On the Outside Looking In
I realize that as someone who works in a clinic for the uninsured, chronically ill in Texas, I have inadvertently painted a rosy picture of the lives of our least fortunate citizens. There is nothing rose tinted about the view when you are born to a family in which one or both parents are afflicted by disease, a family in which you have to leave school early to get a low paying job without benefits to help support siblings and parents. Then, in your 40s, you get struck down by the same inherited illnesses that made your parents’ lives so hard---asthma, lupus, diabetes, heart disease, depression, schizophrenia, rheumatoid arthritis, cancer, sleep apnea. Though we like to claim that everyone is born equal in the US and that we can all pull ourselves up by our bootstraps, the truth is that illness is a huge cause of poverty---multigenerational poverty. And many illnesses are hereditary, meaning that they hit generation after generation.
Sick and poor go together for a reason. In this country, you get sick. You lose your job. You lose your insurance. You lose your health care. You get sicker. You either die or, you get on disability and a nice fat $600 a month check. Two years later, if you are not dead yet, you get Medicare.
Years ago, Texas had its “state” hospital in Galveston. Folks would drive for hours from the piny woods of east Texas to get health care. One man showed up with a gangrenous limb that he had been doctoring on himself for months----finally, someone had convinced him that it was time to go to Galveston and get that leg chopped off. Another man drove up from the Valley for a blood transfusion. So anemic he could hardly walk. They had doctors and hospitals in the Valley. But he had no insurance. So he was directed to Galveston.
Now, almost every urban area has its “free” clinic---they are not really free. The local property tax owners pay for them. If they didn’t, the private doctors and hospitals would go bankrupt taking care of all the people without health insurance. You can’t have a profitable medical center without someone to treat the people who cannot pay. The “free” clinic is not as pretty and the waits are longer, but you can get your chemotherapy and your coronary stents. You can get your mammogram and your colonoscopy.
But rural areas are a different matter. If you live in the country in one of the 24 states that refused the Medicaid expansion on principle not cost---it was not going to cost your state anything--- and you’re poor and sick, you are truly on the outside looking in. You’re like that farmer in the piny woods of East Texas, looking down at the swollen, red diabetic foot that you can no longer feel. It gets you around, more or less, but you know that sooner or later the infection will spread to your blood. There is a doctor down the road and a shiny new surgery center ten miles away, but you can’t go there, they don’t take emergency cases, just elective surgeries and for that you need insurance. You’re 64. One more year until Medicare. The Medicaid expansion would have come in useful. But on principle Rick Perry did not want you to have it. Something about how it would have made you weak.
Our brothers and sisters are on the outside looking in. They don’t begrudge us our good fortune, so please, don’t turn your eyes away from their misfortune. You can enjoy what you have and still want something better for them. The two are not mutually exclusive.
A map can't show you their faces. You'll have to imagine them yourselves.
http://www.whitehouse.gov/share/medicaid-map
If you want to let the people on the outside in be sure to get out there and vote this fall.
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It's funny. I had to become an old woman to realize how much my patients like having me hold their hand and hug them. I guess when I was younger, I was self conscious about it. Getting older can be a good thing.
