When it comes to glittering generalities pulled out of a wordsmith’s talented ass, grand-sounding but largely meaningless, American Exceptionalism is no exception. What it actually means … well, it’s similar to The Free Market, Manifest Destiny or Making the World Safe for Democracy.   I offer a humble example here, of how profit-driven private industry is the most exceptional possible answer to American health care needs [1].  

I went to a lab for a blood test today, in preparation for next week’s telephone appointment with a nephrologist to find out if my rare kidney disease is still in remission, as it was seven or eight months ago, when we last checked.   I was supposed to have checked in with the doctor last month, but as I found out on the eve of the visit, I had no health insurance, though I’d paid my premiums through June.  Nobody had bothered to inform me that my health coverage had been summarily cancelled a few weeks earlier.  Oh, well.  Apparently no law requires it.

No worries, problem fixed, a few short weeks later I have my affordable health insurance back.  I call the lab yesterday to make sure they have the digital paperwork, but because of COVID-19 nobody at the lab can pick up the phone to confirm this.   No appointment needed, come on in, short waiting times, says the recording.   So I take a ride over today.   Pleasant place, everyone very nice, short wait, plenty of hand sanitizer available, they call me in and ask for my paperwork.  

I explain that it was digitally transmitted, on April 10, according to a note on my phone.  The lab has no paperwork on the computer for me.   Perhaps there was a paper file faxed over?  I am asked.    They open the file cabinet, check the hanging folders of paper files.  Nada.   Can I have them fax over the paperwork?   I call the hospital where the nephrologist’s office is, navigate the phone tree, get connected to the person I need to speak with.

Carmen at the nephrologist’s assures me they uploaded the document on April 10, it’s in the lab’s database, she’s looking right at it on her computer.   I give her the fax number and she tells me she’ll fax it right away.    No fax arrives.  I call Carmen again and she informs me the lab’s fax machine is not receiving faxes.  She reads me a requisition number 0062216, this should allow them to pull it right up on the network.  Only it doesn’t, as I find out a few moments later.  

Crystal, a lovely phlebotomist with whom I am starting to become friendly by now, asks me to spell my name.  I do.  She is surprised.   Somehow they had my name as a long, hard to pronounce one, starting with a P, not a W, something like Pidelszkfflmm.  Crystal asks if I could have typed it in wrong when I signed in on the iPad.

I look at the keyboard on my phone and notice that P is all the way on the other side of the keyboard from W, the first letter of my last name.   Not likely I typed in my own name as Pidelszkfflmm, I’ve typed my name many times, never anything like that.  Never mind.   There must be some work-around.   Yes, Crystal says brightly, I can ask them to email it to me, go home, print it out, bring back the paper copy. When I explain the many extra steps involved for me, and how I want to leave time for the results to come back, and remind her I’m still fasting and ready to have my blood drawn, Crystal gives me her email address.  I call Carmen a third time, we repeat the email address to each other a few times, she tells me she’s emailing it, she waits with me on the line until the email arrives.

“You got any jokes?” I ask Carmen after a while.  She finds this funny, but can’t think of one.  

“I watch the news conferences every evening,” she says, and we do a kind of sickly pseudo-laugh together.  

Crystal gets the email from Carmen,  she does the blood test, all very pleasant, all within an hour or so of walking in to the place.   I am ready to leave, take off my N95 mask, find some food, break my fast.

“I hope you didn’t just use the bathroom,” Crystal says to me after my blood is drawn.  I’m thinking of COVID, but it’s not that, she also needs some urine to send to the lab.  I shake my head, three minutes ago I could have filled up two of those little cups, but…

While I’m waiting for a tall cup of cold water to do its thing, thinking about Crystal’s warning to me that the PSA test (prostate-specific antigen — a screen for prostate cancer)  included in the kidney doctor’s blood test might not be covered and I may be billed separately (I assure her I throw such bills in the recycling bin) I ask her if she knew that in Iraq, under the brutal dictator Saddam Hussein, Iraqis had universal health care.    She is non-committal.  I continue: after the US liberated Iraq from the dictator and brought democracy, after destroying hospitals and so on, they instituted American-style health care, with the result that today many Iraqis no longer have health care at all.  

Crystal nods. “Of course, of course we did that, ” she says, her eyes smiling savagely over her mask, “American Exceptionalism.”  I give a little chuckle, have to hand it to her.  Great girl, and the way she slipped the needle in, with barely a prick, also most exceptional.   We talk about how it is exceptionally American that teeth, vision and care in our old age are not considered part of basic health care, not covered by most American health insurance.  I nip off to the bathroom for a moment with the little plastic cup.   She calls me Mr. Eliot again as I hand her the little cup of warm urine.   As I’m leaving, her last customer of the day, she fondly calls me Mr. Eliot again.   Very likable young woman, Crystal.

If you have a “Free Market” where the fittest bring the best product to market for the cheapest price for the invisible hand of the marketplace to place in front of wise consumers, why wouldn’t you commoditize every aspect of human life?   Health, you understand, is just a commodity like everything else.  Life itself, you can actually put a price to it, make a pretty exact valuation based on net-worth and earning potential, easily calculated by actuaries.   There’s actually no guesswork involved, it’s practically science, fixed and elemental as the stones themselves; that’s the exceptional thing about American Exceptionalism!

[1]  I think of the Grey Lady, America’s second finest news source (The Onion is America’s finest news source), whose distinctive, objective style of reporting harkens back to an earlier time, when the status quo was not questioned in any fundamental way by decent people.   She fittingly got her nickname in a more proper era when we still had firm notions about what was ladylike and what was gentlemanly, when an unruly girl was admonished to act like a lady.   The Grey Lady, now a stately, dignified, respected old matriarch, was, in her earlier days, a hard-working, discreet and strictly upper-class sex worker.    You can look it up.