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17 July 2007 @ 11:37 pm
Health Care in America, Pt. 1  
I made the decision to become a nurse largely as the result of giving birth to my first daughter, here in the US. I was quite poor at the time, married, working part time, with a husband working more than full time hours, even by American standards (60-80 hours a week), and I was young (21 years old) - all of these things shaped the experience I had of the US health care system, circa 1982.

Because I was low-income and pregnant, I qualified for Medical, my state's version of "socialized" health care - and I was extremely grateful for it. My husband worked for his father in his small automotive repair business - which meant long hours with no benefits. My part-time job as a caregiver for housebound elders carried no benefits as well. So Medical enabled me to get regular prenatal care (with a small monthly co-pay, and a more considerable co-pay for my child's birth). The bottom line was, Medical gave my child a shot at a healthy birth, and that was all that mattered to me.

Naif that I was, what I didn't realize - having grown up in a solidly middle-class, medically insured family where issues like this never reared their ugly heads - was that Medical recipients carried a stain. Though this state insurance scheme provided coverage, physicians were under no obligation to treat you. If they did choose to treat you, they were still within their rights to treat you like shit.

My first prenatal interview went like this:

MD: "So...are you on drugs?"
Me: "....no!"
MD: "Alcohol? How much do you drink every day?"
Me: "I don't drink."
MD: "Mmm. You smoke?"
Me: "I do. I know it's not good -"
MD: "You need to quit. Are you trying to kill your baby?"
Me: "Well, no, of course not -"
MD: "Are you sure you aren't on drugs?"

Monthly visits involved vaginal exams so painful, I left the office crying and shamed for hours afterwards, but too young and stupid to challenge the manner in which I was being treated.

When my daughter was born, healthy and beautiful, 9 months later, the doctor was nowhere on the premises. Though I'd faithfully followed his directions for the entirety of my pregnancy, showed up for every prenatal visit, and spent countless hours in the local library, reading books on pregnancy and childbirth, trying to figure out the best way to maximise my child's chances of a good birth - apparently, we weren't worth his trouble. When I went into labour and was admitted to our local hospital, he'd been alerted to the fact that I was thisclose to having my baby - but when Siobhan was born, it was 2.30am, he really couldn't be bothered to get up at such an ungodly hour, and a young nurse caught my girl as she came into the world.

My firstborn spent her childhood showing suspicious signs of, and has subsequently grown up to be, an intelligent, irreverent, highly responsible, adventurous, thoughtful, hilarious, kind-hearted human being, as did my following children - and I couldn't be prouder of any of them.

So: that's one dag's experience of health care in the US, warts and all. 25 year later - where do we go from here?

As I mentioned earlier in a review of Michael Moore's "SiCKO," arguably the most significant impact of Mr. Moore's documentary will be - or perhaps already is - raising the visibility of the health care crisis in the US. "Crisis" might seem like an overblown word, but consider: with a documented and anecdotal war chest of stories at least as unsettling as mine; with a per capita spending greater any other country on the globe; with only the 37th best health care outcome despite this; with more than half a million countrymen/women declaring bankruptcy due to catastrophic health care bills - that dog don't hunt, y'all.

Both 2008 presidential candidates Barack Obama and John Edwards are yakking up federal health care proposals that closely mimic the Massachusetts Mandated Health Insurance Law. Neither has endorsed the far more comprehensive vision of fellow candidate Dennis Kucinich's/Rep. John Conyer's HR 676. Hillary Clinton has backslided so precipitously on this issue, compared to her championing stance of the first Clinton administration, that it's flatly not worth discussing.

At the state and local levels: apparently, even the Governator is keeping an efficient ex-Austrian eye on good ol' Massachussetts' progress, which is also being very closely followed by politicians, insurance companies and health care providers across the US. On a less publicly frenzied scale, the city of San Francisco is quietly undertaking a similar project - slowly, warily, with good intentions and a long stretch of road paved therewith.

"SiCKO" does a surprisingly decent job of covering the travails of the insured under our current system, so I'd direct anybody interested to see the film, or visit the website, for more details. What the doco doesn't cover is the plight of the uninsured/underinsured, and I thought I'd address that here.

Despite a lot of rightwing handwringing in the US at the notion of "socialized" health care, we have a deeply retarded brand of it already. At the federal level, Medicaid/Medicare and State Children's Health Insurance provide free-to-low-cost health insurance to qualifying applicants:

  • Medicaid is a federally and state-funded, state-administered program which covers "certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law." Eligibility is based primarily on income, but can be modified (depending on the state of application) by assets and resources, age, disability, pregnancy and immigrant status.
  • SCHIP is a federal/state partnership which seeks to cover low -income families who earn too much to qualify for Medicaid. Eligibility guidelines, however, vary from state to state - a working family whose children are covered in Ohio may qualify for total family coverage in another state - or vice versa. Under SCHIP, the states have much greater discretion to determine the range of services provided and eligibility of applicants; however, its stated goal is to cover "targeted, uninsured low-income children" - those whose parents' earnings fall between 200% below, or 50% above, federal poverty levels. This qualifies one's children for coverage, no mean feat in our current political environment. However, it doesn't automatically qualify those kids' parents for coverage. So what happens to those kids if their folks are caught up in the maelstrom of bad luck and lack of health care? Good question. Wouldn't it be nice if we had an answer?
  • Medicare is a federally -funded health care program for people over the age of 65, people under the age of 65 with certain chronic illnesses, and anybody (regardless of age) with end-stage renal disease. Starting in January 2006, Medicare was expanded to include a prescription drug benefit, Medicare Part D - which not all seniors qualify for, and almost all seniors have a monthly premium, yearly deduction and co-pay for, and has proved to be so ridiculously cumbersome and confusing that a plethora of websites are dedicated to discussing it - despite the fact that fewer than 31% of all seniors in the US have ever been online, and less than 15% with incomes below $20,000 annually have ever accessed the Internet.

O, our several confusions! I'll continue with suggested fixes tomorrow, in part 2. Don't even think about putting those calculators away, you sorry bastids - despite my decrepit old age, I'm watching you...=O

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