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Voices of the Nation I called my old friend Patricia the other day. For some reason she has been on my mind. She has lupus but has never defined herself as a victim or patient. Her attitude is positive and she cheers people up just be be around her. But when we exchanged the usual greetings, "How are you?" I was surprised to hear her update. She agreed to "go public" for herself and many others in the Medicaid system.
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Isn't there a safety net? Under President Johnson's War on Poverty and Richard Nixon's social programs, there was an major national committment to consolidate and standardize various county, state and federal health programs into a real safety net for the working poor, seniors citizens and the disabled. The federal-state public health insurance partnership was born.
There were neighborhood, senior and women's health clinics. This did not happen in a vacuum; there was a mass outcry in the 1960's about the social costs of poverty and neglected health. Medicare (for people over 65 years of age) and Medicaid (for younger people in need of public health insurance) became law by an act of Congress. The federal government makes matching grants to states to finance that state's Medicaid program. Each state administers it as it sees fit although there are volumes of federal and state procedures and guidelines to provide access and prevent fraud.
What about the coming state budget crisis? In California where Patricia Sweets lives, the state Medi-Cal (Medicaid + California health plan ) system is looking at budget cuts of $758.3 million. The state will lose another $350 million in federal matching grants. Doctors who accept Medi-Cal patients soon will be reimbursed $16 per patient visit. 30,000 adults waiting to go on the Medi-Cal program will be left out in the cold. All dental and foot care will end. What does this mean in terms of the human cost? Do Patricia Sweets and thousands of other poor, ill and/or disabled adults and children needlessly suffer as a result of recessionary state budget cuts and the new defense spending economy? Who will really pay the costs for the war on terrorism?
Over 42 million people are now without privately or publicly financed health care insurance. When people call to see a doctor, the first thing the appointment desk clerk asks is not "What is your condition?" but "What insurance are we billing?" Private insurance or a COBRA (Continuation of Benefits portability Act) plan may be available if a person has a $600-1000 to spare per month. Savings are used in a short time. Frequent secondary ailments that could be serious if not treated are most often excluded. (Beware if you have had a series of sinus infections or a trick back.) Your Cadillac premiums will help you wonder how good the publicly -financed health care insurance may be. Soon your savings will be gone and maybe you'll qualify?
Ask Patricia Sweets. Patricia, now 61 years of age, was struck with lupus disease (an auto-immune disorder) in her early forties. It hit pretty hard but she continued as best she could to raise her son and carry on as an artist and teacher. But her life became more difficult. She began dealing with the effects of lupus which eventually affects major organs (like lungs and heart), joints, bones, and circulation, Like her mother, Patricia has been an artist all of her life. In ceramics, weaving, sculpture and jewelry her work is widely recognized in the West for its quality and imagination.
When I first met her she was the "Golden Dolphin lady". The Golden Dolphin was her jewelry design shop in the San Diego area. She helped organized local art shows and events. She was one of the original founders of the Metalsmiths Guild. She showed in the world-class, juried Laguna Art Show. She also taught the arts. Like thousands of self-employed, taxpaying artists, Patricia Sweets had no health insurance. When the lupus began to take its toll on her health and she found she had to cut back on the physically demanding work, she needed regular medical care. She had her first introduction to the maze of publicly financed health care when she sought help at a local community clinic.
Patricia 's lupus was well established by the time she got a diagnosis. The disease took a toll, including decreasing her earning capacity. Eventually Pat had to get financial help. She turned to the federal Supplemental Social Security system. Even with the debilitating effects of lupus, it took yearsof applications to be certified as eligible. She finally had to appeal twice (no simple process) to receive some the monthly help. She also was eligible for Medi-Cal, most of which is now organized on the managed care model. The SSI helped her establish the legal fact she was officially handicapped by lupus disease.
But Patricia is a fighter, not a whiner. She carried on as best she could. Besides caring for herself, she began caring for her mother who is ill, blind, and has suffered recent strokes. Four years ago Pat returned part-time to school to keep her mind vibrant and to earn a degree. She is two semesters away from a degree in Psychology.
A few months ago, Patricia had bouts of unexplained, fierce back pain. A basic x-ray showed one fracturing vertebrae, due to a kind of sudden-onset osteoporosis, a complication associated with lupus. Her doctor wanted a MRI (magnetic resonance imaging ) test, more accurate and expensive than x-rays. For two months, Medi-Cal has dragged its feet. No answers, no help, no serious, specific treatment. No MRI approval. Now a second x-ray is showing 5 vertebrae are fractured. Her rate of fracturing vertebrae is alarming. It could be reversible with prompt medical treatment.
In extreme pain and dire need for speedy treatment Patricia Sweets has been lost in the maze of Medi-Cal bureaucracy for over two months. She is currently wearing a back brace, and uses a supportive walker. She can not bath, sit up, cook, clean without help. So far, family and friends are filling in. Patricia Sweets needs an MRI test in order to see what is happening and a chance to try new osteoporosis reversing drugs ( that may or may not help). (And will Medi-Cal cover the cost of the prescription?) Also, her doctor is thinking surgery on her back may help. She would have any surgery at University of California Medical School and Hospital at San Diego, a teaching hospital. Like most big medical institutions in the "first" world, UCSD has an MRI machine. If most people, covered under private insurance can have a MRI for relatively minor bone diagnosis, why can't one of the best public teaching hospitals in the West make a time available?
She explains her life is now conducted on the telephone, trying to get some Medi-Cal action on her medical crisis. Why is Medi-Cal acting like Patricia Sweet's case is a case of sprained toe when in fact it could be life threatening? The looming budget cuts? Perhaps Medi-Cal rather have two more patients in the nursing home care system then help her (and indirectly her mother) now. The fact of the case is that once a person is eligible for medical care under these public health insurance programs, they are entitled by federal and state law to fair and equal access to medical treatment. (Maybe Governor Gray Davis will donate a tiny bit of the $12 million dollars spent to date on his campaign for re-election for medical crisis patients like Patricia Sweets.) The Medi-Cal budget cuts are not Patricia Sweet's personal responsibility. She should not be forced to pay with any well-being that she still has. What a waste for Patricia, her family and friends, and the world. Her's is a vibrant and creative spirit which never gives up. Her motto is, "My attitude is gratitude." Her philosophy about life may not extend to Medi-Cal right now.
Medi-Cal and the UCSD Hospital both receive major federal grants. The seeming violations of state and federal laws may be spread over a wide section of the Medi-Cal population. How many Patricia Sweets are there? Patricia stands at the tip of the Medi-Cal iceberg. She is educated, Caucasian and poor. She has friends who are lawyers and e-publishers. How would she fare if she was even more "invisible" as poor people often are? Who are their advocates? Is this what we want happening in the so-called safety net of publicly financed health insurance? How can we let the people who depend on Medicaid down so hard?
Sorry. We have got an endless war to wage so we can save lives.
Afterward: Sudden Progress!
As I wrote this article on June 12, 2002 , Patricia was on the phone again, as usual, three times a day for over the last two months. She told the Medi-Cal contact person, "I am at the end of my rope with this situation. I have been in agony for over two months. I am getting outside help." Within twenty-four hours, in the late afternoon of June 13, Patricia had an appointment for the MRI. Why the Medi-Cal office stopped stone-walling may be another article but medical testing and treatment is scheduled. At last! --MGH
Links of interest:
HealthLaw
Medi-Cal
Health Care for All - California
Universal Health Care Action Network
Lupus Foundation of America