An American Death

[McCamy Taylor]

Nobody in Johnny’s farm family smoked. When he was drafted in 1970, he picked up the habit in boot camp. Smoke breaks were one of the few luxuries the new recruits enjoyed. In the jungles of Vietnam, the rations contained name brand cigarettes. Camels, Marlboros, Lucky Strikes to name a few. Another branch of the federal government had already declared “Caution: Cigarette Smoking May be Hazardous to Your Health.” But so were bullets. So were land mines.

Johnny was lucky. He made it out of the jungle alive and returned home, bringing with him a two pack per day habit. Over the next forty years, he would stop and start again numerous times. His bride did not like way his smoking made her hair smell, so he stopped for her---and then, picked up the habit again when their child was born, and he needed an excuse to get out of the house. A bout of bronchitis persuaded him to quit again, until he got laid off during the Reagan-Bush recession. During the boom years of the 1990s, he had his first heart attack, and his doctors told him he had to quit—or die. Nobody in his family had ever suffered a heart attack so young. His relatives lived into their nineties and most of them died of pneumonia or just plain old age. But in the factory where he worked, everyone smoked. And his insurance, which paid for his hospitalization, did not cover smoking cessation. If it was really that important to his health, surely Blue Cross-Blue Shield would pick up the tab.

During the second Bush administration, Johnny began to cough and wheeze. His doctor told him he had COPD. Again, he was advised to quit, and he made an effort---until his company sent their manufacturing plant abroad and he was downsized. His wife got a job at a convenience store making a quarter of what her husband used to earn. There were no benefits. For six years, Johnny only saw a doctor when he was having chest pain. Twice, he was hospitalized. He could never keep the follow up appointments. The doctors wanted cash before they would see him in their office. He started smoking less---cigarettes were so damn expensive. But he never quit entirely. He was too depressed by his unemployment.

Johnny is on Medicare now. Though he does not know it, he is a member of the small group of folks on Medicare---about 5%---- with multiple complicated medical conditions that account for half of the program’s annual spending. These problems---coronary artery disease, COPD, congestive heart failure and end stage renal disease are all directly related to smoking.

Johnny is on Medicare, and Johnny is dying. In the months to come, he will be in and out of the hospital. He will see specialists. He will take a bucket full of drugs. Home health nurses will check on him, to monitor his progression to death. Just turned 65 and too weak to get out of his chair, too short of breath to sleep in the bed beside his wife. His legs will swell until the skin cracks and blisters and his toes turn black. During his last hospitalization, his heart will stop, and they will get it started again. He will be on a breathing machine for a couple of weeks, before the doctors decide that he is not coming back.


Ever wonder why we, in the United States, spend twice as much per person as any other country on earth for health care and yet we have such low life expectancy, such high infant mortality, so much preventable disease? Ever wonder why our public medical expenditures are as high as those of France or Canada, even though the public does not start paying the bills until we are on Medicare (elderly or disabled) or Medicaid (dirt poor)? Ask Johnny. He’ll tell you that when he was young and scared of dying in a jungle on the far side of the earth, his country did not do what was best for him. It did what was best for Phillip Morris.

It was inevitable that the Baby Boomers would age. With a little bit of sensible public health planning and a lot less catering to big business, we could have aged so much more gracefully.

Links: High Cost Medicare Beneficiaries http://www.cbo.gov/ftpdocs/63xx/doc6332/05-03-MediSpending.pdf

Also recommended Unhealthy societies: the afflictions of inequality By Richard G. Wilkinson