Tough decisions are ahead for our health

by Marty Wiseman

Published: July 29,2012

Tags: Affordable Care Act, health care, Medicaid expansion, Obamacare

Wiseman

Recent focus on the Affordable Care Act, or Obamacare as many have come to call it, has mainly been on the expanded Medicaid provisions, especially the requirement that individual states create insurance exchanges as means of making insurance markets more readily available to consumers. There are some tough decisions ahead.

Data from a number of recent news stories indicate that as much as a third of the population of Mississippi would be eligible for expanded Medicaid. A person becomes eligible, by the way, by being poor enough to qualify. It seems like some more of our state’s chickens are limping home to roost. The usual take on this dilemma is that charity of this sort is an individual matter; there is no role for government in addressing the misfortunes of other individuals. The old saying “Out of sight is out of mind” is applicable here.

Sadly, recent personal experience has demonstrated the fallacy of such a hands-off approach. No one invites life-destroying misfortune simply in order to be able to inconvenience the tax-paying public.

I’ll call her Janie to protect her identity. Janie is a single mother of a Down syndrome child who is now in his early 20’s. As is the case with all Down syndrome people that I have ever met, Tony is one of the most lovable and engaging human beings you would ever encounter, and there is a lot of him too in that he weighs around 300 pounds.

Janie has always worked hard to provide for Tony and herself. She had a good, though not high-paying, job as a teacher’s aid and director of in-school suspension at a middle school. During her time there her mortgage was paid on time as was her car payment. Janie was not getting rich, but on balance life was good. Nevertheless, Janie thought she could do better.

She was admitted to cosmetology school, with the goal of going into business for herself. This meant Janie would have to leave the security of her job at the school for the better part of a year in order to make the leap to being an entrepreneur. She made the mistake of not continuing her group health insurance.

A few months into her cosmetology course, Janie collapsed during a training session. The diagnosis was a brain tumor. Doctors were able to remove the benign tumor. Although things seemed on the upswing, the question arose as to what happens to a mother and a special needs child when they are totally alone in the world? There is no margin for time off.

A year or so later, problems returned for Janie. Tests revealed a new tumor, and this time it was malignant. Once again doctors were able to remove the tumor, but they indicated a recurrence was highly probable. Medical bills, time off from employment earnings and continued expenses associated with caring for the health problems of a child with Down syndrome took their toll. Janie filed for bankruptcy and lost her home.

Janie and Tony moved to a rent-subsidized apartment in a federal housing project. Janie was never free of pain or seizures following her second surgery. Several months ago Janie’s symptoms returned with a vengeance. It was discovered that she now had three inoperable brain tumors. Months of chemotherapy were unsuccessful; hospice care was called for.

Before decisions could be thought through, Janie did not respond to the knock of a volunteer on the door. Janie was found comatose in the floor with Tony sitting beside her crying. Janie was revived in the hospital, but it was determined that she would not be going home again. Tony, the 23-year old Down syndrome son, is soon to be alone in the world.

Fortunately, a place was found for Tony in a group home operated by the state mental health agency. Janie has been placed in the nursing home wing of a hospital, but the bureaucratic labyrinth to be negotiated to keep her there is daunting.

The lessons learned are too numerous to delineate here. I will highlight only a few. First, inoperable brain cancer and a host of other dreaded diseases and conditions cannot simply be treated in a trip or multiple trips to the emergency room. Secondly, every situation is different. Stereotyping everyone who has no option but to depend on an entity beyond themselves as a freeloader or worse is cruel and inhumane. Thirdly, many problems this day and time are too big and too expensive to be left totally to individuals, churches and charities.

If, indeed, upwards of a million Mississippians wind up in the Medicaid boat there are simply insufficient resources outside of government to address these needs. In this part of the country we proudly proclaim that we are a Christian nation. All too often it seems that we begin modifying that proclamation through theological sleight of hand when we are faced with an inconvenient price tag for caring for the “least of these.” It seems that we think we can explain away any role for government when confronted with the magnitude of the task in today’s dollars.

Mississippi does, indeed, have some difficult decisions ahead.

 

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