(Jehosuah HaLevi)
Why is it that advocating for one cause sometimes makes us blind to another?
In November, 2009 the Huffington Post reported that insurers in 8 states and the District of Columbia permitted denial or cancellation of coverage due to a history of being a domestic violence victim. There was a huge PR storm in the general media lamenting how wrong it was to punish innocent victims.
Two blogs focused on disability issues protested: Three Rivers Fog and FWD/Forward, which cross-posted the Three Rivers Blog post. The post and both blog discussions argued that there is something outrageous in the idea that people would think that denying coverage to a survivor of domestic violence is more heinous than denying coverage to a purely medical pre-existing condition.
Both blogs have an important point to make. In the public zeal to protect the innocent, someone seemed to have forgotten that those living with chronic health problems are no less innocent than domestic violence survivors. No matter who you are or why you need coverage, making insurance too expensive to pay for or denying coverage outright is a terrible thing. The US medical system’s price scales presume insurance coverage. A person who does not have medical coverage is penalized twice, first for the lack of coverage, and second because what medical costs he or she can pay for are priced on the assumption that the average payer is an insurance company with deep pockets.
Who should live and who should die should not depend on who has enough money to pay for medical care. We should be equally upset about this whether the person is denied coverage for acme, asthma, AIDS, a genetic disease, or domestic violence. Life is sacred and all society is responsible for maintaining it.
Unfortunately the two blogs went a bit further and insisted that the outrage was outrageous because denying insurance to an asthma sufferer and domestic violence survivor were morally equivalent. The post concludes “What justification is there for acting as though these practices are any worse than the practice of denying coverage to women who have lupus? There isn’t any that isn’t rooted in a deeply ableist bias.”
Hurling accusations of bias and saying that denying coverage for an inherited disease or domestic violence are morally equivalent fails miserably in respecting the trauma and moral significance of violent crime. Asthma, acme, AIDS, and a genetic disease are no-fault disabilities, unless we want to blame fate or God. On the other hand, domestic violence, is anything but no-fault.
First there is the choice of the abuser to abuse. If we argue that the abuser is a product of his circumstances and didn’t know better, then we shift the burden on society. Society failed to do enough to change the circumstances. Government and charitable institutions, as agent of society, must therefore be responsible. Whether we blame the abuser, the government, or charitable institutions, there are human agents that are responsible for what happened.
Domestic violence does increase health costs, particularly for women. As long as insurers are expected to make a profit on their risk pool, they will have to exclude or charge high premiums to high risk individuals. The moral offense isn’t that it costs more to insure a domestic violence survivor. The moral offense lies in who is expected to pay for that increased cost. Charging a person for a purely medical pre-existing condition is charging an innocent. Charging a victim of domestic violence for the extra cost isn’t just charging an innocent, it is charging the wrong person.
This is the kind of injustice we ought to recognize from elementary school days. From the time we are very little we are taught to take responsibility for our actions. If we spill milk, we clean it up. If we hit a baseball through a window we pay to repair the window. The one person who is not responsible is the victim. Yet in the case of medical insurance in the USA, the victim, the one person not responsible, is the only person being charged.
When insurers charge high premiums or deny coverage to the victim, they are making the victim pay twice for the abuser’s crime: first with bodily injury and second with having to pay for the increased risk posed by the abuser’s violence.
After the bru-ha-ha, the Democratic party pledged that the current medical reform bill would ban insurers from denying coverage based on crime victim status, but a simple ban, doesn’t solve the economic problem. The insurers still need a way to pay for the increased cost of coverage. Once again we have a case of one cause blinding us to another.
Unfortunately we have no mechanism for making the abuser or even the government pay for the economic costs of medical care due to domestic violence. Insurers therefore charge the easiest target: the one actually needing medical care, rather than the one morally responsible for the increased medical risk. They will provide coverage, but at a higher cost to the victim.
Victims of domestic violence aren’t the only people that suffer increased premiums due to another person’s wrongful behavior. People with black lung from their workplace have successfully sued their employers. People whose mobility were permanently impaired from an auto-accident can and have sued for lifetime medical costs.
In theory, a victim could sue her attacker in civil court. However, a lawsuit is useless if the defendent doesn’t have funds to pay the judgment. Employers and drivers have liability insurance that cover the cost of any financial damages. Spouses don’t usually carry liability coverage in case their abusive activities get them into trouble. Unless the abuser is especially wealthy, he isn’t likely to have the funds. Furthermore, domestic partners often have children, so suing a domestic abuser with limited resources takes funds from the same pool as child support.
Even if the defendant has money, not every lawsuit is the gold mine portrayed by the media. All too often negligence and personal damage suits are settled out of court for much smaller sums. After lawyers and out-of-pocket legal expenses are paid, there is little left from the settlement but vindication.
Only one state in the USA, Illinois, has a law requiring that convicted abusers and criminals pay lifetime medical costs for their victims, The Michelle Eppel law (Public Act 94-397) . But even this law has its limits. The state does not step in if on-going medical expenses are beyond the ability of the offender to pay. Additionally, the law only covers the actual cost of treatment for the injuries inflicted by the abuser. It does not compensate the victim for higher overall insurance premiums.
Justice is not just about focusing attention on a cause or the avoidance of victim blaming. Justice first and foremost is about creating a right balance in the world. We cannot achieve justice by looking at one cause to the exclusion of others.
B is for bone. We need to understand that we are strong like bones, yes breakable, but also incredibly strong, durable, and resilient. At times we can break, but mostly we endure.
