Survival of the Wealthiest

By Rickie Emilie Farah / Winter 2020

I grew up in Peru, a third world country, unaware of how the medical system worked there. We, my family and I, had medical insurance, but when things got serious I don’t ever recall using the services provided through our insurance. Instead, our parents would take us to a clinic where the cost of everything was quadrupled; we could afford it, and in that moment the price didn’t matter, what mattered was our wellbeing. Due to my upbringing in a foreign country, I am constantly comparing and contrasting my current reality in the U.S. to what it was like living in Peru. I am reminded of the difference every day. A minor example is going to Trader Joe’s; an avocado there is $1.29, but in Peru you can get 4 avocados for the same amount of money. I can pay $1.29 for an avocado, and it won’t impact my life in a drastic way. The cost of healthcare is another difference I’ve noticed between the U.S. and Peru. Unlike an avocado, the cost of a checkup or a medical emergency in the U.S. could impact me economically in a drastic way. I have insurance, and even after insurance the cost of medical care is sky high. I hadn’t considered how a massive medical bill could impact someone without insurance until I met Eli.

My father has met a lot of women from South America on dating websites. It is not easy navigating them and meeting honest people, because a lot of the women on the websites live in poor countries, and their ulterior motive is to find someone who can give them money. However, my dad met Eli, a petite woman from Peru with an engraved work ethic and great hands in the kitchen. She is a kind woman who—like the other women—comes from a poor background, but unlike the other women, works for what she wants. She is independent.

As soon as she arrived to the United States, she found a job so she could make an income and send money back to her family in Peru. I could tell how much she cared about my father when she came to visit him for six months; she would cook for him, help him with things around the house, and she even helped my dad by working with him on his properties. One day, I was there too, and we were working on cleaning the backyard of his apartments, when suddenly Eli tripped over a rock and fell. She was clutching her arm and the expression on her face said it all; she needed to go to the hospital. I was ready to take her to the nearest emergency room when it hit us that she didn’t have insurance in the U.S., and if we were to take her to any hospital the bill would cost two eyeballs and a kidney.

At the time, my dad did not have property insurance, which would have helped cover the expenses of whatever procedure Eli needed in that moment.  Neither Eli nor my father had the funds or the desire to pay for such an expensive procedure. My father went to three different hospitals to find her affordable treatment: Novato Community Hospital, Petaluma Valley Hospital, and Santa Rosa Memorial Hospital. When Novato Community Hospital learned that Eli did not have health insurance, they said they would do the surgery—but in a week—which was not good enough. Petaluma Valley prepped Eli for surgery and the doctor was ready to do it, but when he saw the x-rays and the CAT scan he doubted his abilities and cancelled the surgery. He wanted to have a hand specialist at his side, but the specialist did not make himself available (we suspect the specialist knew Eli didn’t have health insurance which is why he refused to help). Eli was charged $6850 for being admitted to the emergency room and being prepped for surgery even though she was not treated. Santa Rosa Memorial Hospital initially said they could not treat Eli. Their excuse was that they didn’t have a doctor available to do it. Eli and my father were considering purchasing a ticket to Peru so Eli could return sooner and have her first surgery there. Fortunately, Eli had made a friend in her English class who knew a doctor who worked at the Santa Rosa Memorial Hospital.

Finally, twenty-five days after the accident happened, Eli received surgery at the Santa Rosa Memorial Hospital. Because the surgery was delayed for so long, some of her bones began growing together in an inapposite way, not proper for healing. They inserted metal rods in her arm to stabilize the bones, which would later need to be removed through yet another surgery. The initial bill for the surgery was $114,700, but after the hospital realized she didn’t have insurance, they reduced the bill to $74,000. Eli was reluctant to apply for Medi-Cal because she did not want to compromise her tourist visa, but she did eventually. Eli returned to Peru in time for the second surgery to remove the metal in her arm. In Peru the cost of her surgery was only $5000 without insurance. In the U.S., the cost of her second surgery would have been approximately $30,000.

Eli suffered greatly during those twenty-five days before the operation, and she shouldn’t have had to. Although it was not said aloud, these three hospitals did not try to help Eli to the best of their abilities because they knew she didn’t have health insurance. Why is it that good medical care is only provided to those who have money? Shouldn’t receiving good medical treatment be a right for everyone? Where are the values and morals when a hospital gives a patient preference based on their income?

