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Field Notes From a Lagging Indicator

By William Neil

Your editor struck up a correspondence with the author of this article after we both responded to a group email from William Greider linking us to one of Greider’s recent pieces. It led to an exchange about the Affordable Care Act and to this piece of “samizdat” detailing one desperate senior’s angle on ACA (and the state of his state’s healthcare system).

Last fall after Feds screwed up the ACA website, journalist Ezra Klein zeroed in on problems with the rollout. He was abused by a Salon columnist for giving aid and comfort to opponents of national health insurance. I still remember the look on Klein’s face when he was placed next to his critic on an MSNBC chat show. It seemed hard for him to get his mind around being trashed as insufficiently supportive of the ACA when he’d done as much as any public intellectual to make the case for the legislation. He may have been hurt (for a half-second) but his expression registered something more than pique at an unfair attack. You sensed Klein was suddenly feeling from within why so many folks assume politics and journalism are dishonorable professions. But truth is truth (as Klein knows), even when it hurts your side of an argument. B.D.

Here are my facts, and I won't take them any further than the ACA 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 $6-8,000 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 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. Oh 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...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 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 dependent 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 written any number of essays that prove I can think consecutively...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.

I apologize now for using the phrase "medical Gulag." That is not the best description. Yet my mounting waiting room experience of the beaten, bent people who are being shepherded through a system with high technological capabilities and very little humanity, still leaves me with the sense that I am in a vast "refugee" flow. That's what it feels like. My appointments, along with the one hospital procedure and one due next week led me to this vision. Though 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...he said you need this blood work and must 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 office manager—praising the humanity of the blood-worker, caught, along with me, in this vast system of extraction and reminding them of the outrageousness of the credit card machine in the 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.

From July, 2014

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