Monday, March 01, 2010

Health Care Reform Starts with Those Who Are Willing to Change Existing Policies

I again write today about what has become a completely inadvertent, but nonetheless growing series of personal anecdotes which reveal both the depths of our broken medical system and the shocking limitations and abuses of a system of social services designed to care for the poor and disabled. In so doing, I have uncovered a tremendous number of objectionable practices that would never be considered acceptable among the more fortunate. Established policies designed to assist and give comfort instead punish the genuinely needy. For example, in the process of applying for a variety of safety net programs, I have been threatened with complete termination of coverage if I didn't follow every step exactly as requested and in a supremely timely, if not obsessively punctual fashion. In some states and municipalities this sort of conduct would be not just be bad form, it would also be against regulations. Not here.

In the District of Columbia, no one apparently sees the problem in treating low-income and disabled residents like criminals. To make my case once more, let me provide a bit of backdrop. The District is a very unusual place in lots of ways. Though technically it is merely the physical location for the seat of national government, it is governed as a kind of odd mix between a state and a city. Like most American cities, its population consists of an often uncomfortable combination of the affluent and educated, most of whom are relatively financially secure whites, and a core of heavily impoverished and undereducated residents who are usually black. If DC were a state, and much larger based on surface area alone, there would be more of a middle ground between the have-everythings and the have-nothings, but this is simply not the case here.

The District contains its own particular system of distributing food stamps, low-income medical insurance, prescription drug coverage, and providing disability benefits to those unable to work. In roughly six months of trying to work a system that is both ridiculously ineffective and unnecessarily complex, what I have come to realize is that it is also a system based on punitive retribution, which is neither fair to applicants nor particularly effective to everyone. With every step of the process, regardless of what it might be this time, the necessary paperwork I was provided screamed out in bold, block letters, often capitalized lest I overlook it, that I better fill this latest form out perfectly and as soon as possible, else I'd find myself without anything at all.

The existing system itself is so unwieldy that I have often been provided incorrect, or at best inexact information. I don't fault those who gave me wrong information because learning all the particulars takes months, if not years, and turnover in social service agencies is often quite constant based on the fact that the job promises low pay and high stress. I was, for instance, told that I would only need to re-apply for food stamps once every six months. However, within two months I received a letter in the mail, one printed so cheaply and faintly that often reading the words was a challenge, specifying that I needed to re-certify how much income I was currently making, else I be denied next month's allotment. The return envelope was just as difficult to read and after affixing a stamp to cover the cost of postage, I took the time to write out by hand the return address, else some postal carrier not be able to discern its destination.

The implication of this was quite clear. The instant I could be have my monthly allocation reduced, or even trimmed from the rolls altogether, the better. I do certainly recognize that we've all been hurting and will continue to suffer so long as this recession, or at least the lingering effects of it doggedly persist, but I hardly think the solution is in weeding out those who depend on these services, particularly since so many of them are the very definition of working poor with their own children and families to support. When I had the benefit of an increased income and decent benefits, no one ever made me certify that I still needed them. I was trusted, for the most part, to not abuse the system. Now, I am automatically suspect.

The low-income health care coverage I use via the District's own program is sufficient, but hardly convenient. After filing for disability, I assumed once granted it that I would also receive Medicaid. Medicaid, while it certainly contains its own limitations, still provides a greater sphere of coverage than the DC program. Medicaid would allow me to have my prescriptions filled at a conventional pharmacy like a CVS, Rite Aid, or Walgreens, whereas the only way to get my medications via the other coverage plan is to visit the sole pharmacy in the District that stocks the drugs I require on a daily basis to maintain my health. It is located in a tremendously inconvenient part of town to get to, based on where I live, and it takes thirty to forty-five minutes via public transportation to arrive. Often I end up expending the better part of a morning from start to finish once one factors in sitting in a waiting room, trying to be patient while the drugs are filled. As it turns out, no one told me that according to District-only procedure I needed to apply for Medicaid separately and go through another time-consuming process. Of course, this is a means of saving money and reducing cost on their part, but in my opinion, it is silly to assume that someone who is DISABLED and has to subsist on a minimal monthly allowance wouldn't need basic health insurance as well.

To chalk this up to something as relatively straightforward as racism, classism, abelism, or the like would only be confronting a small sliver of a larger problem. I fault those who set policy in the first place, whomever that might be. To return to my own struggles once more, I believed originally (and even wrote in an earlier entry) that one of my medications was available to be filled at the low-income on-site pharmacy, though there was often a substantial delay in getting it in stock. As it turns out, I was once again told wrongly. The drug is not stocked at all because with it comes the threat of a hypertensive crisis if very specific dietary restrictions are not adhered to exactingly. Obviously, no one wants the bad press or potential lawsuits that might transpire if a patient had one of these (or if, God forbid, he or she died as a result), and this goes for doctor and District government alike. But to be deathly afraid of litigation, regardless of how baseless it might be doesn't so much reflect upon a problematic legal system as a complete lack of basic trust and compassion for our fellow beings. We could make sure that frivolous malpractice lawsuits were minimal, but unless we get to the reason why people file them in the first place, any legislation passed into law will not achieve its purpose.

Returning again to my medical situation, the particular medication I take is absolutely essential to assure my continued basic functionality and it works so well that the difference between not being on it and being on it is like night and day. That I am able to manage the restrictions competently speaks partially to my willful desire to stay healthy, but also that I am educated enough to recognize what foods I need to avoid and to do my research accordingly. The assumption in not stocking the med, regardless of whether or not it could really help someone in need, is that a person with barely a high school diploma, having grown up in utter squalor and with all the problems that result from it might not have the same capacity and level of personal responsibility as me. Yet again, here we have a punitive, blanket response when basic compassion and an examination of people on a case-by-case basis would be much more effective. Once more, we opt for the quick fix instead of really examining the full picture.

As for whether Congress will pass health care legislation, I'll leave that never-ending speculation to someone else for today, at least. What I do know is that whatever reform measures we pass will need to take into account whether we treat fellow human beings as numbers, money drains, or as only waiting for the next opportunity to take a mile once we grant them an inch. We certainly don't seem to wish to grant anyone who we perceive as other than us the most basic of trust, nor do we take into account that all humans make mistakes, are fallible, and aren't perfect. We read about drive-by-shootings, petty crime, and drug deals and think that anyone born into such circumstances must be guilty by association. Fifty-two years after the film Twelve Angry Men was released, we're still stuck in that same way of thinking.

Juror #8: Look, this kid's been kicked around all of his life. You know, born in a slum. Mother dead since he was nine. He lived for a year and a half in an orphanage when his father was serving a jail term for forgery. That's not a very happy beginning. He's a wild, angry kid, and that's all he's ever been. And you know why, because he's been hit on the head by somebody once a day, every day. He's had a pretty miserable eighteen years. I just think we owe him a few words, that's all.

Juror #10: I don't mind telling you this, mister. We don't owe him a thing. He got a fair trial, didn't he? What do you think that trial cost? He's lucky he got it. You know what I mean? Now look, we're all grown-ups in here. We heard the facts, didn't we? You're not gonna tell me that we're supposed to believe this kid, knowing what he is. Listen, I've lived among them all my life. You can't believe a word they say. You know that. I mean, they're born liars.

Juror #9: Only an ignorant man can believe that... Do you think you were born with a monopoly on the truth?

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