On Monday, the day after passage of the new health reform law, I received a visit from a friend (call him Vic) who’s perpetually broke. He and his wife (Tina) lived with us at one point when their only other alternative was the street. Now they pay $39 a day to stay at a seedy hotel near the Interstate.
They were supposed to have moved on by now, to have a place of their own. Months ago, a man set aside $1,000 for Vic and Tina to pay a deposit and first month’s rent on an apartment or rental. But Vic and Tina haven’t found a place they can afford, at least not one that Tina is willing to move in to. Vic won’t even look in Birmingham, where rents are lower, because they want to be in a good school district. Their 11-year-old daughter lives with Tina’s parents, and they want her back.
It hasn’t occurred to them to get a cheap apartment for the short term in order to save money. Saving is not a realistic prospect to them. In their entire adult life — Vic is 48 — they have only experienced two conditions: not having enough, and having just enough.
The daily round
Neither of them has a job now, so most of their work hours are spent in the daily round of begging at churches, charities, and the doors of people like me. If they manage to come up with five days’ rent at once ($259), they can stay free through the weekend; otherwise they are on the hook for $72 more to avoid being locked out on Saturday and Sunday. In a typical month, they pay between $1036 and $1170 just to keep their place in that hotel.
I knew the gift of $1,000 had been set aside for them months ago, so I was surprised that Vic had not found a place yet. I asked him what the hold-up was. He said the newspaper ads were not much help, and he didn’t have much time to look while driving around begging for rent and gas money. Still, he did look at a few places: This week he went out to Morris, a small town about fifteen miles north of downtown Birmingham, and there he spotted — well, a single trailer that was empty. It wasn’t advertised as being for rent, but he figured that it was likely to be. No, he didn’t find out anything specific about it. But he counted this fruitless discovery as a success.
If Vic seems to be living in a dream world and reasoning like a child, there’s an explanation for that. About eight years ago he was working a low-wage job as a security guard, for the kind of company where you have to pay for your own equipment and don’t come out ahead on wages for a week or two. He had a toothache that he tried not to worry about: Neither the dental bill nor the time off work, with a risk of dismissal, were things he could afford. So he took pain relievers and waited for the toothache to go away.1
Long story short, the untreated toothache spawned an infection that made a life-threatening abscess in Vic’s brain. At this point, the health care system intervened to save him. With dazzling skill and at enormous cost, doctors and surgeons worked miracles to keep him alive. Then they grappled with the complications: epileptic seizures, sinus problems, sleep apnea, anxiety.
Vic’s damaged brain hasn’t made him dangerous or obviously abnormal. It does seem to have affected his ability to concentrate, or to reason with anything more than childish insight. The seizures terrified him, and he often dreamed about his own death. Vic slept with a mask on his face connected to a BiPAP machine. Your tax dollars and mine are still paying for his care.
Meantime, Vic’s working-poor diet of fast food, dry breakfast cereal, and 32-ounce soft drinks came back to bite him. In his mid-40s, unable to work, and spending most of his time sitting — in waiting rooms, in the driver’s seat, on the sofa — Vic came down with diabetes. Here, too, the public is paying for his treatment. (One of those law firms specializing in winning SSI benefits convinced Vic to hire them, and took a cut of the government checks.)
From what he’s told me, Vic costs the government at least $600 a month just in direct payments to health-care providers. That’s during the good times; whenever he has a crisis, this cost balloons. All this because he couldn’t afford to see a dentist about his toothache.2
The private sector at work
Not that Vic is a fan of health reform. He listens to Christian radio, and he and Tina accept that the Obama administration is an enemy of everything that makes our nation great and our people free. Since his brain injury, Vic has become more loquacious; he does at least nine-tenths of the talking in any conversation with me. So of course he raised the subject of the health care bill, then dropped it again after I compared the Republican reaction to the reactions against Social Security, Medicare, and Medicaid. Since the brain abscess, Vic has seemed more obtuse about other people’s feelings and perspectives. He has more trouble escaping the vortex of his own ego, and his manners have suffered. But he understood enough to know he was a supplicant, who probably couldn’t afford to argue with the guy he hoped would give him money. So we didn’t debate health reform.
Vic pretended he hadn’t really come to ask for help. But the fact is, I only see him when he needs money and doesn’t know how else to get it. Our visits always end with a transfer of funds from me to him: an example of that private charity that some conservatives insist is all we really need to do to address social problems. They’re not entirely wrong, of course: Private charity is essential, and as a people, we don’t do enough of it. I’ve tried to make it a discipline to always give something to people who ask for help, even the ones with unlikely stories. It’s not my place to search their faces and decide who is a lying dope fiend and who is really trying to get home to the kids. I may only give pocket change, and sometimes, just because of my mood, I don’t give anything at all. I think this is a failing in someone who has received as much as I have.3
But private charity is inefficient. Often it simply amounts to an indirect transfer of wealth from people who help the poor to people who exploit the poor. This is what happened when I withdrew cash yesterday for Vic, who handed it over to the hotel manager. The hotel’s success, at least under its current business plan, depends on the continued failure of people like Vic and Tina — on their never making a better housing deal, no matter how much help they get. Like any unregulated market, the housing market in Birmingham only obeys the law of the jungle. People like Vic and Tina, weakened by sickness and misfortune, can only survive as long as the herd consents to protect them from the hyenas.4 So yesterday I let a hyena take a nip out of my hide instead.
