By William Neil
Introduction:
Anyone with a social conscience or who
has just followed the news since 2010 knows that the struggle for decent health
care is not an issue that can stand isolated from other intimately intertwined
factors, although our medical and political system tries to keep it that way. My
tale is not unique….it has been already
lived by millions if not tens of millions of others, and the pattern by now has
become a familiar horror story, if not a drill: a medical crisis leads to an
income crisis which leads to a housing crisis…which can in turn create a
further medical crisis. My situation is
not the worst, but it is mine and it seems bad enough, so I thought I would
share it with Sardonicky readers
because living it out in silence does no one any good, and indeed, seems to me
to be a form of acquiescence if not complicity with the status quo.
What follows began as a dialogue
triggered by an essay recently sent out by William Greider on the failures of
the Democratic Party…I shared my response with those on the Email list and it
turned into a dialogue with one of the recipients on the efficacy, or not, of
our new health care system, the ACA. From my email sent out earlier this month:
“Thanks for getting back to me. Just for the greater public interest and your
own education, my private life and struggles are now going public, and I've increasingly
been working that perspective into my last four essays, over the past three
years. So here are my facts, and I won't
take them any further than the Affordable Care Act’s reality for me. I hope the President's plan has been able to
help millions.
I receive early SS retirement, reduced
amount, out of economic necessity, well under $1500; I receive a small NJ
pension under $500 and work part time at Target for $8.97 per hour. As my second year evaluation rolled around in
April, I received a 22 cent per hour raise bringing me to that figure. I got a good evaluation. My 2013 gross income was just under $34,000. I am single, divorced. I applied for the OCA (That should be ACA but
I guess the “O” for Obama, does just as well) on Dec. 17, 2013 plugged in all
the numbers on the Maryland Exchange and was told quickly and bluntly that I
did not qualify for a) Medicaid (income cut-off 14,000) and b) any subsidy.
Now I live in one of the most expensive
counties in the country, Montgomery County, MD but none of these calculations
take that into account, only the income.
The County Council's own numbers show that the minimum wage required to
be out of poverty is $17.50 per hour. I
finish most months with only $100-$200 to spare, sometimes less, and have been
living on the edge that way for two years now. I haven't missed a credit card payment yet,
but my two bills for the cards are $140 each and bound to rise as the $20,000
in medical bills, or more, is, as slowly as I can manage, added to them. My rent is 1,450 per month and I have to pay
all utilities. I still owe my landlord
for several months’ rent when my savings ran out three years ago and before the
Social Security arrived and I had to go back to work. I live at his forbearance on a month-to-month
lease and have, most months, paid him what I can spare as “back rent” owed.
For further economic clarification, and
in preparation for testimony before a Republican ethics committee on debtors
and personal character, I have not purchased a single appliance or capital good
for the past ten years; two pots and pans and a computer (replacing an eight
year old one, and a necessity in modern life) in 2011, which went, along with
car repairs, auto insurance and vet bills for my beloved Josie, a Belgian
Malinois now deceased, on the credit cards out of necessity. My last vacation was 2006 and I didn't pay
for it. My car is 14 years old - a VW
beetle from much happier times.
So when my heart crisis arose out of the
blue (I've never smoked and don't drink) with no prior history...here I
am. Over the past week I've spent hours
on the phone to utilize the "life event” (I guess they don’t like to use the
word crisis, which is surely what it is) clause of OCA in MD, and the drop in
income at Target of 50% means I can get a subsidy of $333 per month on the
premium and 73% on the co-pays and deductibles...but the only plan I can make
is still $165 for the premium plus 900 deductibles and 5200 out of pocket
(reduce them by 73%) plus whatever the plan is on drugs (I’ll pay 20-30%). So very helpful, but still an additional
expense with my reduced income and other fixed costs. Ah, I forgot to add an
important detail: failing to qualify for ACA/OCA in December, I was planning on
picking up Target’s medical coverage for part time workers, at a pretty
affordable rate. Unfortunately, they dropped it entirely in the early winter of
2014.
I spent most of today on the phone with
our Montgomery County's housing assistance programs. We are one of the most progressive and
sophisticated county governments in the nation.
There is no additional money, long waiting lists (years in some cases) and/or
lottery luck for any/all of the housing problems. Summary: no help on the horizon and none
likely to arrive. If I get an eviction
notice, I can get emergency help for one month rent and security deposit...but
there are no available public housing places...go read the private want ads was
the advice. The system, as one neighbor told me, gets you a little more help
when you are homeless, surrounded by your belongings, sitting in the middle of the street – destitute, in
other words. In preventing that
destitution, there is almost no help, and women with dependent children will,
rightly so, be first in line. I told
the social worker that I would kill myself before entering the group shelter
system. He seemed to take that easily in
stride. I don’t know if that is courage
or cowardice on my part, and I won’t know until if and when I stare that
situation in the face. And I guess it
will depend on your point of view. I’m trying now not to have that staring
match.