If you think about it, the medical community is basically conveying the idea that ‘if you have money we will take care of you, but if you don’t you are going to have to wait.’ And it’s not just about having money, it’s about having enormous sums of money to afford health insurance or having a steady job that has it listed as one of the benefits. How does this system tend to the children of immigrants or immigrants themselves? This system is meant to aid those with higher incomes, and to exclude those with lower incomes. If Eli was an employee at Apple, she would have most likely received immediate treatment for her injury, but because she is an immigrant, with no health insurance, she had to wait long enough for her injury to become even more complicated than it was initially. The system reinforces an unjust socioeconomic hierarchy the same way it did 500 years ago. Our evolution and natural selection process has shifted from “survival of the fittest” to a more modern version, ‘survival of the wealthiest.’ That is no way for a country that claims the motto “life, liberty, and the pursuit of happiness” to function. The healthcare system in the United States needs to be rethought. Something needs to change.

Let’s take a deeper look, how exactly does the medical system work in the U.S., or more specifically, in California? First, there is Medicare which is a federal health insurance program for Americans over the age of 65. It was inaugurated by President Lyndon B. Johnson in 1965 (Canopy Health). Then there is Medi-Cal, which allows low-income individuals and families free healthcare or remarkably low-priced healthcare coverage (Canopy Health).  If you do not fall under either of these two categories, in other words, if you are not over 65 and you are not a low-income individual, then you must enroll with a private insurance company through Covered California, which includes health insurance companies such as Blue Shield of California, Kaiser Permanente, Molina Healthcare, among others. Covered California is basically a marketplace where you shop for private insurance. 

The purpose of the Affordable Care Act of 2010, also known as Obamacare, was to guarantee that every American, no matter their age or socioeconomic status, would have health insurance. However, Americans who are not considered low-income don’t have much of a choice as they are forced to pay for health insurance whether it be directly or through a fine. In 2018, according to the Affordable Care Act, if you did not have health insurance then you were to be fined $295 per adult or 2.5% of your household, whichever was the highest amount (eHealth). This amount of money could be devastating to a family that lives from paycheck to paycheck and is already struggling to make ends meet. Our current President, Donald J. Trump, wants to repeal the Affordable Care Act, but he has so far been unsuccessful. Having health insurance distributes the risk of having to pay a ginormous amount of money in case of an unfortunate situation.

Each private insurance company under Covered California offers different tiers. It is similar to choosing a phone plan; you select how much you want or are willing to pay each month in exchange for specific coverage. Which again, grants those with more money better access to specific healthcare benefits. Back to the phone plan analogy, the more money you have, the more minutes and roaming data you can afford. So, the government has established the Affordable Care Act to make sure that all citizens have insurance, but that does not change the astronomical medical costs we face every day. How did the cost of healthcare become so expensive? The privatization of systems such as healthcare, and the high demand for it; capitalism. The medical industry has become a business. We have the tools and medicine to cure most ailments, but they aren’t free, they all have a cost in this country. It is as if there has been a shift from our human rights which have now become privileges.

We live in a capitalistic society which reinforces a competitive environment. We are fed with the idea that we have to work hard to achieve our full potential. It is so easy to get lost in that mindset and forget about what matters, to forget about why we stand on this land and what it means to be in this territory we call the United States of America. The reason we can live such a comfortable life is because of those who came before us and fought for our rights. People like Franklin D. Roosevelt who fought for “the right to adequate medical care and the opportunity to achieve and enjoy good health” (Roosevelt, “State of the Union 1944, (Second Bill of Rights)”). When the government does nothing to intervene, or when the government tries to take away the few systems that help Americans on a daily basis, we are in trouble.

Our capitalistic society has bred the privatization of our healthcare system. David Harvey argued that “while it may be crucial to preserve the integrity of the financial system, the irresponsible and self-aggrandizing individualism of operators within it produces speculative volatility, financial scandals, and chronic instability” (Harvey, 80). Individualism, the social theory that favors the individual over the collective, the common good, produces inconsistencies within our society, which in the end derails us from progress. The government is setting up minorities and low-income families for failure by allowing our basic human rights to be brought into business.

