Paul Krugman is one of my favorite columnists. I think I had withdrawls when the NYTimes.com ferreted away Krugman and the other columnists worth reading behind their 'Times Select' pay-per-view gatehouse.
That's why it makes me almost cry to have to take him to task for his repetitious use of the following line,
"Mr. Obama claims that people will buy insurance if it becomes affordable. Unfortunately, the evidence says otherwise.
After all, we already have programs that make health insurance free or very cheap to many low-income Americans, without requiring that they sign up. And many of those eligible fail, for whatever reason, to enroll."
Apparently, Mr. Krugman didn't take the time to see just how far off the mark he is. I challenge you, Mr. Krugman, to go down to your local county Health and Human Services office and apply for benefits yourself, just to see what a convoluted route it is to 'enroll' in a low-income Healthcare Insurance program.
Here is the problem.
For those in the lowest income brackets, Medicaid is the last line of defense. It is a comprehensive medical insurance program, covering everything from primary care to prescription drugs, to imaging procedures such as MRI and CT scans.
Yes, it is a great program for those that qualify. The problem is multi-fold in nature.
First, you must qualify, there is a matrix and your income and assets place you in a bracket and that determines your elegibility for Medicaid in your particular state. If you make $1.00 over the limit to qualify, sucks to be you. There is no '2nd opinon' or any other kind of way to work with the state. Either you qualify, or you don't. It doesn't matter how much over the limit you make, one dollar is enough to disqualify you.
How does one proceed through this process? One completes an application, either on paper or, in our state of Washington, right on the internet.
How easy is it? Pretty easy, if you know just exactly how much income you've had for the past three months, and if you know exactly how much income you'll have for the next three months. It's that second part that can be tricky, especially if you work just under full-time, and have variable hours.
The next difficulty comes in processing. You complete and submit your application for assistance. You have to wait for a letter to come to your home, with a date and location for your in-person interview.
If you are late (meaning if you get tired of sitting in line for hours with no idea whatsoever if you'll be called in the next five minutes or in five more hours), they cancel your appointment, and you have to hope that the reason for missing the scheduled appointment is on their list, or your have to start all over and resubmit another application.
Finally, you get your appointment. If you failed to bring a single item to the appointment (including all the stuff they failed to list on the letter you got) you have to re-schedule to come back after you submit all requested information.
If your former employer (if you had a former employer) fails to produce any information requested by you (like a signed statement about your past three months income): again, you get re-scheduled. They don't notify you that you should just stay home, you have to come even if the requested information doesn't arrive, just so that they can tell you that you have to come back.
So, after 30 to 45 days, you finally get notified that you are now eligible for Medicaid, and your first Medicaid medical coupon arrives in the mail.
In SW Washington, there are only a couple of programs in the Medicaid basket - CNP (referred to commonly in the medical field as an 'open' coupon, with no designated provider) or CUP (Columbia United Providers). Providers may be contracted with the state of Washington for one or both programs.
Try and find a primary care doctor with the 'open' program coupon. Our clinic is currently scheduled out to the end of June 2008 for new patient appointments. If you call my clinic on Monday, February 4th, the earliest date I could schedule you for is Wednesday, June 11th.
That's five months away.
There is only one other clinic in our county where new Medicaid patients with 'open' coupons can be seen. Imagine how many people I turn away each month? Imagine how many people die waiting for these appointments? In the past six months at least three patient passed away before their scheduled appointment arrived.
Every three months, you have to be re-qualified for your coverage. So it's back on the merry-go-round to hell.
If your financial circumstances change (if you get any income not projected on your calculated income for the next three months) you must notify the Department of Social and Health Services (DSHS) within 10 days - or face termination of your benefits or being denied future benefits.
Imagine how stressful it would to be, to be terrified that every three months something will change just a little bit for the better for you and your family.
The cost might be the healthcare insurance, without which your family cannot afford heathcare. Many primary care offices will not accept patients without insurance. A single out-of-pocket visit to a hospital ER, without any admittance, is generally over $600. That's without any test or medications.
My personal income for a mostly full-time,front-desk position is just under $13,000. For the entire year.
My IT-IS sister who is both an analyst and project manager just demanded a $17K a year raise, and she is outraged that she has to ask for it. She's out the door with another offer already waiting if they don't come up with the scratch.
She doesn't understand when I don't have the patience to listen to her whinging about her job to me on the few occasions when we get together these days. She wants a raise that is more than my entire year's salary. I just don't have any pity for her.
I know that I should apply for Medicaid, I know what the income guidelines are, I know that I'll qualify. But my boss, the Doc, treats me for everyday needs, like regular tests to check my type II diabetes compliance. He even covers the cost of the tests. My Rx is for Metformin, and Costco sells this drug (and about 100 other commonly prescribed medications) for under $10 for a month's supply of medicine.
I can manage the cost of my regular, preventative medical care. I have access to a doctor.
If I didn't, I would apply, even though in past years, I didn't do so.
If you've never had to do so, you cannot understand the invasion of every aspect of your life by the government.
Should they be able to have some say if the public dime is paying for my healthcare, of course they should. But does the process have to seem so despicable? Why can't I simply submit my faceless facts by computer? Why can't copies of my paycheck stubs on an ongoing basis be all the proof of my income required to keep my eligibility in the program active?
Why do I have to ask my employer for an entire day off to go to an appointment every three months to continue to receive these benefits? What if my employer doesn't care and won't give me the time off to attend these appointments required by the state?
Sucks to be me. I've been there before. I'm sure that I'll be there again, unless at some point I'm able to complete my college degree started in the early 1980's. Even if I do complete that degree, I'm already 46 (when did THAT happen?), and am uncertain that a college degree of any kind would be beneficial to me at this point in my life, combined with my work history.
So, when Mr Krugman chides Mr Obamo for thinking that those who are eligible currently don't do what they should NOW to get on a subsidized medical insurance program, consider just what it is he is asking of them (of me) before you agree with him.
Contrary to the fears of most conservatives, and many middle-class democrats, those of us stuck at the bottom of the ladder aren't to lazy to climb up, sometimes there just aren't enough hours in the day to both work our jobs and keep the required appointments for public benefits or there are just too many damn rungs on the fracking ladder to get to the top of it.
With a single-payer system, our country's businesses would achieve parity with other nations, who give businesses relief by providing healthcare to all citizens directly.
The cost of administering complex, error-racked private insurance plans would be replaced with low-cost, simplified administrative costs (Medicare costs about 3% for administration), transferring those administrative dollars to treatment dollars, increasing the number of patients seen for the same number of dollars.
Preventative healthcare, which in turn improves productivitiy rates, would be practiced by a majority of Americans, with ease of access to a primary care provider, much like the populations of European nations of France, Britan and Germany.
Both businesses and the general public are 'profited' by a single-payer universal healthcare system.
Why should European citizens get the benefits of such a program while Americans are left to fend for themselves in an increasingly adversarial for-profit private healthcare insurance system that leaves almost 1 out of five Americans with no health care whatsoever?
It's time for a change.
Vote Obama.
