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.

One thought on “Appalled

  1. Healthcare administration is 31% of healthcare costs. Instead of raising taxes and continuing to feed the beast, I think we’d all be better served if admin payroll was put through audit. Or perhaps the millions of “research” dollars could no longer be spent on door to door pharmaceutical salespeople giving free samples to doctors as a way of marketing, or spending hundreds of thousands each year for conventions, flyers, televisions ads, guest speakers, etc. etc. Also, any new drug gets a patent, which means a generic substitute cannot be made for a certain period of time (maybe a few years, may vary). So, a drug that could cost $10 a bottle is currently costing $150 a bottle because you have no other choice and the pharmaceutical company is racing to the finish to make billions during their time of monopoly.

    As an insured person, my doctor can only get paid what my insurance company deems an appropriate amount for each procedure. If you are uninsured, you have to pay whatever they charge you and uninsured people normally don’t get the same quality of care. How is my xray worth less than someone who can’t afford insurance?

    Insurance companies, pill companies, and doctors don’t need more money from me. They need to be held accountable for the money they already receive.

    Here in the welfare state of Massachusetts, all of us pay a pretty penny for MassHealth. It pays for my 35 year old friend’s healthcare and the healthcare of her 2 high school aged children. I have to continue to work so I can pay for her apartment that she also gets a state check for, as she doesn’t want to work and certainly no one is going to make her. Thank god for taxes or she might have to pay for her own groceries. If they took away free healthcare, housing stipends and food stamps from people who could go to work, there would be more money to go around to disabled people who really need it.

    Sorry, Mark, that may sound a little rant-like. I agree that people shouldn’t have to make a choice about what medications they can live without. Taxes are a sore spot here in Taxachusetts 😉

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