By MICHAEL MILLENSON
Maybe the uninsured could learn something from Egyptians and the Arab street. At a time when landmark health reform granting most of the uninsured access to medical care for the first time in their lives is being seriously threatened, protests by the uninsured themselves are nowhere to be seen.
In 2009, a staggering 51 million Americans from every walk of life and every corner of the nation had no health insurance. The Urban Institute estimates that 400 of them die each week due to lack of access to care. However, instead of pouring into the streets to protest when an activist judge calls the health reform law unconstitutional or conservative ideologues threaten to cut off funding, the uninsured leave the loudest push-back to (well-insured) political partisans.
This quiescence on a basic human right to care contrasts sharply not only with those braving tear gas and truncheons in Cairo. In this country, merely mentioning gun control fuels a firestorm of protest by firearms supporters. Gay marriage has mobilized liberals and libertarians alike over the “freedom to marry.” The children of undocumented immigrants have dared arrest and deportation to plead publically for the right to become American citizens.
More than one in six Americans is now uninsured. Where are they? The few exceptions to this rule show how much their faces and voices and names are missed. At a hearing by Sen. Tom Coburn (R-OK) in 2009, a sobbing, middle-aged woman confessed she couldn’t afford care for her brain-injured husband. Coburn, a physician, glibly responded that “the idea that government is the solution to our problems…is very inaccurate.” The partisan Republican crowd applauded, in an exchange captured by CNN, but the reaction of ordinary Americans was far more negative.
An estimated 690,000 Oklahomans have no health insurance. Why were so few in the room? Why did hundreds of them not pour into Coburn’s office the next day? Why do they not continue to tell their stories?
Like the ruling elite in Egypt who genuinely don’t comprehend the problems of the average family, polls going back more than a decade show that Republicans are more likely than Democrats to genuinely believe that the uninsured really don’t have any problem getting good-quality care.
Yet among the less partisan, there’s a readiness to reconsider. Personal experience plays a key role, an analysis in Health Affairs concluded, with those who are younger, poorer and female being more sympathetic. The elderly, whose rich Medicare benefits have shielded them from the brutal effects on medical care access of the weak economy, “are not cognizant of the problems faced by the uninsured,” the article noted. A just-released poll shows a majority of the American public does not back repeal or ending funding, but how the issue is framed is critical.
Put plainly, the political and legal peril in which health reform finds itself is directly attributable to the failure of the uninsured to visibly advocate on their own behalf. Those without health insurance have allowed a civil rights issue of guaranteed access to medical care to become a referendum on Big Government rather than a test of basic human compassion for brain-damaged husbands. And, even more ironically, have left the heavy lifting on lobbying against repeal to the big insurance companies of the world such as Aetna, Humana, UnitedHealth Group and WellPoint
Worse, while the prestigious Institute of Medicine characterizes the consequences of a lack of access to care as “needless illness, suffering, and even death,” it is Republican physicians in Congress brazenly lead the effort to repeal care coverage.
By coincidence, there are about the same number of elderly on Medicare as there are uninsured. Egyptians understand the power of an aroused populace. Do the uninsured? In Red States and Blue States in 2012, there will be Congressional districts and senatorial races up for grabs and a contest for the presidency featuring a man who made a historic effort on their behalf. Will Republicans whose party has never put forth a serious proposal to provide access to care for all suffer any consequences at the ballot box from turning to the sick, the scared and the suffering with a curt, “Government is not the answer.”
Or, perhaps, have conservatives been right all along that liberals have vastly overestimated the scope and impact of this problem?
If there’s anyone who understands the power of individuals coming together to make demands on their own behalf, it is a black man who rose to the presidency from being a community organizer on Chicago’s South Side. Yet rather than rally the uninsured to present their case as people just like us, President Obama has allowed Republicans to frame the issue as a debate over the Commerce Clause of the U.S. Constitution.
Fortunately, the fight to retain actual funding for the expanded coverage in the Affordable Care Act is just beginning, with “aggressive” hearings scheduled by Republican committee chairs in the House and by opponents in the states. It is a battle that Democrats can win only if Americans genuinely understand that it is the health and lives of their friends, neighbors and relatives that is at stake. For that to happen, those whose lives are most intimately affected must first stand up for themselves.
This post was first published at Forbes.
Michael Millenson is a Highland Park, IL-based consultant, a visiting scholar at the Kellogg School of Management and the author of "Demanding Medical Excellence: Doctors and Accountability in the Information Age".
