Occam’s Razor

Appalled

If you need more proof that our social fabric is unwinding, this story “Health Care Creates Dilemma for Tennessee’s Poor” today on NPR’s All Things Considered should scare you and make you very angry.

You can read the story on the NPR site, but please listen to it online if you can. As shocking as it is to read, it is even more appalling to listen to it. Linda Warner is a great grandmother who lives on a $600 a month disability check in a doublewide trailer in Cocke County, Tennessee. She is mostly confined to a wheelchair and helps take care of her three-year-old great grandchild. Because she is poor, Medicaid covers her. However, Tennessee got permission from the federal government to provide the poor with a cut rate version of Medicaid called Tenncare. As a result of a state budget crisis a few years ago, the state’s Tenncare program was cut back. Way back.

So this is what is left of our social safety net. Despite being disabled through no fault of her own, despite doing good for her family and her church, the state set a limit. No Tenncare patient, unless their circumstances are “unique and complicated” can receive more than five prescription drugs per month from the state. As you might expect if you are a great grandmother who is living on $600 a month, that does not leave much money for other prescriptions you might need to stay alive. Therefore, Linda Warner, like many of people in the program, has to make painful choices about which medicines she will or will not take.

She gave the pharmacist her prescriptions, but told him not to fill the bladder medicine. Normally, she takes it four times a day.

“It stops me from wearing a diaper, a disposable diaper,” Warner sighs. “I really hate to do without the bladder medicine because I can’t go anywhere without it.”

Along with the bladder medicine, she decided to skip her pain medication for the month. That way TennCare would cover the $28 worth of antibiotics she needed.

“You have to choose,” Warner says. “And I have to have the inhaler … because I have to breathe. It’s OK that I’m wet, but I got to breathe.”

One would hope that she were the exception, not the rule. This is not quite the case according to local physician Dr. Edward Capparelli:

In fact, says Capparelli, since the drug limits took effect, he’s spent almost as much time figuring out how to take people off medications as figuring out which medications to put them on.

“This is a real problem because the clock resets on the first of the month,” says Capparelli. “So if you happen to get your meds on the first, and then on the 15th you get sick, you really are not allowed to get any more prescriptions on that limit until the first of the following month.”

Capparelli says that for relatively healthy people, the five-prescription limit hasn’t been much of a hardship.

“But for people who have more than one chronic illness, it’s impossible to try to pick which is more important,” he says. “And unfortunately, physicians have often had to choose for what’s life-threatening today and give up on what might be life-threatening tomorrow.”

Here is what is left of our social compact. If you lead an honest life, earned an honest wage, yet can no longer work and have to live on a disability payment that keeps you in deep poverty you get to enter a medical Twilight Zone. You probably will not get the health care services you need. You may have to choose between breathing this month and accidentally urinating all over the house. Perhaps when the state’s coffers are a little flusher they will allow you to have an extra prescription per month. You may die or suffer some chronic illness needlessly but that is just too bad: the state only pays for five prescriptions per month. Here is your best advice: stay healthy. Never get sick. The state cares, but not enough to matter if you are old and chronically sick. Moreover, consider yourself lucky that you get any care at all. There are thousands of others in the state worse off than you with no health insurance.

There is no question that health care is expensive. On one level, it makes complete sense for Tennessee to cut back on these rising costs. Unlike the federal government, they do not have a printing press to manufacture money. Yes, there are other expenses for which the state has to pay besides ballooning medical costs for its poorest citizens. Those schools, roads and law enforcement officers do not come free.

Still, how can societies which call themselves civilized being just accept this? How can anyone see this as a situation where the glass is half-full? Why can we not summon the political will to raise our taxes so everyone at least has the medication they need to live their life with some modicum of decency?

Apparently, we are a first world country with third world values. We should be ashamed of ourselves.

June 20th, 2006 at 08:59pm Posted by Mark | Politics 2006 | one comment

Viagra for sex offenders?

In 2003 forty five million Americans could not obtain, did not choose to purchase or simply could not afford health insurance. That’s 15.6 percent of the United States population. Some of these people may be here illegally but most likely they are decent, hard working Americans who were priced out of the health insurance market. Too young to retire they are not eligible for Medicare. And apparently they are not destitute enough or cannot meet some of the weird criteria in order to qualify for Medicaid provided by their state.

But if they had been convicted of a serious crime at least their health insurance would be paid for. Admittedly it might not be much fun being in prison, and just evading rape can be a full time occupation. In the state of Virginia where I live and in many other states, when prisoners have served their sentence and are released to the community they usually qualify for Medicaid coverage paid for by the State. So crime seems to pay, or at least ensures that for a while you will receive free or heavily subsidized medical care.

But did you know that until very recently that if you suffered from erectile dysfunction and were a registered sex offender you could receive Viagra on the taxpayer’s dime? Sadly, I am not making this up. According to a survey by the Associated Press, here in Virginia and in 13 other states Medicaid paid for 788 sex offenders to receive drugs for treating impotence.

Silly me. I assumed that Medicaid administrators in these states had some lick of common sense. Some of these Medicaid administrators claim a 1998 Clinton Administration Medicaid policy by inference allowed sex offenders to receive these drugs. A letter sent to certain states by the federal government required Medicaid to pay for all legal FDA approved drugs with a few limited exceptions. Apparently erectile dysfunction wasn’t on the exceptions list. But that letter also said that restrictions could be put in place to cover abuse. I would hope this issue was simply overlooked by these state Medicaid administrators. But at a minimum it suggests officials in these fourteen states were asleep at the wheel.

This is not hard to figure out. No we certainly don’t want to do anything that would make it easier for proven sex offenders to potentially have more victims. And we sure don’t want to do it on the taxpayer’s dime. So of course we don’t want to subsidize these costs for registered sex offenders. My governor Mark Warner was one of the governors figuratively caught with his pants down. He issued an emergency order to prohibit future prescriptions of these drugs to registered sex offenders by the Commonwealth.

In my opinion as a condition of probation registered sex offenders should be required to take drugs that actually cause impotence. There are a number of them out there, and certain antidepressants actually have impotence as side effect. In addition to frequent checkups from their parole officers, sex offenders out in the community should be getting therapy to reduce the likelihood that they will sexually assault anyone again. Indeed the mayor of Miami has proposed a new ordinance that prohibits registered child sex offenders from going to certain places like public parks where children are present.

Miami’s proposed ordinance is a sad but necessary policy that I would like to see in other communities. I would like to hope that even a sex offender could be rehabilitated. However when it comes to crimes that tend to profoundly affect the victim for the rest of their life, such as serious sexual, physical or emotional abuse, it is completely reasonable for society to insist that registered sex offenders have their privileges sharply limited, providing they are released back into society at all. This should be a two strikes and you are out crime. A second offense should require these offenders be locked up again for the rest of their lives.

I hope that state Medicaid administrators use this opportunity to review their implementation of the federal Medicaid statutes so egregious actions like this do not recur.

May 28th, 2005 at 07:12pm Posted by Mark | Politics 2005 | no comments