to the concept of a universal health care system, I challenge you to present a workable solution for Thomas Wilkes.