Categories: Uncategorized
MD as Hell: honest folks who are desperate for care for a child or a spouse with a catastrophic illness will do anything to get that family member care.
Thre are many more “worried well” burning through benefits than there are sick people burning through benefits.
Fix that and you have a sustainable system.
Lynn,
Honest folks don’t lie to get Medicaid.
I love people like you Steve, so easy to argue with cause your foot is always in your mouth. So I administer COBRA, send the letters out, see who elects. I see how long people work and with HIPAA certs how long since they worked. Are you claiming I don’t know current labor trends? Who would possibly know more about enrollment in group health plans then the person who administers the group health plans?
“People change jobs and are out of work for extended periods of time much more than in the past.”
Are you trying to say its longer then 18 months? Labor statistice would disagree with you, so if your not claiming all the facts are wrong COBRA would already address this sitution.
” These plans may cover just $2000 in benefits per year.”
May but they don’t? Why would you base an argument, let alone policy and something that is not real. People get hit by cars should we outlaw all cars so the 0.0001% of the population that get hit by cars won’t? The number of people with a $2000 mini med is a rounding error, but this is your argument for changes in our system?
Steve is it safe to assume you are even more opposed to pensions since they are even less mobile then healthcare? Think of all the Union employees trapped in their job chasing their 30 years instead of opening new businesses or chasing better opportunities…..funny the liberals never complain about that shackle….
Does the author assert healthcare as a “basic human right” on a moral basis? If so, that acknowledges government can and should legislate morality on a wide basis.
Barry-nate knows enough to spin it his way. Talk to your kids and their friends, or read Douthat and Salam’s Grand New Party. The way we work is changing. People change jobs and are out of work for extended periods of time much more than in the past. It is now predictable that a growing number of people will be unemployed for some period of time each year. That 51 million number will grow. It wont be the same people and they may not be all unemployed at the same time, but they will be there.
Which brings us to the poorly functioning individual insurance market. It works well if you are young and healthy. If you are older and/or sick, you quickly get priced out. If you are sick enough, say you had a prior PE, you cannot even get price quotes (at least in Pennsylvania). So, we have a large group, at lest 5 million, that cannot get insurance at all.
Then we have the group that is not talked about enough, the underinsured. The working poor who have mini-med type plans. These plans may cover just $2000 in benefits per year. These are medical discounting plans, not insurance. One delivery or one procedure of almost any type will go way past those limits. These people do not show up as uninsured for statistical purposes, but they are.
Most OECD countries have figured out better ways to handle health care. Our politics cripples us on this issue. Just for fun, here is libertarian writer and editor at Reason on how things could work.
http://reason.com/archives/2009/12/07/why-prefer-french-health-care
Steve
Lynn is correct. And sick people are not well enough to fight.
“Only 5 million americans need insurance and can’t get/afford it. Why not create a sensible program to help those 5 million instead of screwing up coverage for the other 300 million that are happy with what they have?”
Nate – While I agree with you conceptually and you probably know more about this than I do, I thought I would pass on what I learned at a recent health policy conference in DC regarding the state high risk pools.
Prior to PPACA, 35 states operated high risk pools which covered 208,000 people altogether. While the insurance is very expensive, especially for the 55-64 age group, the medical loss ratio for these plans ranged from 150%-300%. One panelist who was familiar with Maryland’s pool said its medical loss ratio, when he worked there, was 275%. Only about one-third of the revenue needed to run the pools came from member premiums. A significant piece of the rest was funded by surcharges on insurance companies and there was a general revenue component as well. At the population level, the 55-64 year old age group consumes 5-7 times as much healthcare as those in their 20’s. Decent insurance coverage for this population could easily cost taxpayers $10K per person or $50 billion per year for the whole group less whatever could be collected from member premiums that these people could afford – perhaps 8%-10% of income.
Under PPACA, a 4 to 1 age band is allowed for high risk coverage vs. 3 to 1 for regular insurance. Moreover, one has to show that they were uninsured for at least six months before becoming eligible to buy what is likely to be very expensive coverage. It’s no wonder that only 8,000 people or thereabouts signed up for it so far.
I’ve tried writing my Congressman and Senator about it, and gotten the usual form letter acknowledgement back from them along with being added to their PR mailing lists.