I live in the smallest one story house
type in the entire county built in 1953: about 1100 sq. feet. I don't know if I can survive, if I can find,
a small one bedroom apt. near me - they all seem to be 1200-1400 dollars....no
help.
So that's the story. With a great deal of luck I can make the
August rent, no way September. I have
no criminal record, great driving record (although my eyesight is now going
downhill) and have 1400 pages - or more than four large books - in essays written
over seven years ...you've seen two brief unpolished samples...Such is the
state of my state, and our social service "net" for someone in my
circumstances at age 64. If the heart
troubles (two bouts of angioplasty) don't kill me, the stress of just facing
this reality probably will. When I was
discharged last week from the hospital after my first operation, I saw the
listing of psychological factors contributing to heart disease centered on
various types of stress. I scored an A+
on each of them…the basic facts of my life over the past nine years.
And I apologize now for using the term
medical "Gulag," that is not the best description.
My mounting waiting room experience
though, the beaten, bent people who are being shepherded through a very
impersonal system with high technological capabilities and very low humanity
treatment ones, leaves me still with the
sense that I am in a vast "refugee" flow...that's what it feels
like...my appointments aside from the one hospital procedure and one due next
week led me to this vision: rather than a "Gulag,"…the complexes
where I get diagnosed, blood and credit drawn out of me...are in sprawling one
and two story office complexes that go on for square mile after square mile
around Shady Grove hospital...like the old industrial towns of Newark, Philadelphia,
Camden and Detroit in their glory days, there is a vast subdivision of labor and
practice which fragments the experience and ups the demands on patients. It is industrial medicine and I had no idea
of the tremendous and confusing physical network which surrounds the
hospital.
My last trip to the blood lab, yesterday, went
like this: I saw my cardiologist Tues...he
said you need this blood work, and have
to fast ten hours; I went to the Quest firm, right next door; they don't have a
receptionist or an office manager it seems, they all multitask, but I couldn't
verbally set up an appointment, face-to-face at their office, I had to call and go through an automated
system. When I finally set it up, two
days later, and when I went in after fasting at 9:30 for a 10:00 appointment…they said they had
no record of it...but took me anyhow after a 35-40 minute wait. The person who drew the blood had a credit
card machine right in the examination drawing room; I told her I only wanted to
put $50 down, but the system would take only the full swipe for $306. We made each other laugh with the absurdity;
but that afternoon I left critical comments about the low morale, lack of
receptionist and no office manager to keep it going – and praised the humanity
of the worker, caught, along with me, in this vast system of extraction. And reminding them of the outrageousness of
the credit card machine in an examination room....
That's all for now, thanks for asking, I
needed to get this word out. My "samizdat." I really don't know if I will make it and
only the glimmer of the hope that I can
tell the story, almost as it happens in real time, to change what others might have to
face, keeps me going. “
Best,
Bill Neil
Rockville, MD
PS
I have emerged alive from my second round of angioplasty, or cardiac
catheterization, in technical terms. I
tried my best to keep a sense of humanity alive in all my interactions with so
many people caught up in this vast system, and I had some wonderfully frank
exchanges with nurses, aides and cleaning people. In some ways, I was working to keep their
spirits up, besides my own, knowing a bit about “life on the job.” But I failed on the last day, after my
overnight stay, waiting and wading through the prolonged “discharge process.” It
was the knowledge, beyond my own health and the medical aspects of the
hospital, that upon my walking out of that recovery room, I would be heading
down to visit the “charity” application office for help in dealing with the
vast bills I had accumulated without any medical “coverage.” I knew better, the full risks of not having
insurance at my age, of skipping check-ups and all the tests that ought to be
run after one turns 50-55, much less 60.
And I had lived with and been married to an emergency room doctor
myself, a wonderful woman…but the bleak, on the edge finances of the last five
years of my life overruled all, seem now like a vast, blind driving fate I
could not overcome. And the last part of
my body that I thought would let me down, my heart, had done so. So I was angry and yelled at the nurse’s
station that after their good medical care I was going to face the grim
financial reaper, that was the other side of it and I could not suppress the
anger. My discharge nurse then gave me a
pep talk about keeping a “positive attitude.”
She was very, very good, in retrospect, but that wasn’t her best moment
– nor mine either.
***
(Ed. note -- I'd also like to direct readers to this recent essay by activist and writer Bill Neil.)