Life & Wisdom Quote by David Lehman

A poet borrowing the blunt logic of an actuary is its own kind of irony: the line lands like a proverb, but it’s really an indictment. Lehman’s “If you’re not paying for it through the health plan, you pay for it in the emergency room” treats American health care as a closed system that will collect its debt either way. The sentence is engineered to sound commonsensical, almost parental, and that’s the point: it drains the debate of moral theatrics and replaces it with arithmetic.

The specific intent is persuasion through inevitability. By framing costs as unavoidable, Lehman shifts the argument away from whether society should fund care and toward where the bill will be routed. “Health plan” signals foresight, pooled risk, and bureaucratic regularity; “emergency room” evokes crisis, delay, and the most expensive point of entry. The subtext is that refusing to pay up front isn’t fiscal discipline, it’s a form of denial that turns predictable needs into catastrophic events.

There’s also a quiet rhetorical trap: it collapses the illusion that the uninsured are somehow “off the books.” Emergency rooms are the backstop, meaning the costs get socialized anyway through higher premiums, hospital closures, public subsidies, and debt. In that sense, the line isn’t just about compassion; it’s about realism. Coming from a poet, the compression matters. No policy jargon, no statistics, just a two-part rhythm that turns the ER into a metaphor for what happens when a society insists on dealing with preventable problems only at the point of panic.