Tiny Tim Health Care By Michael L. Millenson

Dickens3Every 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

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Quentin Colgan
Quentin Colgan

By now, we have all heard about the tragic case of Nataline Sarkisyan. In case you haven’t, she is the young lady that died recently after her father’s insurance company refused to pay for a liver transplant. The company, CIGNA, said the transplant was experimental. After a flurry of protests, the company relented, but by then it was too late, and Nataline died. Enter Mark Geragos. The fame-seeking attorney of Michael Jackson has filed suit against CIGNA, and has tried to get the District Attorney to file manslaughter charges against them. It is one thing to file a suit for… Read more »


I believe the best thing to fix the health care is for Americans to get more healthy.


though to be fair we should note:
1) There are many folks WITH good health coverage who don’t get effective preventative services for many reasons (i.e. system error, patient preference)
2) Some preventative measures don’t save money. Corrolary is to caution against the assumption that all prevention saves money.
3) (And most difficult) Preventative strategies in the elderly are problematic given lack of agreed upon outcome standards (i.e. is a prevention measure that adds six months to an 84 year old’s life at “X” cost worth it?)


“The Cratchit families of this country are costing you and me money.” Not recognized unless it’s right in front of the average American’s nose. Does anyone consider the cost of untreated mental illness and the crime rate? Or the cost of poor kids who can’t see any options for themselves but to stay in the hood and continue the cycle. No, we’d rather focus on tax cuts. That’s the touchy-feely part we like, and we can always buy a gun to keep the riffraff at bay anyway. The NRA solution. As for the cost of the healthcare uninsured why not… Read more »