I just spent the last week engaged in an apt, object experiment in budget reduction and austerity measures and before I begin? Let me state unequivocally that this post is not about me — I’m FINE, in relative terms — my concern lies with those much more vulnerable than myself, who will soon experience an even worse set of prospects than they do presently.
Nor is it about whatever measures might be taken to reduce federal spending or reform entitlement spending. What happened in my instance is the product of a policy already in place. In short, apparently after I began receiving Social Security, I became subject to a consideration called ‘spend down’. I’m still not 100% what it means or where it came from, but the material impact is thus: for every $874 I receive in benefits, I am expected to cover $180 in medical costs, to a total of $1080 over a six month period.
I’m extremely fortunate in that my living costs, beyond a combined $353 for insurance and rent, are groceries. But in practical terms? The $539 would not cover the cost of my medications for a single month, and I’m regrettably at the stage where none of them are negotiable. I have problems enough in that I am only allowed exactly the quantity required for a single month — there’s never anything extra. And I’m careful to discontinue what doesn’t work, etc. — but take me off of one or two of them for a few days? I can’t function, period.
So presented this consideration in the middle of last month without either the funds to manage it nor sufficient time to meet the requirement, my medicaid benefit was cut. Three of my prescriptions remained unfilled (and unaffordable) at the beginning of the month, and even my trick of bumping up my prednisone does by 10mg here and there wasn’t cutting it; I’d take two or three steps and have to rest for five before I could take another. I finally went back in to the ER a couple of days back, which proved to be fairly routine, all things considered.
So, if you’re already seeing an anecdote in all this about “cost shifting”, give yourself a pat on the back and a gold star. But then figure we’re talking about a hospital bill that will hit the double digits to meet a $1080 obligation that I have no hope of paying (I couldn’t even put a dollar figure on what this has cost so far). So, in effect, this accomplishes nothing more than to allow medicaid to tweak it’s balance sheet a little, without actually reducing the cost of anything.
Come Monday, I’ll roll to the hospital, collect my unpaid bill, drag that down to DSHS and get my medicaid benefits reinstated. In the interim, I came away from my stay with better pain management options and a plan for coping with some of the insomnia I’ve experienced recently, although I won’t really count that as a benefit because it’s something I should have pursued much earlier.
Thing is, I relate this sort of thing to some of the self-styled ‘fiscal conservatives’ and I keep getting back “Oh, but I don’t mean people like you.” — especially when the individual in question knows I spent the better part of my life caring for people with brain cancer or leukemia or severe disability (which doesn’t pay enough to live on, really, much less provide an option for health care).
But the practical realization of these kinds of policies wind up being people like me who wind up with untreatable, fatal health problems that, had they been resolved properly and at an earlier stage, would have been cheaper and resulted in better overall health for the person concerned.
It can’t be considered a principled position; it neither accomplishes it’s stated objective nor would it’s consequence be regarded with less than horror by anyone who was not completely insulated from the harm that results. But let’s not be coy; the motive isn’t principle or even ideology, it’s punitive.
It’s that old-timey, pre-renaissance/reformation urge to get one’s holy smite on and solve the fear and uncertainty by making someone pay. And it’s becoming as virulent and pronounced as it is because, well? It’s dying, and has been with each successive generation for some time. When we reject this kind of authoritarian submission as a social/ethical framework, it isn’t just that it results in an ideological clash with those unable to adapt to the change, it’s that it hits these populations as a rejection of themselves.
And there’s still a few decades left in this. I have to smile a little every time I hear someone under 80 lament the passing of “the good old days” because even my grandparents could scarcely identify what portion of US history actually numbered them. But the real problem is just that there’s not much one can do about it except to avoid empowering it, something we’re still notoriously poor at avoiding.
The only thing worse is to avoid paying any attention at all; it isn’t possible to justify apathy. There’s very little in the world that isn’t reasonably simple to research and be informed about — there is a direct correlation between information consumption and public policy and specific consequences when they run afoul with one another.
The moral? Think your own positions through clearly, and don’t worry about people who won’t do so. You can’t help them but you can hurt them if they’re allowed to subvert public policy, as well as yourself and everyone else. It doesn’t matter if anyone judges on outcome or not; reality will do that, itself.