Thirty-five pounds of flesh

Children pry up our rotting bodies with cries of earn earn earn, says the American poet Jim Harrison.

The line came back to me – high, hard, echoing – when recently I got bumped from a medical insurance program in New York. I'm a novelist, I'm self-employed, I've three youngsters ranging in age from two to nine. Being without insurance is not an option.

You hear stories about people who don't have the proper coverage. The carpenter who cut off the top of his thumb and tried stitching it back by himself because he couldn't afford the prospective hospital bills. The freelance photographer who lost his leg when he just let the infection go. The wine-shop owner who died when his kidney prescription wasn't filled. I was quite sure that these were warning stories, the sort of thing you might think of as urban legend, but then I went searching for a policy that might suit me.

The first quote from my own insurance company was a little over the top, I thought. Two thousand six hundred and seventy dollars. Steep enough... $2,670 per annum. And then I read a little closer. Per month. The oxygen was taken from the air. Per month? A mistake, surely? So I called them up. It was a machine of course – and machines don't lie. They might cripple you, but they don't lie.

"The cost for your healthcare program is $2,670 dollars per month."

That's $32,000 a year. I laughed. It was all I could do.

Children pry up our rotting bodies...

* * * * * * *

A couple of years ago I was back in Dublin for a family visit and my second youngest, Johnnie Michael, who was three at the time, took a fall in Herbert Park. He came down a clatter and scraped his knee. I didn't think much of it. When I got him home he wanted to sleep. So my wife, Allison, put him to bed. A couple of hours later I could hear Johnnie Michael crying softly. "My neck hurts, dad."

I sat on the bed beside him. The mattress shifted slightly and he screamed in pain. I thought I should take him to the doctor. The office was closed, so, a little worried, I veered off to St Vincent's Hospital on Merrion Road. The Filipino nurses admitted him immediately. They brought my wife and I a cup of tea. They came back to say they were very sorry but they had to bring Johnnie Michael to the Children's Hospital in Crumlin. They were afraid he had broken his neck: the X-ray showed a bone was sticking out. An ambulance was arranged. They strapped my son down and hit the siren.

At Crumlin, one of the top pediatricians in Ireland was called. He looked at the X-ray and thought it was bad news but he wouldn't commit himself. It might just have been the angle of the X-ray. He wanted to check it himself. They took a dozen X-rays of Johnnie Michael's neck. When they came back to tell us that the neck wasn't broken, I thought to myself that the world is wide and good. They kept my son in Crumlin for a night and most of the next day. And then the bill arrived. I would have paid anything. I read the total. Thirty-five pounds.

* * * * * * *

Children pry up our rotting bodies. I've heard the horror stories, of course. The Irish hospitals where patients are made to wait on trollies for days on end. The crusted blood on the scalpels. The viruses. The surgeons and nurses too exhausted to speak. Brendan Gleeson's comments were heard, even on this side of the ocean, when, earlier this year, he lambasted the administration of the country's hospitals – not the doctors or nurses, of course, but the system.

But £35 – or euros or dollars – under my new insurance system here in New York just about guarantees one day's coverage for me. One single day. And while the healthcare in New York is second to none, it's not available to everybody, unless you're ready to rob banks. One only has to sit in an emergency room in a poorer area of the city to realise what an acute crisis the American health system is in. The vast inequality in treatment between rich and poor – in other words, insured and uninsured – is astounding. There are, according to current estimates, 48 million Americans without health coverage. Whole lives, whole families, whole communities get dissolved in a system that has spun out of control.

Imagine this. Your son falls. He is thought to have broken his neck. He sees a leading specialist. He undergoes intense medical scrutiny and stays in hospital for two days. If you don't have the means to pay, the medical companies come after you for you car, your house, your life. You won't get a bill for £35, unless it's 35 pounds of flesh.

Certain lights, when they're shone, just sharpen the darkness. The issue goes way beyond the personal to the political. Every system has its own rot. Bill Clinton tried in vain to confront the issue of healthcare a few years back. Bush and his cronies in the Republican administration don't seem to care that there are over 40 million uninsured people in the United States. This is, in essence, a human-rights crime.

I eventually got a different insurance programme, though it still cost almost $1,000 a month for a family, a hefty chunk of change from anyone's pocket and, while I don't ever want to see those nurses in St Vincent's again, they are brought back to me every time I see my insurance bill.