This part is all background, but you need to know it.
I went to nursing school at the University of Wisconsin-Milwaukee in the late 60s/early70s. During my last year, I took the required Public Health Nursing rotation in my last semester. The instructor wasn't so great, but my mentor, a Public Health Nurse in Milwaukee, was amazing. She talked to be about what public health nursing really was through the eyes of the community, particularly those in poverty, to give me an insight that the university never would.
She talked to me one day about the difficulty those in poverty have in accessing health care. At that time public hospitals and health care facilities were available in nearly all metropolitan areas and provided care to those with no insurance coverage. Getting to them, however, wasn't easy.
In Harlem (New York) the public hospital was a ten dollar cab ride away in those days. Ten dollars was a lot of money in the late 60s (minimum wage was $1.65 per hour and a decent new car cost under $3,000). If someone needed to see a doctor, they had to give up a huge amount of money for food, rent, or other necessities to access that care, so those decisions were always serious. In the community, the phrase Ten Dollars Sick, described how sick you had to be to go to the doctor (that meant you had to be incredibly sick).
She then reminded me how far away Milwaukee County General Hospital was for our own inner city residents (it was located in a Milwaukee suburb) and how those decisions are being made here and how difficult those were. People couldn't just get in their car (no car) and visit the doctor. A bus ride took an hour or more with the need to transfer bus lines more than once to get there.
That story has stuck in my mind throughout the years. When I found myself leaving the private sector after a few years, frustrated with the first procedure being a "wallet biopsy" (checking to see if a patient had insurance or the funds for their care), I left to work for Milwaukee County and saw finally for myself abd was grateful to finally have the opportunity to care for people without turning anyone away. We had a community clinic located downtown to make it easier for people to get urgent care and basic services, but anything else was only available at the main hospital. I worked at that downtown clinic when I began my career in public service.
I saw the faces of patients fall when I told them that they needed to see a specialist or have a test done at the main hospital. I knew how hard it would be for them to get there, even if I provided a bus ticket for their ride there and another for their ride home. But, they did have access to care back then. Hard to get there, but available, and the community clinics were still there for the basics.
Not for long, though.
I saw the pullback of services first from the community clinics as, first one, then all of the community health centers were closed for budgetary reasons. I fought along side of my union, our patients, and the Medical Director (an astoundingly great doctor) but to no avail. We called, wrote, and visited the County Board. We appeared at the budget hearings. So fierce was this fight that the Medical Director was fired (they couldn't touch the rest of us because we were Civil Service employees and they had not justifiable reason). We lost. Actually, our patients lost. They now had to travel all the way to the main hospital and clinics, endure long waits as that facility cared for not only their customary patients, but those who normally went to the community clinics. They were patient, kind, understanding just happy to get care without the hassle.
And then, in a little more than a decade the hospital and clinics closed leaving patients to beg care from local facilities. The low tax crowd won.
It was the start of something that was happening all over the country. I was one of the "lucky" nurses - enough seniority that I could transfer to another nursing position in the County. The bad news? I worked the last 7 1/2 years in a 2000 bed county prison, not the greatest job I ever had, but at least I could continue adding to my credited years of service towards retirement. Many weren't lucky, getting no job at all or getting only part time positions. And patients were totally screwed, even with the travel difficulties, the county hospital did give them care, tests, prescriptions, etc.
Public hospitals have closed all over the country. A terrible decision made to placate the low taxes crowd who didn't want to pay for services for "other" people.
The blowback of that, of course, is the requirement to provide emergency care to everyone. Following the closure of public hospitals, ER use has exploded accompanied by enormous wait times. And private facilities don't "eat" the cost of unreimbursed care. They shift it onto the bills of everyone else in the form of higher rates for services and care. Health insurance companies don't "eat" those higher costs either. They just raise and raise their rates, deny coverage, deny care, waste provider time in begging for approvals from minimum wage bean counters whose job is to avoid spending every penny if a palatable (or selllable) excuse can be found. After all, they have multimillionaire CEOs and executives that need huge salaries and bonuses.
Costs keep going up further as hospitals and health care services need to employ their own armies of staff to jump through all the insurance company hoops in order to get reimbursement. It's gotten so bad that the number of people in the billing department can equal the number of nurses actually providing care.
As the cost of insurance has gone up and up, many employers are converting their plans to high deductible/high out of pocket (junk) insurnace plans with huge employee costs for insurance or dropping benefits packages altogether. The number of people with no insurance is growing and growing and the "uncompensated care" is also growing. It's an endless loop.
And just imagine, it started with the short sighted decisions to close public hospitals. And it has continued with the escalating greed of the health care, parmaceutica and health insurance industries who sometimes just raise their costs not just in response to increased costs, but because they can or want to.
I see no end in sight.
I've thought a lot more about this over the weekend as I've been fighting the flu from Wednesday which has triggered my allergic asthma to become monstrous. I know my own insurance changed on the 1st of this year to what is basically a high co-pay, high deductible plan thanks to Scott Walker who eliminated back huge amounts of state funds to counties and municipalities and prohibited raising taxes to mitigate the extreme losses.
