This going to be convoluted, as my thoughts on the subject are still not set. Recently an article was floating around face book from a young doctor on a rant about the cultural problems with health care/poverty in the United States. I googled him, to find a more stable link to refer to and the first up was Snopes.com, proving that yes, indeed, this letter is attributed appropriately to Dr. Starner Jones. Not that it matters in anyway who wrote this. From the comments I saw - the FB world is largely in agreement, and the lone dissenting voice was berated for his bleeding heart.
I agree with Dr. Jones, that it is a cultural problem. He points out one example of a young woman in expensive clothes with an expensive phone, with expensive vices, that is on Medicaid, and how our culture encourages these people to live off the system, and not take care of themselves. In FB many healthcare providers jumped in on the rant. Many examples. All of them about how these people have no respect for our hard earned monies. One dentist talked about a medicaid patient that put out $2,000 cash for a gold grill for his teeth. Deplorable. Despicable.
Let's tackle the expensive vice problem first. Alcohol, tobacco, and drug use are not only the vices of the very poor. These are horribly expensive, very damaging habits that cross all lines of socioeconomic status. I did not see a single rant from healthcare providers that have to care for older COPD patients (chronic obstructive pulmonary disease, a basket term for all the things that slowly kill the lungs of smokers) on Medicare. This is expensive, largely self-inflicted, and covered by - oh no - don't say it - a Government Sponsored Insurance program - one that your grandma is probably on, one that is paying for the cost of my Mother's lung cancer and COPD care, one that my tax dollars pay for. For those that don't have Medicare yet, but have insurance, these bad-vice related problems are paid for from ever-increasing cost of insurance premiums. It is illegal for the insurance company to charge you more because you are a smoker and drink like a fish, so to cover the cost of your health care, they raise my premiums, and everyone else's. Darn smokers - I'm paying for the poor through Medicaid, the old through Medicare, and everyone else by out of control, crazy high insurance premiums. I DON'T SMOKE.
And Fast Food. How can these people eat that artery clogging, blood pressure elevating drek day after day? Because it is cheap. And convenient. And advertised to be nutritious. And buying, cooking and cleaning fresh, healthy food is expensive. It requires time, and education. A lot of my middle class, insurance packing friends, deplore the "fast food" culture while fixing sodium heavy, fat filled, chemically enhanced pre-packaged, expensive "meals" for their families. Of course, they don't walk 3 blocks to the bus stop, take 2 buses and 45 minutes to get to the grocery store that is barely 2 miles away, haul all the groceries you can carry back, then stuff them into the little tiny refrigerator/freezer, then prepare them. It is way easier to hit the McDonald's on the corner. And there is one. On every corner.
Yes, but what about those spendthrift "poor," using my money to fix they're sniffly noses while talking away on their expensive cell phones. Don't I get to rant about that?
I think most of the people that were commenting on the article in FB were gainfully employed, and most likely have employee sponsored healthcare. I'm assuming. Never a good premise for an argument - but as it is my blog, I get to create my antagonists in whatever image I choose. Even if you see the money coming out of your check, it is difficult to really understand the costs associated with insurance in this country. My husband and I pay for insurance. We found the best plan that we could afford, based on what was important to us. We are relatively healthy. So we really need emergency care, and follow up care for any such emergency. We have a $7,500 deductible, which means for non-emergencies, we pay everything, every year, up to $7,500/per person. To put it bluntly, we pay over $500/month for a family of four for the security of knowing that if I slip off a ladder and hurt myself, we are not going to have $30,000 in medical bills to deal with while I am out of work. We still pay for all doctor visits and testing out of pocket. We still only go to the doctor if death is imminent. Our last insurance plan had "well care," so we did not have to pay for healthy check-ups, but the premiums were almost $200/month more.
So lets take this into the world of those slacker "poor." The thing with insurance, is that you have to pay for it. Consistently. There are no allowances for people that are late on payments, you don't pay, you aren't covered. People with unreliable incomes, even if they are working a little, are not going to be able to budget $500/month for a healthcare plan that is not in anyway helpful to them if they get a flu or sprain an ankle. I have been very poor. When you struggle for every little thing, trying to pay your bills, put food on the table, etc. those rare instances of "found money," you know, when money appears that is not in your budget - the extra check 2x year when you budget for 2 checks a month, winning $50 from a scratch off lottery ticket - that extra money is a little mini vacation. Yeah - you could put it away to pay for 1/2 of your kid's next doctor's visit - but how are you going to come up with the other half? or you could spend it on those cool shoes you've been wanting. What the heck - I deserve a little somethin' somethin' for working so hard feeding all these kids, wipin' these snotty noses, picking up after that drunkin' man. I'm gettin' me those shoes. or Whatever. The one thing we know is that the money is not consistent, and saving it for 3 months, to hope to get enough money to pay for one month of insurance, that won't even pay for a doctor's visit is not an option.
I still agree that this is a cultural problem, but it is bigger, more pervasive, and subtle than my usual rant against the entitlement culture that is being showcased here. The biggest problem that I see is largely the blame of the middle class. We are a society that lives beyond our means and outside of our budgets because we love and value status. We live in America, where everyone is equal. Our kids go to school and everyone is carrying Vera Bradley bags, cool cell phones, designer clothes. We can't afford to keep up with all of that, so we buy on credit cards, shift things around, figure it out, because it is IMPORTANT. Different families have different ways of working it out. Some people work themselves to burn out with multiple jobs, in this economy, that is very hard, finding one job is sometimes a struggle. Some go into deeper debt on credit cards, take advantage of the reduced interest rate and slow foreclosure rules from the banks, hoping things will get better before they lose the house. Some turn to older, more fiscally responsible family members. I actually know a family that made sure that all four of their kids had the iPhone when it first came out. Not something I would condone even if I could afford it. This family was consistently borrowing from the grandparents to pay mortgage. Of course, their dirty little secret didn't end up in a medical record to be ridiculed on face book.
So when the very poor take steps to look like everyone else - this is America, we are entitled to equality - we jump all over them because we have to foot the bill for their healthcare. If we weren't doing that, we wouldn't have to go so far into debt to look like people that are significantly better off than we are. This is a significant cultural issue. We live in a society that values "image" above basic health. Do not think for a minute that this is a cultural crime of the very poor. If as a society, we valued "people" over "status," we would have fewer Medicaid recipients hanging out in the ER wearing designer jeans, fewer healthcare workers that notice the brands they wear, and we may actually have fewer emergency room visits for things that could have been fixed if we put our money toward healthier living, instead of keeping up with the Montgomery's.
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