The Americans at the Mercy of the Healthcare System

CW: Mental illness & death

Andrew Toles hasn’t played for the Los Angeles Dodgers since Sept. 30, 2018. However, he had his contract renewed for another year in March. He played just 17 games during the 2018 season. He didn’t attend spring training in 2019. Eventually, his schizophrenia and bipolar disorder diagnoses became public.

Schizophrenia is a complex mental illness marked by a wide range of symptoms such as delusions, hallucinations, disordered speech or behavior, and reduced cognitive abilities. For many patients and their families, the condition can be overwhelming due to its early start and the need for ongoing treatment and management.

Bipolar disorder is another complex mental illness. It is characterized by a mixture of manic (bipolar mania), hypomanic (bipolar depression), and depressive (bipolar depression) episodes. Intense subsyndromal symptoms typically appear between major episodes.

Toles was discovered sleeping behind a building at Florida’s Key West International Airport in 2020. He was homeless and was brought to a mental health facility. Reports say that Toles is currently living with his father, Alvin.

The Los Angeles Dodgers could have easily parted ways while he received mental health treatment. Instead, they renewed his contract with the team so he could keep his health insurance. Employer-sponsored insurance covers almost 159 million non-elderly people in the U.S., according to a 2022 report from The Kaiser Family Foundation.

The U.S. Department of Health and Human Services (HHS) released a report in August of 2022 showing that the national uninsured rate reached an all-time low of eight percent in early 2022, with more than five million people gaining coverage since 2020. Despite this, many Americans are underinsured or uninsured.

According to The New York Times, the beginning of the coronavirus pandemic resulted in an estimated 5.4 million American workers losing their health insurance between February and May of 2020. More adults lost coverage due to unemployment than ever before.

Being uninsured can have devastating consequences. According to a 2009 study done by Harvard Medical School, a lack of health insurance is responsible for around 45,000 deaths in the United States each year. More people die each year from a lack of health insurance than from renal disease.

One of those deaths occurred in 2017. Alec Raeshawn Smith was 26 when he died. Smith died of complications from diabetes.

Diabetic ketoacidosis (DKA) is a life-threatening condition that affects diabetics. It occurs when the body begins breaking down fat unusually rapidly. The liver converts the fat into a fuel called ketones, which causes the blood to become acidic.

In February 2017, Alec was three months shy of his 26th birthday. A pharmacist informed Smith that without insurance, his supplies would cost more than $1,000 a month. The options with insurance weren’t much different.

Smith was the manager of a restaurant in Minnesota. His salary was too high to qualify for Medicaid. He earned about $35,000 annually. Health insurance was unaffordable for Smith. The plan he qualified for had an annual deductible of more than $7,000 and a monthly premium of more than $400.

He died less than a month after aging out of his mother’s health insurance plan. Smith’s family thought that he might have been rationing his supply of insulin to save money. Approximately 11.3 million insulin-dependent diabetics in the U.S. had done so in the past year, according to an October 2022 report published in the journal Annals of Internal Medicine.

Losing healthcare coverage often means that people remain uninsured. Very few people have access to the healthcare coverage offered to Major League Baseball players. For some people losing insurance is a matter of life or death. The United States needs affordable healthcare for all before this crisis worsens.


“2022 Employer Health Benefits Survey – Summary of Findings.” Kaiser Family Foundation, Kaiser Family Foundation, 27 Oct. 2022,

Abelson, Reed. “Harvard Medical Study Links Lack of Insurance to 45,000 U.S. Deaths a Year.” The New York Times, The New York Times Company, 17 Sept. 2009,

American Diabetes Association Professional Practice Committee. “2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2022.” Diabetes care vol. 45,Suppl 1 (2022): S17-S38. doi:10.2337/dc22-S002

Grande, Iria, et al. “Bipolar disorder.” The Lancet 387.10027 (2016): 1561-1572.

Mitchell , Houston. “Dodgers Dugout: Once Again, Dodgers Do the Right Thing for Andrew Toles.” Los Angeles Times, Los Angeles Times Communications LLC, 21 Mar. 2023,

Mueser, Kim Tornvall, and Dilip V. Jeste, eds. Clinical handbook of schizophrenia. Guilford Press, 2011.

“New HHS Report Shows National Uninsured Rate Reached All-Time Low in 2022.” The United States Department of Health and Human Services, The United States Department of Health and Human Services, 2 Aug. 2022,

Stolberg, Sheryl Gay. “Millions Have Lost Health Insurance in Pandemic-Driven Recession.” The New York Times, The New York Times Company, 14 July 2020,

Sable-Smith, Bram. “Insulin’s High Cost Leads to Lethal Rationing.” NPR, NPR, 1 Sept. 2018,

Searing, Linda. “Over 1 Million Americans with Diabetes Rationed Insulin in Past Year.” The Washington Post, WP Company, 17 Nov. 2022,

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