Friday, September 18, 2015

Medical Care in Kansas and Why It Won't Be Fixed


 Coffeyville, Kansas, where nearly one in five people lives in poverty (source)

by Gaius Publius

I want to present this story as a story first, before I let the writer make an analytical point and I make one of my own. This is from a much longer, excellent piece in The Nation called "Life and Death in Brownback's Kansas" by Kai Wright. No, this story doesn't end in death, but the steps its subject takes along the way, the drops she experiences from one level down to the next, are so predictable as to be obvious. They are also terribly common.

Charmaine's Story

This is one of many example stories in the article. It appears near the end and concerns a woman named "Charmaine," last name withheld. Here is Charmaine's story as Wright tells it:
Charmaine, who didn’t want her last name used, entered the recession feeling good about herself. At 51, she was living in Kansas City and working as a district manager for the discount furniture chain Big Lots, having clambered her way up through the company’s ranks over 15 years. “I started on the floor,” she says. “I didn’t go to college or anything like that, so my hard work got me to where I was. And then…” She swats at the air in frustration.

The recession presented both peril and opportunity for discount retailers like Big Lots, as consumer spending dropped but bargain hunting surged. In 2008, the firm took steps to capitalize on the moment. Company leaders, based in Ohio, streamlined operations by consolidating middle management. Charmaine’s job was gone. “You go from 60-some thousand dollars a year—with great health insurance, company car, everything—to nothing,” she says. She found herself in a job market where all the rules had changed. “Here I am in my 50s. Guess what? They want somebody with education, younger.”

So she downsized, moving from Kansas City to Coffeyville to live with her grown daughter. She got a job as a home health aide for $9.70 an hour, with no health plan. Then she got sick.

It started as a mild case of ulcerative colitis, a disease marked by inflammation and sores in the large intestine and colon. At first, she didn’t feel that bad, and she had more pressing claims on her limited funds than the anti-inflammatory drugs she’d been prescribed. “You know how much the prescription was? $1,000 a month,” she says. “So I didn’t do the medicine, which was my fault, I now realize. But I couldn’t pay for it.”

That was 2011 and, as will happen, over the ensuing years, her condition grew from uncomfortable to debilitating. By July 2014, it had become a crisis. “One day I got up in the morning and just—” She flinches at the memory. “Blood, solid blood just coming out of me like a waterfall.”

She ended up, at Griffin’s advice, in a Bartlesville, Oklahoma, emergency room, one of the nearest hospitals with a gastroenterologist. Charmaine spent two weeks there, the first of five hospital stays over six months last year. The second stay came just two days after the first. She was running an errand at Walgreen’s when she lost control of her bowels. “It was one of the most horrifying things I’ve ever been through,” she says.

This time she went straight to the local ER. They found a gastroenterologist at Kansas University Medical Center who they believed could help, but she would have to get to Kansas City, 165 miles north—an expensive ambulance ride for someone without insurance. “Here I am sitting here, bleeding like crazy, and I’ve got to find a way to get to Kansas City right then. Finally, they had me sign a document saying I had to pay the $4,000 if I wanted to get to the hospital. So I agreed! I signed it.”

The Kansas City doctors discovered that she had picked up a bacterial infection that had complicated the colitis. Now her inflamed colon won’t heal, and the upshot is thousands of dollars in medication and ongoing doctors’ appointments. She’s lost track of the debt she’s racked up. She gets many of her meds free through drug-assistance programs, but the supply can be unpredictable. For her other meds, she’s on a payment plan. When we spoke in January, Charmaine had just run out of her free anti-inflammatories. If she can’t find a new source and her colon worsens, doctors will have to remove it.

Throughout this ordeal, Charmaine has continued working. In the 29 states (plus Washington, DC) that have expanded Medicaid, her income would likely put her in a gray zone; depending on how many hours she puts in each month, she could fall just over or under the 138-percent-of-poverty cutoff to qualify. But in Kansas, she’s completely out of luck. She qualifies for tax credits to buy insurance, but she’s struggled to find a plan in which she can afford both the premium and the cost sharing on all of her meds. She could apply for disability, but she can’t imagine living on the small income that would provide, even if it did bring health insurance.
The steps — decent job with health insurance, then fired at an unhirable age, then service-sector job with no insurance, then sick with barely affordable medicine, then complications to the illness, then mountains of debt with no good choices. And she's still sick.

How common is that? I would guess very, and because there are so many more whites than blacks in the U.S., this happens to far more whites than to any other group. Not just "Life and Death in Kansas" — "Life and Death in the U.S. of A."

Why This Won't Be Fixed

The writer, Kai Wright, offers this tag to the story, which shows one compelling reason why this problem, adequate health care for poorer citizens, is so hard to solve, especially in states like Kansas. Wright closes Charmaine's story this way:
“I’m not ready to give up. I’m a hard worker,” she says, before breaking down in tears. She’s been taking anti-depressants for the first time in her life. “I’ve worked 30-some years and paid my dues, and here I can’t get any help? And all these years that people get food stamps and medical cards for their children, I helped pay for that. So what about me? What did all my hard work get me?”

