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If Ashcroft Were Uninsured...

The likely scenario


From the moment Attorney General John Ashcroft was diagnosed with gallstone pancreatitis on March 4, he without a doubt received the best and most efficient medical care in the world.

While Justice Department officials haven't released many details, the Attorney General, because of his status, was most likely whisked through the emergency room at George Washington University Hospital, into intensive care and then surgery, and has all the while been doted on by a team of concerned and caring medical experts.

Ashcroft has little reason to worry about the charges he incurred. Like virtually all civilian federal employees, Ashcroft is covered by any one of the impressive health plans offered by the United States Office of Personnel Management. The most popular plan, Blue Cross/ Blue Shield "Standard," could conceivably pay for close to 90 percent of Ashcroft's hospital care.

But what if John Ashcroft was never confirmed as Attorney General and didn't have that impressive federal health plan? According to the Chicago-based group, Physicians for a National Health Program (PNHP), 41 million Americans don't have any health insurance and the majority of them, the group says, aren't necessarily unemployed.

So, what would have happened if John Ashcroft was not Attorney General, didn't have health insurance and got sick?

What would happen, hypothetically, is this:

One day, on his way into Washington, DC, to see The Passion of the Christ, John Ashcroft gets a searing a pain in his stomach.

He calls a doctor friend of his for help but the doc is out to lunch. The doctor's receptionist tells him he should make an appointment and asks what type of health insurance he has.

After an infuriatingly incomprehensible conversation about health coverage, Ashcroft realizes that, because he's no longer a Senator from Missouri, he doesn't have insurance. At 61, he's four years too young to qualify for Medicare. And, because of the steady income he gets from speaking engagements, he's not among the desperately poor that receive Medicaid, despite deciding to donate most of that money to a Christian charity leaving him a much more modest man.

The receptionist tells him that without insurance, a doctor's appointment will now run him about $75, and because he's now not nearly as wealthy as he once was, Ashcroft tells her he'll just take some Tylenol.

A week goes by, and Ashcroft's pain grows steadily worse. He doesn't go to a doctor though, because he knows it will cost him money he doesn't have. So instead, Ashcroft pops more Tylenol.

It's worth noting that according to PNHP, some 18,000 Americans die every year because they don't have health insurance and wait too long to see a doctor. A few more days go by, and Ashcroft decides to drive into Washington, DC, to see Passion of the Christ a second time and hope for a miracle. But before he can get to the theater, he's hit with an unbelievable pain in his stomach.

Bravely maintaining his composure, Ashcroft manages to find his way to DC General Hospital, the mammoth public hospital he remembers passing every day on his way to Congress. As he pulls into the parking lot, however, he notices that DC General looks abandoned. Now that he thinks about it, Ashcroft vaguely remembers reading some newspaper articles about how DC General -- the only public hospital in Washington, DC, which mainly served poor and minority residents -- was closed by the city in 2001 because in large part, it was overburdened with uninsured patients who couldn't pay.

And so, Ashcroft sets off in his car around predominantly poor and black Southeast DC, looking for another hospital.

Unfortunately, there couldn't be a worse time for Ashcroft to be sick and uninsured. Not only is there not another hospital in the neighborhood that DC General was serving, but also those hospitals picking up General's slack -- Providence, Howard University, Washington Hospital Center and Greater Southeast -- have been overwhelmed with patients.

Much like in other big cities across the country, Washington's emergency rooms have seen a substantial spike in visits, there are virtually no beds available, and intensive care units are filled to 95 percent capacity. What's more, says Joan Lewis, Senior Vice President of the District of Columbia Hospital Association, now that General is gone, these other hospitals are treating more of the city's approximately 85,000 uninsured residents and spending more of their already depleted cash supply in the process. "Everybody feels like we're on the edge," says Lewis. "If there was a big epidemic, a medical crisis, we'd be in real trouble."

Ashcroft, though, doesn't know any of this. He just knows he needs help and needs it fast. He finally gets to another hospital -- take your pick of the four already mentioned -- and stumbles into the emergency room. Packed with people and patients, Ashcroft is told by the receptionist to fill out a not so small folder of forms which all seem to ask him for the same information. He complies, even revealing he has no insurance.

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