What makes us unique as a species is the ability to empathize, to care for one another. Martin Luther King used the Greek word Agape to describe an “understanding of where the other person is coming from and a belief in redemption for those who do wrong” (Twohig, “Day 11”). I believe most Americans lack Agape, and it is not entirely their fault. We are raised in this country with an individualistic propensity, with the idea that we are supposed to be successful, better than the average. You’ll be happy when you’re successful, and success equals money, because money allows you to live comfortably, it raises your status, the way people view you. They say money can’t buy happiness, but it surely can assist you in obtaining it.

A reason that prevents us from solving this unjust healthcare situation is who we choose as our political leaders. On the other hand, interference from the government through the Electoral College, as seen in our last presidential election, can impose what the majority of people want. In 2016, the majority of the people did not vote for our current President, instead the Electoral College went against the people’s preference and chose him. There is a lack of representation for groups that are considered ‘minorities’ – even though they are now more like majorities—and these groups tend to not be affluent. The people governing us are white men with money; as long as they are not affected by a systemic issue, they do not care to repair it. They are the ones that can afford a fancy and costly private health insurance that minorities cannot.

How is it that a country like Denmark can provide free healthcare to all of their citizens and still function? How is it that the cost of an inhaler such as Advair, one that has 60 puffs, which lasts me about 30 days if I take 2 puffs a day— a survival necessity that I need— without insurance costs $397.45, and with Blue Shield of California costs $79.49 at the Walmart pharmacy in the U.S., but in Denmark it is free? $79.49 times twelve is $953.88. I pay an insurance company a certain amount of money every month, plus I have to pay $953.88 a year to avoid having an asthma attack, but in Denmark it is free.

The answer to these questions is inscribed in the following questions: who are our political leaders and what do they stand for? Do they stand for the people or private corporations? How do they distribute our tax money? Do they pull our tax money from various funds to send troops out to war in foreign countries rather than investing it in our healthcare? Our political leaders, at the moment, stand for themselves and private corporations. They take advantage of their power and avoid paying taxes. They use our tax money in ways that benefit them. Our country is being run by corrupt individuals.

Some could argue that Eli is an immigrant, and her particular situation doesn’t apply to the average American. Well to that I say, let me present what is happening outside your door as we speak: Coronavirus. It is spreading across the world and it is dangerous. According to Worldometer, a website that collaborates with the Real-Time Statistics Project, managed by international researchers, developers, and volunteers, there have been 373,885 confirmed cases of COVID-19 across the globe, and approximately 16,328 people have died due to the virus (Worldometer).

It takes a crisis for all of the issues and contradictions within our society to come to light. I usually find it easy to distract myself from the problems I can’t change by myself. I even tried to procrastinate writing this paper, but it is impossible when all you hear on the news, all you hear on the radio, and every other Facebook post is about COVID-19. The Coronavirus is a flashlight illuminating all of our country’s problems. We are able to see the true nature of our society; from people selfishly hoarding toilet paper, to the president reinforcing discrimination and racism, by calling COVID-19 the “Chinese Virus” (Rogers, Katie, et al.). Calling it the “Chinese Virus” removes the blame from him and puts it on a different country. It makes it sound like it is their fault this is happening, which is not the case.

This pandemic is happening, it is spreading, and you cannot ignore it. You are not special. You are not different. This is affecting and will continue to affect everyone if we do not follow necessary precautions. We could have been prepared for this, but unfortunately our government did not make the right choices. In 2018, president Trump dismantled the entire White House’s National Security Council Directorate for Global Health Security and Biodefense (Cameron). The entire purpose of that team was to prevent a pandemic like Ebola, or the one we are facing today, from spreading.

We could have had scientists working on a cure or a vaccine sooner, but because of political decisions, that process was started late. We don’t even have enough COVID-19 test kits for the whole population. Right now, doctors have to make a choice, they have to play God in a way and decide which patient is a high-risk patient and which one is a low-risk patient to administer the few tests we have. If this gets worse—the way it is in Italy—doctors will be choosing which patient gets a respirator and which one does not. And who are the hospitals more likely to serve, the homeless man who just walked in the door without insurance, or a famous movie star?