It’s a sentiment I heard often, talking with southeast Kansas’ sick and poor. Everyone is convinced that someone else is getting a better deal, that somewhere a horde of Kansans are gaming the system and preventing the truly needy from getting help. It’s a sentiment that Brownback eagerly exploits when attacking Medicaid expansion and other forms of public assistance. In his January State of the State address, he pointed to a black single mom in the audience, saying she had been on welfare and was now in a full-time job. He asked her to stand with her teenage son, then lauded the “courage and perseverance” of her redemptive journey. “We will continue to move forward,” he vowed, “helping people move from dependence on the government to independence.”
It's the song of the hard-working right-wing white person — "Everyone is convinced that someone else is getting a better deal, that somewhere a horde of Kansans are gaming the system and preventing the truly needy from getting help" — and people like Brownback are leading the choir.

This is the writer's problem statement, the finger he points, in telling Charmaine's story. (Did I mention that the whole article is a fantastic read?)

Obamacare and Medicare

I'll point a different, additional finger. It's not just Brownback and Charmaine's complaint about winners and losers that's the problem. There would be no winners and losers, no "better deals" to be had among citizens, if everyone were receiving the same guaranteed government-provided health insurance.

The argument in favor of Obamacare, the patchwork, publicly-mandated private insurance mélange, is: "We couldn't get else anything passed. It had to be this way." The counterargument is: "You could have simply offered 'Medicare for All' or 'Medicare Plus 5%' and voters in both parties would be for it."

Obama rejected Medicare as a solution, or anything else that looked like government-offered "single payer" insurance. Then he rejected the "public option" as a lesser solution. He made these choices based on his relationship with the insurance companies (and drug companies), not based on the unpopularity of his alternatives. He chose to populate the space always intended for Medicare — health insurance for those under 65 — with a cobbled-together private insurance scheme instead.

And this is where we are, some of us doing just fine and some of us where Charmaine is now. One day soon, President Obama will be here...

Barack Obama’s Presidential Library as envisaged by the Chicago firm HOK (view 1; discussed here).

... but he'll need some help to get there. I suspect he has that help all lined up.

Charmaine may have Brownback to blame, though she may not know it. But she also has Obama to blame, for a reason she may not suspect. Brownback and Obama, two politicians maintained in place by money. One of them is close to a well-paid retirement, a choice Charmaine, earning $9.70 an hour, will likely never have.


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At 9:56 AM, Anonymous Anonymous said...

Sounds like my son's experience. Same work up to management, in his case it was a millworks distributor. Then 2008 and nobody was building any more... and 99% of the millworks were the cheap Chinese crap sold through home depot. His distributor went under, bought for a nickel on the dollar by the one remaining distributor left out of the 8 or so that were. His store closed. He's now earning all of $10 per hour and struggling to support he and his daughter.

Fortunately he hasn't gotten sick... yet.

He lives in a blue state that has Medicaid, but the other side of that is this: due to the pathetically low reimbursements, there are almost no providers willing to take Medicaid patients. The mostly immigrant docs that do only do so until they get a practice established. Then they stop. So continuity is a real problem.

And, in the end, it isn't really brownback's (or his ilk) or even obamanation's fault. It's the fault of the voters for putting those douchenozzles into power... and RE-electing them even after they prove their worthlessness.

If the health and welfare of the poor and the non-white mattered a whit to a majority of voters, the brownbacks and obamanations and their evil ilk would never get elected... certainly never get RE-elected.

But that's not where we live. We live as an evil, nihilistic society. And we get what we demand.

At 1:14 PM, Anonymous Anonymous said...

Obama didn't "reject" medicare for all and a PO. He was agaist both from the beginning, though he lied to US/us about it.

It's a matter of record, though almost never reported, that obamanation vowed to the lobbies that there would be no SP nor PO BEFORE he speechified to US/us that he was in favor (of the PO).

He similarly vowed to the bankers that NO ONE WOULD BE PROSECUTED for their 10s of Trillions in fraud that cratered the world economies.

As soon as obamanation started naming his cabinet, we knew... or SHOULD have known... that we'd been had. Starting with his naming of Daschle, top 10 most corrupt congresswhores ever, All those teary eyes from Grant Park should have immediately dried and their owners should have commenced with the expletives.

But, after the immediate and constant betrayals, we re-elected him and his wall street/uber corrupt backers again.

15M from 2008 didn't bother in 2010, so those folks knew.

Imagine if obamanation had put Jamie dimon in jail, demanded a PO and come up with treble the stim he actually settled for... those 15M woulda came out again... and maybe the house woulda stayed D.

Whatever. They don't want a progressive D congress. The money wants a servile congress. Disenfranchising 2 in 3 voters is a sure way to keep it that way.

At 5:13 PM, Anonymous Dan Urbach said...

Her story is tragic and common. I've seen many similar stories in my practice. We have a terrible system, or rather, it's not a system but a mass of inefficient systems that work poorly together or not at all. I disagree with two things in your post. First, Medicare is a very big part of the problem, and Medicare-for-all would be a guaranteed disaster. We need to adopt a successful system from abroad, such as one of the western European models. There are quite a few that work well enough. None is perfect. I know Paul Krugman keeps crowing about Medicare-for-all, but he knows better. The other is that you imply that the problems are Obama's fault. That's below you, Gaius. His plan is imperfect, but many folks without insurance now have it. I have taken care of many of them, often people I've known for years who could not afford to take care of their desperate problems, but who now can because of the ACA. I am not an advocate of the ACA, but it is better than what we had before. As Obama says over and over again, if you want him to do something, you have to make him do it. The most frustrating thing for me is that the people who need help the most are so poorly educated that they can be duped by the GOP into thinking they have to vote against the people most likely to help them. That malignant demagogues like Donald Trump and deluded idiots like Ben Carson are leading the GOP race tells me that we are a very sick country.


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