As has often been stated, the measure of a society is how we treat those less fortunate. The US gets a failing grade for issues like housing, education and health care on these basic measures of how we’re doing in this regard.
nate: tried the INC route but in my state it’s a no go. Why in the US should I have to create an extra layer of private bureaucracy to acquire basic health insurance coverage? This lack of insurance access is a significant barrier to entrepreneurship.
I’ve actually learned a great deal shopping and paying directly for health care services. I know where to find Medicare allowables, I know where the lowest cost highest quality mamograms can be obtained, I’ve learned consulting the pharmacist first then discussing medication changes with the MD saves money.
I also know that many of my physician clients don’t provide insurance for their staffs. The good ones worry about that and the other ignore it and hope for the best. I’ve also watched the perverse incentives rob too many kind, decent, regular folks of any degree of dignity…not for themselves but for care for family members. I’ve watch honest folks lie to get Medicaid.
Our Rube Goldberg system assures those who want to can avoid seeing the misery hidden just out of sight. It’s not the America I feel proud of. Access regular health care shouldn’t be a game with ever more complex and changing rules. It should be a basic, simple, human transaction.
Matthew are you sure Jeff is paying for hair cuts, may be if he paid a little more he’d could go to a stylist while there’s hair left.
Don’t worry. Peter. You are not paying for their care that I provide. They are just stealing it.
“Why Aren’t The Uninsured Protesting In The Streets Like The Egyptians?”
Why don’t poor people vote or even advocate for themselves? Why don’t young people vote in same numbers as older Americans?
“They are just well and see no need to either buy insurance or insist the government buy it for them.
They are free.”
Free to show up at the ER for “free” care that you pay for.
I’m concerned about Jeff’s economic insights in general now I’ve discovered that he PAYS someone to cut his hair.
http://bit.ly/fDAYBe
A key distinction preventing a civil uprising from the uninsured is that ‘uninsured’ does not equate to complete lack of access to health care services. No doubt that the many fine points made on this post hold true, but in the end, when absolutely needed, no one in this country is denied access to health services…just walk into any E.D. Is this optimal? Is it economical? Are the uninsured being treated appropriately? Of course not, but the stimulus to ‘rise-up’ just does not exist.
Many thoughtful comments with much insight. I still believe that with all the barriers, thousands of the 51 million could and should be mobilized. Instead, as we see with this week’s New York Times, we get onesies and twosies as props in newspaper stories, the same way that they show up in speeches and hearings. Perhaps (OK, it won’t happen) the press could ask the victim-of-the-week whether they’ve even tried to contact their representative or senator.
“self employed health care economist”
Then why don’t you create Lynn self employed health care economist, Inc. and buy a guarantee issue policy? What state do you live in? There is an 80%+ chance you have access to guarantee issue insurance at a capped rate and just haven’t put forth the effort to get it, sounds like your waiting for someone else to do all the work.
Or more likley no matter the cost you rather not pay it. To incorporate cost a couple hundred dollars, if your running a business then be a business and incur the expenses other businesses have to. Or should the public have to support you in your choosen field?
Michael why do you leave out all reference to time? 51 million where uninsured for a period of time, at no time where a full 51 million uninsured. Studies done in CO and other states show at any one time those uninsured is half that of those uninsured at some time in the last 12 months. If that held nationally your only talking 25.5 million any given day. Not nearly the problem your trying to portray.
39% of the uninsured are hispanic and a large portion of those are illegal. Its not very likly that illegal aliens will ever march the streets demanding free insurance from americans, no one thinks that would sit very well.
The main reason the don’t march is the majority of uninsured choose not to be, either not buying coverage they can afford or not signing up for free coverage like Medicaid they qualify for.
The real question then becomes why are liberals so damn persistant on solving a problem that doesn’t exist instead of helping the much smaller number of people that really need help.
Only 5 million americans need insurance and can’t get/afford it. Why not create a sensible program to help those 5 million instead of screwing up coverage for the other 300 million that are happy with what they have?
This is the same thing liberals did with Medicare, passed a bill that didn’t address what they said it did and just made everything worse.
“Will Republicans whose party has never put forth a serious proposal to provide access to care for all”
Serious by who’s measure? You can’t grasp functioning markets so any system built on the concept isn’t serious? Compared to liberals who make proposals they can never be paid for and make promises they never intend to keep and those are serious? Medicare and Medicaid are plenty of proof we are better off with any Republican proposal then a serious liberal one.