So it passed, now what?
The health care reform bill is easy to hate. As with the credit card bill that finally took effect in February, the delay between enactment and implementation is going to give insurance companies the freedom to act like plundering barbarians for anywhere from half a year to six years before the feds finally rein them in — all because our Congress was so alive to the tender sensibilities of industry lobbyists and the Dow Jones index. All we get this year is some limited assurance that people who have insurance will actually be covered instead of dumped. Parents who have family insurance plans can keep their children on that plan until they’re 26 years old. Not all parents will welcome this change.
Insurers can still use the “pre-existing condition” dodge until 2014. They have until autumn 2010 to stop using it on children. Until then, expect the hyenas to tear the throats out of as many fawns as they can catch.
The “doughnut hole” in Medicare Part D, which forces elderly patients to start paying for their prescriptions in full, will be closed “gradually,” in case it might inconvenience the drug companies. In the meantime, my mother and her rheumatologist are scrounging to fill her asthma prescription with free samples, after another doctor prescribed a drug that cost $600 for a single month’s supply. Neither the doctor nor my mother were aware of the cost until it was too late, after the drug company had already been paid for its deception. This never-ending battle between insurers and drug makers, which mainly harms patients, is a problem that has yet to be addressed by reformers. “When elephants fight,” the proverb says, “the grass gets trampled.” Who besides the federal government can tame the elephants?
Dealing with hyenas
The crippling rise in health care costs will not be reversed by this law. All that anyone expects is that the rate of increase will be moderated, and the stage will be set for more rational reforms that actually make the whole system more efficient and effective. Insurers, drug companies, and other vested interests will continue to fight dirty to prevent this. After all, as long as costs go up, they stand to make a killing off the rest of us, like hyenas feasting on baby gazelles.
In the short run, there is nothing to prevent insurance companies from jacking up their rates. It’s little comfort to point out that they would have jacked up their rates whether health reform had passed or not. From this moment, Vic and Tina, along with millions of their countrymen, are likely to blame any bad news about insurance on “ObamaCare.”
For all its shortcomings, this law is a victory over some of the hyenas in our economy, those who live exclusively by tearing flesh from the weak and helpless. But the nature of our republic is such that, in order to pass a law that reins in some hyenas, we had to make concessions to other hyenas so they would allow it to pass.
Many of those who receive the most benefit from the law will never acknowledge it, or even realize it. And no law will change our bad habits as consumers. By 2015 there might be less reason for someone like Vic to put off a trip to the dentist to see about his toothache. [See comments.] But even if we enact genuine universal health-care coverage, that doesn’t guarantee that the next Vic won’t put off treatment anyway, like his momma and daddy did, until the public has to intervene with heroic measures to save his life.
That’s no excuse to oppose reform — and by that I mean further reform. It’s going to take more than one act of Congress, and a lot of actions outside of government, to get health care where it should be.
[P.S. Corrected bill signing date and age cutoff (26).]
1 At the time, Vic and Tina still had their daughter and were living in a rented trailer in the woods between Gardendale and Mount Olive. The septic tank didn’t work properly, and sewage regularly backed up out of both the toilet and the bathtub drain. But Vic and Tina were flexible: They had taken to bailing the evil-smelling sludge into the backyard and forbidding their daughter from playing there. I was an eyewitness. At the time, Alabama state law provided no recourse to tenants who were living in an unhealthy dwelling, so Vic and Tina were still subject to the terms of their lease: No matter how nasty the place was, they had to either pay the rent or break the law. Vic and Tina only got out of their lease after the Health Department condemned their home. On that day they were tossed out on the street without compensation or assistance, as if they were at fault for renting the place. Their landlord, James Shoemaker, only suffered the loss of income he’d been getting from renting out that death-trap of a trailer.
In 2006 the state finally enacted the landlord-tenant law that Alabama Arise had been advocating for more than a decade (over the strenuous objections of the Realtors Association, acting as the slumlord lobby). So at least abuses like this are no longer legal in Alabama. That doesn’t mean they don’t happen, especially in the poorest counties. ↩
2 Alabama has an exemplary children’s health insurance program, but Medicaid provides absolutely no help to poor adults. Unless you are very young or very old, you can’t be poor enough to qualify for Medicaid in Alabama. The new federal health care reform act will change that, but not for another four to six years. ↩
3 I do refuse to give to this one guy who hangs out near Southside bars and admits that he plans to spend the money on alcohol. At least he’s honest, and yes, I admit that I’d be more likely to give him a few dollars if he were less honest and told me a lie. But the decisions about whether to beg, and what to say, are his, not mine. Leaving it with him, instead of second-guessing him, is a way of allowing him dignity. He doesn’t have to earn that dignity from me. He deserves it just because he’s human. ↩
4 At this point, libertarians would argue that the herd would be better off, in economic terms, if each member of the herd acted in its own best interest. Unable to sponge off the charity of fellow hoofstock, Vic and Tina would either learn to fend for themselves and become productive, or they would become hyena food. At least their ruin would enhance someone else’s profits. If hyenas had economists, I’m sure they’d try to make this same argument to the gazelles. ↩