So severe were the cuts that even retirees were affected even though our benefits are supposed to be locked in. Milwaukee County unions have given up plenty over the decades to protect retirement benefits (when I retired my salary was about $5 per hour less than a similar private sector position). One of the biggest (health insurance) was eliminated in 1992 for any new hires. On reaching age 65, it turns in to an extender plan to supplement Medicare. Well, it's junk now, too.
So, when I got sick, I went to get a 3 of my asthma meds refilled. Total cost for 2 inhalers $60. The third one, Allegra, is over the counter now, so I can't get it from the pharmacy anymore. Total cost over $1 per tablet! At twice per day, it's over $70 per month.
Nothing was working and over the weekend things got much worse. I realized I was Ten Dollars Sick and called this morning to get an appointment. Cost $30 up front co-pay plus all costs up to $500 for which I will be billed.
He was very concerned (so concerned I didn't get the smoking lecture) and wrote an addiitonal prescription. I can't take oral steroids (for some reason they make people in my family worse when we use them - go figure) to calm what has become a virus complicated with status asthmaticus (an asthma attack that won't resolve).
End of background stuff.
This is what I came to talk about:
I Am Not Alone
The rollbacks and peel aways that affected the poor in the 80s and 90s to remove our once vibrant, but never generous social safety net have marched on upwards in the monetary food chain. We're all targets now. The folks who never fought for public hospitals, or health care as a right, or financial industry rules, or our social safety net are now becoming victims themselves. Not a surprise to anyone with their eyes open for a few decades.
The poor have been squeezed to a dry husk, so onwards to taking from the middle class. The monied interests have gone after wages, benefits, pensions, health insurance, and anyplace else there might be a nickel to steal. And when people won't work for 50 cents an hour, just move those jobs to a country with virtually slave labor. You can always bring your crap back in to the good old USA, sell it at the regular price and pocket the savings. And taxes, our individual obligation to maintain a civilized society, has become a dirty word. Even Democrats fear raising taxes now. And look what's become of our country as a result. Ditto regulations. No rules for the big shots. They own our government now.
The tax avoiders who don't want an extra nickel on their property tax bill to support public hospitals are now paying thousands extra for medical cost shifting and the massive costs of illnesses untreated until they're life threatening. Of course, much of that added cost goes to extraordinary profits of the health care, pharmaceutical, and health insurance industries that could have been kept in check by governmental action, but, hey, Get Your Government Hands Out of My Medicare! Regulations are bad. Right?
As the forward march of profits over people continues on in a no holds barred fight to the finish we need to realize we're all in the same boat. It's sinking and we're miles from shore. We need to bail out the boat and row as fast as we can to land.
Cuts to the poor, vulnerable, disabled, etc. blow back on us. Failure to maintain and improve our infrastructure has consequences. We've done a crappy job on education because the anti-tax folks are well funded, powerful, and always take the first 82 places in line to see government officials.
I can always tell a Republican by their consistent refusal to recognize a problem until they or a member of their family is personall affected. Those that scream the loudest over the need for cuts to Medicaid change their tune in a hurry when it's their Mom or Grandma in the nursing home who will get their cut. The anti-tax crowd doesn't want to pay taxes until it's their road in front of their house that's riddled with unrepaired potholes. Walkers $1.8 billion education cuts in Wisconsin are just fine and "necessary" until they realize it's their kids who are being jammed into a classroom with 40 or more other kids and there's no more art, music or sports because the school can't afford it anymore.
The wolf has to be at their door before they adknowledge that wolves even exist. And then they wonder why nobody has done anything about the wolves.
We need to spread the word: harm to one is harm to all. No one is immune. The monied interests will be going after the suburban McMansion dwellers after the rest of the middle class has been squeezed dry. They won't stop until they have it all and then they'll fight among themselves (we'd eat popcorn and enjoy the show, but we won't be able to afford it by then).
And Democrats! Psssst! Populism is popular. You just need a backbone to stand up and fight for it. It shouldn't be hard at all. Our social safety net is popular! Check the polling on Social Security, Medicare and Medicaid. Don't talk about cuts. Don't go along with the pretense that you're "reforming" or "strenghtening" those programs either. We know that those are code words for severe cuts. Show people that there really is a major difference between Democrats and Republicans.
Forget about being "bipartisan". To Republicans, that word means "we get what we want and the other side gives it to us because we're tough". Remember that FDR was unbeatable for 4 terms because he stood up for people. Now is the time for you to stand up for what's really important (and that's not campaign payola either).
It should be easy to point out the differences between parties. Even the most RW Blue Dog should be on the right side of these issues. And the people will help you. After all, these things are popular. And desperately needed.
Update: My apologies that this is so long, but I wanted to take you on a journey so you could see how we got here from there. I also didn't write this to whine. I'm doing incredibly better than folks with no insurance. And definitely better than those unable to find work. I just want everyone to do better.