Margit is right. The safety net, though strained, still holds.
If all we had was a private health system, many of the conditions for the revolution Mike seems to lament we haven’t had yet would be present.
To imagine what medical care might look like without much government interference or national coordination, compare dentistry. Dentists are largely unmolested by the same problems, mostly because theirs is not a life and death enterprise. But thanks to the much worshiped free enterprise and competition system good dental care goes to those with the means to pay and those who cannot learn to do without. Most of the working poor simply endure toothaches and abscesses until they become intolerable then find a cheap dentist who will extract the tooth (or teeth) that hurt. When they are all gone the lucky ones might find a lab that will fit them with cheap dentures for a couple hundred dollars… if they can scrape up enough to pay for it ahead of time.
That’s how most of my employees lived in the food business. They are the working poor. I watched it first hand for thirty years before I retired.
What? Medical care, you say? Pretty much the same. No bells and whistles. Those who worked had to remain healthy or they couldn’t keep a job. Employer-subsidized insurance was available, but only about four or five out of a hundred could afford it. The rest either did without or waited for emergency care. A handful were covered by a spouse’s policy.
In my post-retirement life I spent five years in a healthcare system with five hospitals in several campuses, and for the last two years as an hourly paid non-medical caregiver for (other) seniors through an agency. Looking at the system up close I have come to these conclusions.
►Hospitals have three big revenue streams (insurance payments, Medicare, Medicaid) and one smaller one (co-pays and cash). A low profile “indigent care clinic” was available for a small number of patients with too many assets to qualify for Medicaid, but anyone with the right ticket went in the front door.
►The accounting and tax-advantaged status of not-for-profit institutions works to some extent as a money laundering system for many for-profit enterprises. Insurance and government money is far more important to the system than incidental amounts from other sources. From an accounting and tax perspective the relationship is symbiotic and incestuous.
►After spending my whole working life in the private sector working hard to squeeze a nickle or a dime out of every revenue dollar, I was shocked to see the wholesale waste of material and human resources in the so-called “not-for-profit” health care systems. Marble floors, expensive potted plants, flat-screen TVs and the rest took my breath away, especially knowing that every dime had to come from someone’s medical charges.
Just as shopping malls are giving way to strip centers, a tectonic shift I read about in another post is happening to health care. As time passes I’m hoping more people will realize that health care and insurance are NOT in the same line of work. Health care is in the business of healing. Insurance is in the business of risk management.
Of course both are in business to pay the rent, but in the case of medical care, too many medical professionals confuse professional compensation with business profits. Any accountant can explain the difference. Compensation is always an expense. And profits are always diminished by too many expenses. These two accounting concepts, well understood by accountants, are very mixed up for most health care professionals.
That’s enough for one comment. If I don’t stop I’ll get to ranting.
It’s because the Left is poorly organized.
It’s because we live in a democracy and we don’t settle things via dysfunctional methods such as Molotov cocktails in the street anymore. Instead we engage in representative dysfunction in the nation’s capital.
Both Jeff and Lynn are correct. The safety net is still holding and being uninsured is not something you want to advertise in “polite company” (been there too, Lynn).
The middle class uninsured regard “uninsuredness” as a temporary misfortune to be remedied by the next job offer. The poor uninsured have become accustomed to sub standard care and ER visits.
What people fail to realize is that health care reform is not needed for the bad situation we have today, but for the unbearable situation we will inevitably have in the very near future.
I hope people start to understand the stakes here and I hope they engage in our type of activism and GO VOTE, precisely so that we don’t have to become just another Egypt.
I have been a pediatric nurse for the past 6 years. I have worked at several different large Children’s hospitals around the country. I have not noticed a change in the way the uninsured or under-insured have advocated for themselves. I believe that every child in this country is entitled to have free health care. My question is, why don’t these parents have health care for themselves? We are fighting for them to have access to the care and medical services that they need and the majority of the time they remain apathetic. Most of the children I care for now are on Medicaid or SCHIP because their parents remain at or below the poverty line. Even so within the hospital, medicaid and the child health plan refuse to cover certain costs so the money has to come from somewhere. I don’t see why the parents of these children, who don’t have insurance or don’t qualify for medicaid themselves have any motivation to fight or protest for themselves. In many cases, they drive nice cars, have their nails done on a weekly basis, have cell phones, and no job. They get away with doing nothing about their situation so why, from their perspective should they change? I have seen many illegal Mexican immigrants who steal other peoples medicaid numbers so that their child can be seen in clinic and get the preventative care that they need. Within the confines of a hospital, emergency medicaid seems pretty easy to obtain even if you aren’t a legal citizen of this country. All a provider has to do is sign a piece of paper and boom free healthcare to a non-citizen! Our country allows this and these people slip through the cracks without being noticed so why would they stop doing this? Why would they fight for insurance when the way they go about things now seems to be working and is free?