If we want to live in a fairer society, if we want everyone to be healthy and happy overall, then we need to care about who makes the decisions that affect our country the most. We, you, me, the person sitting next to you, we, need to get involved. We need to vote for people that intend to promote a healthier environment. We need to vote for people who are educated. People who have an idea of how the world works. Our current president is completely lost and out of character when it comes to COVID-19. On January 22nd, he said “We have it totally under control. It’s one person coming in from China.” (Belvedere, 2020) On March 6th, “Anybody right now, and yesterday, anybody that needs a test gets a test. And the tests are beautiful. They are perfect just like the letter was perfect. The transcription was perfect. Right? This was not as perfect as that but pretty good” (The White House). But they are not, not everyone who needs a test is getting a test because we are late to the game, because those in power chose to ignore the warning signals. On March 9th, “The Fake News media and their partner, the Democrat Party, is doing everything within its semi-considerable power to inflame the Coronavirus situation” (Trump). On March 10th, “And we’re prepared, and we’re doing a great job with it.  And it will go away.  Just stay calm.  It will go away” (The White House). And only on March 13th – too late—did he announce, “NOW, THEREFORE, I, DONALD J. TRUMP, President of the United States, by the authority vested in me by the Constitution and the laws of the United States of America…do hereby find and proclaim that the COVID-19 outbreak in the United States constitutes a national emergency” (The White House). Blatantly uninformed statements like these are the reason we need to care about who we call the president, because whoever is at the top calls all the shots.

To conclude, the American health system is unfair. The medical system is controlled by political leaders with their own biases. They do not care about the overall wellness of the country, but instead about how it will affect their individual pockets. There is a lack of solidarity for one another in this country made up of immigrants, because who are the “real Americans”?  It is not that our political leaders are evil, but they are ignorant and uneducated. If we want change for the better then we need honest, humble, collectivist people in office. We are not overreacting; we are acting. If we wait much longer for the system to fix itself then we will be RE-acting, and then it will be too late. It is time for us to come together. My only hope is that we will recover from this, and that when we do, we can use this experience as an example of what not to let happen again.

Works Cited

Belvedere, Matt. “Trump Says He Trusts China's Xi on Coronavirus and the US Has It 'Totally under Control'.” CNBC, CNBC, 22 Jan. 2020.

Cameron, Beth. “Perspective | I Ran the White House Pandemic Office. Trump Closed It.” The Washington Post, WP Company, 13 Mar. 2020.

eHealth Insurance. “Obamacare Tax Penalties.” Health Insurance - Find Affordable Health Insurance Plans and Buy Medical Coverage Online, EHealth Insurance, 15 Nov. 2019.

Harvey, David. “A Brief History of Neoliberalism” Oxford University Press, 2005. pp. 64-86.

Rogers, Katie, et al. “Trump Defends Calling the Coronavirus the 'Chinese Virus' Despite Outcry.” The New York Times, The New York Times, 18 Mar. 2020.

Roosevelt, Franklin Delano. “State of the Union 1944 (Second Bill of Rights)”. WCWP 100: Systemic Analysis for Everyday Life.

The White House. “Proclamation on Declaring a National Emergency Concerning the Novel Coronavirus Disease (COVID-19) Outbreak.” The White House, The United States Government.

The White House. “Remarks by President Trump After Tour of the Centers for Disease Control and Prevention.” The White House, The United States Government.

Trump, Donald J. “The Fake News Media and Their Partner, the Democrat Party, Is Doing Everything within Its Semi-Considerable Power (It Used to Be Greater!) to Inflame the CoronaVirus Situation, Far beyond What the Facts Would Warrant. Surgeon General, ‘The Risk Is Low to the Average American.".” Twitter, Twitter, 9 Mar. 2020.

Twohig, Niall. “Day 11 – Look Deeply to Understand Clearly.” 11 Feb. 2020

“Understanding the Differences Between Medicare and Medi-Cal.” Canopy Health, Canopy Health, 25 Jan. 2017.

Worldometer. “Coronavirus Cases” Worldometer.