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Opinion | Leila Philip

So you think you can do without health insurance?

associated press

For a moment, I saw what looked like an explosion of white stars, then black cobwebs floated in and out of my field of view. I thought I must have become slightly dehydrated (I’d been out walking in the heat), or had a migraine coming on. I drank water and resumed my business trip, although I kept having this annoying sensation that there were grease spots on my glasses.

Three days later I gripped the arms of the chair, trying not to scream as a retina specialist performed laser surgery to repair three tears in the retina of my right eye. As I struggled to keep still through the procedure, which was cauterizing blood vessels in my eye, all I could think was how lucky I was. I had health insurance.


Retinal tears like the ones in my right eye lead to a detached retina, which is why the doctor’s office had rushed me into the slot for emergencies when they heard my symptoms, and why I was in surgery 45 minutes after getting the diagnosis. Once a retina fully detaches, a much more complex surgery is required, and only 55 to 60 percent of eyes with reattached retinas retain full vision. Another 5 to 15 percent of retinal reattachment operations are unsuccessful, meaning the patient loses their sight. In contrast, the preventive treatment that I received to repair the tears in my right eye has an excellent success rate. In four weeks, I’d be having a similar laser coagulation procedure on my left eye, which was also diagnosed as needing treatment.

If I didn’t have health insurance, I would have been left with a hefty bill for these laser procedures. What is more likely is that I would not have gone to the eye doctor at all. My retinas would have detached, and I would have been faced with paying for a much more complicated and expensive surgery with less certain outcomes — the possibility of permanently reduced vision or even blindness.


This did not happen because, in the scheme of things, I am a privileged white person and I have employee-based health insurance. Even so, because there was a $40 co-pay, I wasn’t in pain, and I didn’t realize the real risk I was taking with my vision, I waited four foolish days before calling an eye doctor.

Numerous studies, including the gold standard of health policy studies, the Rand Health Insurance Experiment, have shown that health insurance plays an invaluable role in getting people the types of preventive care that both save money later and preserve quality of life. Not surprising, the Rand study also demonstrated that cutting benefits has the most harmful impact on the poor and the sick, people who might be covered by Medicaid or lack insurance. Studies of specific conditions and diseases found that up-front costs prevent poor Americans from getting preventive care and that this decrease in use of medical services had particularly adverse effects on vision health.

My own experience was a stark reminder that beneath the effort by the Republican Party to dismantle the Affordable Care Act, people’s lives and well-being are at stake. Without health insurance, many Americans, but especially the poor and the sick, those covered by Medicaid, and those who don’t have insurance will simply not get preventive care.


The GOP’s move to cut health care for millions of Americans so that it can reduce the federal deficit in order to provide tax cuts for wealthy families and corporations is shameful in and of itself, but it is also economically flawed. The preventive surgery I had on my right eye cost about $2,000, and the left eye will cost the same. Factor in that expense against the astronomical costs of recalibrating my life for blindness — which would have been a likely outcome without the care I was able to receive at the right time — and plans to cut back funds that provide preventive care make no sense.

Leila Philip is a professor in the English department at the College of the Holy Cross. Her latest book is “Water Rising,” a collaboration with artist Garth Evans.