Used up

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.

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  • Comments (10)
    • nusz
    • April 10th, 2011

    but enough about you! 😉

    if i have anything resembling a life goal (which i don’t, not in the sense that i noticeably pursue anything with consistent focus), it’s to be able to ‘let down gently’ the vast majority of my acquaintances who seem to utterly buy the notion that “having democracy” . i could start just by carrying around & broadcasting Carlin bits about the nonexistence of “rights” (“what you have are a set of temporary privileges… ‘rights’ are just an idea – cute idea, but that’s all they are…”) but that’s already old news to me and would of course rapidly become so to others.

    okay, the real pipe-dream life-goal is to impose a powerful aura of critical thinking on my environment. pathetically, i’m still getting over the smug-egghead-elitist-knowing-wink-shrug-headshake-lingering-frustration in reaction to the world’s ‘overwhelming’ ruthlessnesses, ignorances and oblivions. plus i couldn’t even begin to explain logical argumentation if my life depended on it. sentence structure i’m okay with – what i need is yet another intensive course in rhetoric, if only to be able to call others on their derailz.

      • Max Bell
      • April 11th, 2011

      This deserves a blog post of it’s own and a better one than I’m probably capable of, but I’ll take a crack at it, presently.

        • nusz
        • April 11th, 2011

        pshaw! you call up the specter almost every time you open your fingers! perpetual kudos for ever even bothering to express just how wildly frustrating “humanity” can be.

    • Laroquod
    • April 10th, 2011

    Horror is absolutely the right word for this situation. Your optimism about our ability to overcome the darker forces that have personally pushed you and so many others into a health corner, is highly commendable.

      • Max Bell
      • April 11th, 2011

      Individually? No. This is about the species. But I look at what’s going on in Yemen and Bahrain and Libya and Egypt and so on… I mean, these guys have no alternative but to fight. They can simply give up and wait to be slaughtered, but those are the options. And it’s not about the elimination of corruption or the ineffectiveness of brutal repression, it’s just that when a culture achieves a certain, critical mass, any pretext of legitimacy among the powers that be is lost.

      The way some of these pricks lie put people like Michele Bachmann to shame.

      But it’s not about ticking a box on a piece of paper and voting for the lesser of two evils, it’s about being so hip that you can’t be lied to — and being supported by a substantive enough population possessed of a similar level of awareness.

      I mean, seriously, if your conception of the future is a booted foot stamping on a human face forever, your next step is to eat a shotgun. You don’t really believe that, or you’d have done it already. So the next step is to figure out what your principles really are and live up to them.

      It feels pretty good to give into despair when things are tough, but it actually goes back to Tigh’s metaphor about alcoholism and depression. Sooner or later, you just pick up and get out of that room.

        • nusz
        • April 11th, 2011

        i just had a mini-epiphany along these lines after amending a profile as follows: “if you insist on pulling everybody’s head out of the clouds, block me now. (out of the sand is another matter entirely.)”

        ***being so hip that you can’t be lied to — and being supported by a substantive enough population possessed of a similar level of awareness.***

        the total crux for me. if i weren’t so demoralized by reflections on http://www.johntaylorgatto.com/underground/toc1.htm , i might devote my activism-ness purely to railroading Critical Reason into every term of schooling after age ~9.

        • nusz
        • April 11th, 2011

        e.g., and even bringing the thread back in line, “The clearest escape route from tidal recurrence of caste madness is a society bred to argue, one trained to challenge. A mentally active people might be expected to recognize that the prizes of massification—freedom from labors like toilet cleaning, a life of endless consumption (and reflection upon future consumption)—aren’t really worth very much. The fashioning of mass society isn’t any chemical precondition of human progress. It’s just as likely to be a signal that the last act of history is underway.” -j.t.gatto

        • Max Bell
        • April 12th, 2011

        A little less certain of what you’re getting at on further examination of your comments, but I’m going to take a crack at it, anyway.

    • Laroquod
    • April 10th, 2011

    Sorry that was meant to be a reply to the original post, not to nusz’s.

      • nusz
      • April 11th, 2011

      perhaps, some day, you may atone for this injustice. 😉

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