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Tiny Tim Health Care

Posted on | December 20, 2007 | No Comments

Dickens’ Christmas Carol carries a health care message for all of us

Every year at this time, millions of Americans turn their attention to a much-beloved story about health care reform. I refer, of course, to Charles Dickens’ A Christmas Carol.

While this is not the traditional plot summary, it aptly describes a story rooted in the plight of a crippled young boy whose father cannot afford the care his son desperately needs. The prospect of Tiny Tim’s eminently preventable death finally breaks through Ebenezer Scrooge’s bitterness, causing the old miser to abandon his hard-hearted ways.
Alas, we Americans still seem inclined to treat the demand for universal health coverage like the Scrooge of old. His dismissive cry, “Are there no poorhouses?” is echoed by our smug assertions that those in dire medical need can “just go to an emergency room.”

Would-be reformers have responded with statistics about 18,000 preventable deaths each year and stories about the real-life Tiny Tims in our midst — to no avail. A new report from the American Cancer Society concluding that those without health insurance are 1.6 times more likely to die of their disease than those with private insurance came just a few days before Christmas and a few days after President Bush’s latest veto of the State Children’s Health Insurance Program, which would help millions of children living in near-poverty.

So this holiday season, rather than tugging on heartstrings, I’d like to take the opposite approach. Forget about the waifs: let’s talk about your wallet. The Cratchit families of this country are costing you and me money.

For instance, in communities with a large numbers of uninsured, moderate-income families who actually have health insurance are twice as likely to suffer from high medical costs, according to recent research from the Center for Studying Health System Change. Communities as different as Chicago and West Palm Beach, FL are being affected, although the rural South suffers a particularly heavy burden. (No one seems to have told Mike Huckabee.)

A Commonwealth Fund summary of the overall societal price tag of the uninsured contained these sobering items:
• Developmental deficiencies rooted in childhood
• Lost income due to reduced employment and job productivity (Scrooge, of course, was worried that Tiny Tim’s illness was affecting Bob Cratchit’s work.)
• Diminished public health (for example, due to low immunization rates)
• Uncompensated care (about $35 billion in 2001)
• Higher public program costs (Medicare, Social Security disability insurance and the criminal justice system)

The Fund concluded that the “cost of uninsured people’s lost capital and earnings from poor health and shorter life spans falls between $65 billion and $130 billion for each year without coverage.”

In other words, our lack of caring about the Tiny Tims in our midst – and their parents – comes not just with an ethical price tag, but an actual one – upwards of $200 per American per year.

Oh, and about those emergency rooms? Patients in overcrowded ERs now routinely wait hours for care, in part because the flood of uninsured patients has made it more difficult to persuade doctors to take call. So if someone in your family has to be rushed to the hospital, there may not be a doctor available to treat them.

Dickens’ Christmas story was aimed at reminding us that whether we are rich or poor, all of our lives are connected. That lesson still rings true. As Tiny Tim famously put it, “God bless us, every one.”

(Michael L. Millenson is president of Health Quality Advisors LLC, an author and a visiting scholar at the Kellogg School of Management. He can be reached at

Opinions expressed by Health Commentary guest bloggers do not necessarily represent the views of Health Commentary.


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