Insight: Health care, Alabama style — A miserable history, a future worth saving
by Wayne Flynt
Special to The Star
Feb 02, 2014 | 11152 views |  0 comments | 36 36 recommendations | email to a friend | print
Sam Walker, of Selma, stands on the steps of the Statehouse in Montgomery to demonstrate for the expansion of Medicaid on the opening day of the Alabama Legislature’s 2014 session. Photo: The Associated Press
Sam Walker, of Selma, stands on the steps of the Statehouse in Montgomery to demonstrate for the expansion of Medicaid on the opening day of the Alabama Legislature’s 2014 session. Photo: The Associated Press
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Gov. Robert Bentley described the State of the State. President Obama discussed the State of the Union. As a political independent who voted for both of them (is it possible to rescind both votes?), I have earned the right to an ordinary folk’s version of both subjects. Since Americans trust used-car salesmen more than politicians, I figure I can’t lose.

The three pivotal components that will determine Alabama’s future are the health of its people, the education of its children and the creation of decent jobs. Alabama does a miserable job of all three.

To some degree, the topics are related. Children who suffer from chronic health problems have more trouble in school. Unhealthy employees reduce productivity, raise insurance rates and reduce their own employment options.

Part of this essay is intensely personal. As I recorded interviews with Mom and Dad while writing my book, Keeping the Faith, I noticed how often their wrenching childhood poverty involved health care. As a young girl, Mom walked a mile with her mother down Alabama 79 from Pinson where they boarded a bus for Hillman Charity Hospital to have her diseased tonsils removed.

Dad told about chopping firewood in the early 1930s on his family’s Calhoun County sharecrop farm when the ax blade glanced and gashed his foot. Usually, his mother’s turpentine and home remedies cured a cut. Not that time. Osteomyelitis, a bone infection, cost him two years of school. But for the kindly ministrations of a doctor who drove muddy dirt roads to care for him (in return for eggs, smoked hams, sausage, firewood and other payments in kind) it would have cost him both legs.

After he recovered, married Mom, and I was born, they saved $3,000 on his salesman’s salary. But before they could purchase a home, reoccurrence of osteomyelitis in 1943 sent him to famous Birmingham surgeon John Sherrell, whose skill saved Dad’s legs from amputation. Dad, uninsured and with a three year-old toddler, added a $500 dollar loan to his $3,000 savings to pay Dr. Sherrell, and paid a monthly installment for years on his hospital bill.

Physicians like these make their profession the one I most respect. They enforce high standards on themselves. They work long hours. They pay homage to a sacred creed of conduct and caring. The Alabama foolishness that such physicians will desert their patients if their average incomes drop to only three to five times the median American incomes besmirch an entire profession. But if conservative politicians and economists are correct and they do retire in mass, a rapidly expanding market will quickly attract a new labor source. In the future, more physicians will be black, Asian-American, Hispanic, female, foreign-born and educated (or re-educated) in the United States. But if a short-term medical vacuum occurs (and if conservative economics prove true), market forces will solve the long-term problem.

In Alabama, this new generation will have a challenge. While researching health data for my book, Alabama in the Twentieth Century, I discovered our state’s rankings: obesity, 49th; diabetes, 49th; high blood pressure, 49th; child poverty, 49th; infant mortality, 48th; heart disease, 46th; strokes, 43rd; smoking, 42nd; cancer, 42nd. If you think this is the description of a labor force prepared for a global economy, you may be part of another problem health group: people who can’t pass a drug test.

Some of these rates have improved slightly. Others have worsened. But Alabama remains one of the poorest and sickest states. Of the 28,000 bankruptcies filed during 2013 in the state, most resulted from unpaid medical bills by uninsured citizens.

Here is one such story recorded by a new group called Bama Covered. A 62-year-old roofer employed by a Birmingham construction company works 40 hours a week for $10.50 an hour. His total annual income amounts to slightly more than the poverty rate for a family of two, himself and his wife. They are also raising two grandchildren, which drops them below the federal poverty line. Company administrators have health insurance. Roofers do not. Had Gov. Bentley expanded Medicaid, this family would have been covered. As is, any illness or injury in 2014 will be catastrophic.

I will let God and Gov. Bentley sort this out some day, but the good news is Bama Covered and its founder, Josh Carpenter. Josh is one of us. He hails from Florence. His dad was a bi-vocational Baptist minister. He graduated from UAB with a degree in business. He taught English and coached football in Perry County with Teach for America. He won a Rhodes scholarship to Oxford University.

This winter, he left his graduate studies, returned home and established Bama Covered. He contacted state opinion-makers, enlightened business people and organized a network of our best, brightest and most caring community college and university students. They trained for eight hours on how to access the Affordable Care Act website. In January, they spread out across Alabama to walk people as technologically illiterate as I am through every option for health care available to them.

Alabama, which suffers from a stunning lack of vision, leadership and courage among its elites, may yet be saved by its youth. They remind me of another generation of young idealists a half-century ago who wrote their names in history and forced Alabama to jettison a world of mythology in order to enter a world of flesh-and-blood reality.

Wayne Flynt is Distinguished University Professor Emeritus at Auburn University.
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