The legal citizens of this country should protest to the government for a basic insurance plan that covers the cost of preventative care (primary care visit, vision, and hearing screens, etc.). The people who are not citizens of this country are getting these basic health needs met so why cant the American person who is uninsured?
Speaking as an uninsured person for more than six years (with the dreaded pre-existing but manageable condition) and a self employed health care economist, let me share some observations.
When speaking to groups on health topics, I always introduce myself as uninsured. The immediate reaction from the good people in the service clubs I’m talking to, is a not so subtle gasp and then the fidget. Why? Because for someone who is obviously professional, educated, funny and middle class, I can’t possibly be uninsured! The uninsured are “the other.” “The other” in America are poor, minority, they a not outwardly “middle class,” educated, articulate,and white!
I have been asked, in all honesty and sincerity by folks, “Aren’t you embarrassed or ashamed to be uninsured?” Wonderful opening for me to explain that in America all you have to be in older, female and have a medical condition and you get priced out of or denied coverage. You aren’t a “good” insurance risk. It’s not personal it’s just business.
I think the reason the uninsured don’t revolt is that they accept their status as uninsured as an individual failing, their own fault. If only I worked harder or for the right employer or were better educated or were a nicer person. The uninsured, all to often, don’t see or understand the political/economic nature of their status. They fail to comprehend that being uninsured is NOT THEIR FAULT. It is more than just bad luck.
The uninsured don’t understand the nature of the political and business forces that determined in the United States, the individual is totally responsible for their health status and for financing their health care. If you are sick, it is somehow your fault. Get a catastrophic diagnosis and watch how people react. Watch how they question what did or didn’t you do to get cancer or arthritis or whatever. We are very quick to blame the victim. We got older (beats the alternative) or we had the wrong parents (pesky genes) or just had bad luck. If it isn’t your fault they someone is negligent of course.
In the United States, we mostly by political default, decided to finance health care via a private insurance model, making health care a private good available to those who can afford it or are blessed with an employer who can afford it. The exceptions of course are those who are old and had worked hard (Medicare) or those who we choose to believe are the deserving poor (except of course they aren’t because we know those Medicaid folks keep on having those babies they can’t pay for.)
Every industrial society treats health care as a public good, covers everyone, and struggles just as the US does with rising health costs. Only the in the US is it OK to leave millions of citizens to fend for themselves depending on the “kindness of strangers” and public policy that says emergency departments have to stabilize you before they transfer or discharge you.
So the uninsured don’t rise up and take to the streets because then the neighbors would know we don’t have insurance and therefore can’t really possibly be middle class and like them, or are in denial that they are uninsured, or are politically unaware their collective voices might make a difference. Some are sick or are simply tired from caring for the sick. Some are unfortunately too nice and nice people don’t make a fuss or scene. (That’s the Southern Way.)
Like most people, the uninsured are not seeking healthcare. They are well. They are not the worried well. They are just well and see no need to either buy insurance or insist the government buy it for them.
They are free.
There was actually a great NEJM article on this a few years ago (Lawrence Brown’s “The Amazing Non-Collapsing US Health System Jan 24, 2008), reinforcing Dr. Marcinko’s point: it’s the safety net that he mentions that has prevented the revolution/collapse that Mike wonders about. I blogged about it here shortly thereafter.https://thehealthcareblog.com/the_health_care_blog/2008/02/is-mandated-uni.html
Supporters of health reform view providing universal health coverage as a basic human right. It is legitimately debatable if that’s the most cost effective or humane solution to improving the public health. The existing system gives many without coverage access to community health centers, an increasingly effective VA health system, public hospital and health department clinic systems, etc. that provide them free care. It isn’t just the hospital ER’s that the Republicans sometimes talk about. And we provided coverage directly to the two most sympathetic and potentially downtrodden groups: children and mothers through Medicaid and the “elderly” through Medicare, and have for 45 years. We’ve thus unsystematically stripped the revolution of most of its troops.
