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July 13, 2012 11:05 AM Your Experience Is Not Everyone Else’s

By Aaron Carroll

This is one of my all time favorite Doonesbury strips, from October 1982:

I case you can’t read it, a cleaning woman is talking to Jane Fonda. Ms. Fonda tells the other woman that she looks worn down and that she should exercise more. The cleaning woman replies that she doesn’t have time for such things. Ms. Fonda than lectures her on the fact that no one is busier than her, as a “wife, movie star, activist, and entrepreneur”, and that if she can find time to exercise, then anyone can.

The cleaning woman responds with one of the most insightful retorts I have ever read. She says, “you’re as busy as you want to be. I’m as busy as I got to be. I hate to break it to you, but there’s a big difference.”

I bring this up because there’s been a resurgence this week on the blog of people who are lecturing others (and the public) that if they can save enough for their health care, and be “responsible”, then so should everyone else. What they are forgetting, though, is that their life experience is not everyone else’s. It’s great that they can save as much as they like. Not everyone can.

If you make $50,000 a year, and you’re pretty healthy, then it may be completely reasonable to save enough so that if you have to go to an emergency room, then you have the $1000 available. Doing so seems responsible. But you have got to realize that you’re making an above-median income. More than a quarter of households make less than $25,000 a year. The world looks very different to them.

Moreover, many people aren’t healthy. Health care for them is expensive:

If you’re in the top 10% of spenders, then your medical costs are more than $26,000 in a year. If you’re in the top 30% of spenders, then your costs are more than $12,000 a year. There are lots of people who make below median incomes and are in the top 30% of expensively sick people. They are not you. Don’t assume they are.

If you’re doing reasonably well, and your life is stable, then it’s likely you’re saving and spending as much as you “like” to. That’s very different than spending as much as you “got” to. Try to remember that the next time you’re lecturing someone you don’t know on how you’re doing a better job than they are.

[Cross-posted at The Incidental Economist]

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Aaron Carroll ,MD, is an associate professor of Pediatrics and the associate director of Children’s Health Services Research at Indiana University School of Medicine.