More on Rosa

Before I get back to the issue of doctors and patients (which is clearly the people's choice), let me take a moment to say a bit more about the case of Rosa, below. The physician's insensitivity is what stands out for most readers, but there is a lot more to this story.

First of all, its largest context. Rosa and Carlos fled El Salvador during a civil war. Actually I didn't even tell you that Carlos was originally from Guatemala. They were indigenas, Native American people, and their governments were waging war against them on behalf of the European settlers who dominate those countries economically and politically. In El Salvador, people who were suspected of revolutionary sympathies would disappear in the middle of the night.

The United States was supporting the government of El Salvador because the rebels were supposedly part of the international Communist conspiracy. (The President at the time they came here was George Bush the First, but the policy started under Saint Ronald Reagan.) So, people like Rosa and Carlos couldn't get political asylum in the United States. They were here illegally, to be sure. You can imagine what it meant to them to leave their infant son behind. At the same time Nicaraguans, whose government was on the "wrong side," could enter the U.S. with a claim of political asylum presumptively granted.


So they're here, working hard, doing jobs U.S. citizens won't do, and yes, paying taxes. But they don't have health care. In the United States, a vaccine for chicken pox was approved for adults in the early 1990s, and those adults who had not yet had the disease were immunized. Rosa was not. We don't know a whole lot about the etiology of lupus, but it is likely that had she been vaccinated against chicken pox, she would not have come down with the disease.

Although she could not have seen a doctor to receive basic preventive care, once she was seriously ill and needed hospitalization, she was taken care of, no questions asked. Who paid for it? In Massachusetts, it was paid for by the so-called "free care pool," which comes from a surcharge on insurance payments to hospitals. Ultimately, everyone who has insurance pays for it.

By the time of the events described below, the civil war in El Salvador had ended. Rosa and Carlos would have returned home, but now they could not, because without the high tech medical care available to them here, she would have died.

This is a morality tale that is too complex for me to parse. Who is responsible for what here? Who should pay? What should have happened differently? How far back does it go? Columbus and the Kings of Spain aren't taking my phone calls, however.

And by the way, this is not a fable. It is a 100% true story.