If all we had was a private health system, many of the conditions for the revolution Mike seems to lament we haven’t had yet would be present. It’s an open question whether it would actually be more cost effective to expand and strengthen the present safety net or to provide universal insurance coverage. Health reform actually did both, thought the lion’s share of the funding went to coverage. I think the safety net expansions- particularly the community health center expansion- were a far more judicious and effective use of scarce public dollars.
The reason no one’s rioting about the Republican pledge to “take health reform away” is simple: most of the intended beneficiaries of health reform never believed they were actually going to be helped. The person who cut my hair, who voted for Obama, and has two kids and is uninsured, said to me after health reform passed:
“I’m going to get health coverage from my husband before I get it from Barack Obama”. The irony: she was merely dating at the time and he hadn’t even proposed. She might be right.
It was a fatal strategic error on the part of ACA’s drafters to postpone the coverage expansion for three plus years. That is a political eternity, and none of the Democratic strategic thinkers had the foresight to consider that they might lose control of Congress and possibly even the Presidency before they could “deliver’ the new entitlement.
Mike,
The short answer is because we have MC/MD, VA, PHS, IHS and local ERs, etc,
Uninsured Hospitalizations
But, the lack of real health insurance does have serious consequences on individuals and producing societal tensions. For example, the uninsured may be more likely to delay or forgo necessary medical care until eventual hospitalization makes care much more expensive.
Yet, the number of uninsured hospitalizations increased by 34%, thru 2010 over the last 10-year period, and the number of Medicaid hospitalizations increased by 36%. However, a report from the Agency for Healthcare Research and Quality (AHRQ) suggested the number of privately insured hospitalizations remained about the same. Hospital charges increased for the uninsured faster than for overall hospital charges (76% for compared with 69% for all hospital stays). The average hospital charge for an uninsured stay in 2006 was $19,400 compared to $11,000 in 1997 (after adjusting for inflation). The average length of stay for the uninsured remained the same at about 4 days per hospital visit. Other findings included:
• Compared to all hospital stays, uninsured hospitalizations begin in the emergency department much more frequently (60% for the uninsured compared to 44% for all hospital stays).
• The number of uninsured hospitalizations for skin infections rose sharply over the 10-year period, increasing from about 28,000 stays in 1997 to about 75,000 stays in 2006. Early appropriate outpatient treatment for skin infections can usually prevent the need for hospitalization.
• There was a 36% increase in hospitalizations billed to Medicaid during the 10-year period.
• The average the costs (not charges) to provide hospital care to the uninsured are about $1,500 less expensive ($6,800 vs. $8,400 per hospital stay) than costs for all other hospital stays.
Intuitively, as spending on Medicaid increases; the number of uninsured hospitalizations ought to decrease proportionally—adjusted for population increases.
Unfortunately however the opposite has occurred in the private sector too, as health insurance premium continue to increase.
Dr. David Edward Marcinko MBA
http://www.BusinessofMedicalPractice.com
[Editor-in-Chief]
The population of uninsured in the U.S. is not a homogenous population. There are those who make an active decision to remain uninsured, and self-finance their medical care. There are those who remain uninsured by default — I imagine this group is largely young, healthy single people who don;t have families and don’t qualify for their parents’ insurance. Paying extra for health insurance they can’t envision ever using is eqivalent to paying for car insurance when they don’t own a car. (I was uninsured for five years in my early 20s, in the early 1990s. I had no sleepless nights about the situation. As a parent of a 20-something today, I have gone to great extremes to make sure she has stayed covered by health insurance.)
The population of uninsured who REALLY need coverage are those who are very sick and disabled — which is probably why you don’t see them, or their caregivers, in the streets protesting — they are too sick or too busy or too overwhelmed to protest.
The question sounds snarky but I’m sure plenty of people will take it seriously. The answer lies in the uncounted millions of Egyptians who live out their lives in a pitiful subsistence on the razor’s edge in the endless slums, not only in Cairo but big cities all over the world. If there is a “silent majority” it is not the cell-phone, literate, Twitter-connected, camera savy and fairly well-dressed people and families raising hell in Egypt.
Likewise, the uninsured population of Americans is either healthy enough to get by, too ignorant to know better or resigned to the helplessness of their circumstance. That line in the Declaration of Independence says it well: “Accordingly all experience hath shown that mankind are disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed.”