Medicaid has ceased to cover such optional, luxury services as dentures, artificial limbs, or wheelchairs. Optical, dental, and hospice care for the dying are no longer covered. Now a dying patient will have to be admitted to the hospital to recieve intra-venous palliative care (IV Morphine, Fentanyl, or Demerol) in their final days. This despite the fact that a day of hospice care costs about $200.00 and a day as an inpatient costs upwards of $1,000.00 - double that figure for ICU patients. I am certain that people were just lining up to lose limbs, become paralyzed, and get cancer so they could stick it to the taxpayers of Missouri.
Medicaid patients, at least in inner-city areas, and I live and work in the inner city, are served by a very limited number of public health clinics. I know of not one single dentist, (or primary care physician for that fact - specialists operate under different strictures) in private practice in the Kansas City metro area who accepted Medicaid assignments. Medicaid patients were seen by the Samuel Rodgers Clinic, or by the doctors, nurse practitioners, and dentists at Swope Health Services. These medical providers dentists, and the assorted members of their support staffs bust their asses every day to provide necessary care to a community of patients whose needs far outstrip the abilities of the providers to render enough services, but they don't quit. We never give up. These true American heros get up every day and they go to work and they do their jobs and they render care, and they make a hell of a lot less money than their professional school classmates, but they do it becacuse they feel that they are providing a necessary service, and they have squared this in their own minds, just like I do, and just like the x-ray technicians, lab technicians, interpreters, clerical staff members, and mental health professionals do.
These clinics will struggle to continue to provide care to their patients, and when the state cuts were announced the residents of KCMO passed a healthcare levy to benefit the Swope and Rodgers clinics, Children's Mercy Hospital, and Truman Medical Center; however the levy keeps the doors open. It doesn't fully fund services. Cutbacks with these facilities went into effect on Friday as well. These struggling facilities will soldier on, but they will feel the pinch. This will seriously affect their ability to function. They stand to lose experienced, seasoned staff members to better paying private and specialty hospitals, because people have to live. I don't care how dedicated someone is, three or more years without a raise of even a cent; or a year-end bonus, takes a toll on ones job satisfaction.
I have worked in these clinics. I was a nurse for the Swope Health System's Northland Clinic, and I was a lab tech at the Rodgers Clinic. I can say with absolute assurance that the people who are there are there because they give a damn. They believe, to a person, that access to quality healthcare is a basic human right. It is not a commodity, like so much soda-pop, to be dispensed only to those with the ability to pay.
It is unconscionable to simply dump even more patients on emergency rooms that struggled to provide care to the already sizeable population of uninsured individuals before the cutbacks. The state to the hospital system: "We are begging off. You mind taking care of this for us? See you around."
Until February of this year, I was an integral part of a trauma team in an inner-city 500+ bed hospital. I worked for that well-known slave-house Research Medical Center, an HCA facility. (That's another post too.)
I have seen a whole lot of shit (on a daily basis) that you should thank your lucky stars that you have never had to bear witness to. Abused children, abused elderly, abused spouses, dead teenagers. (Anyone against controlling the handguns proliferating in our midst needs to work three consecutive summertime shifts with me. But that is another post as well.) Last summer, I saw at least as many bullet wounds a week as the average currently deployed military surgeon. And this was In Kansas City. Over the summer of 2004, I averaged about 10 gunshot wound trauma responses a week. And not every wound merits a trauma be called. I don't know how many of these patients I saw. I also don't know how many GSW traumas other staff members covered, but I supervised a crew of 12, and I didn't work them all. Those traumas I mentioned were just the ones I was involved with.
These Emergency Rooms are already hemmorhaging red ink. For one thing, dead and permanently incapacitated traumas don't pay hospital bills. Many of the ER's serving inner city KC were already feeling the strain of serving the uninsured before these draconian cuts were shoved down our collective reluctant throats by the Republican Governor and legislature. Some may collapse under the strain and close their Emergency Rooms. That will be a disaster if it comes to pass.
Just wait until cold and flu season, when those kids they just kicked off of the Meeicaid rolls get colds and other assorted winter viruses that morph into Otitis Media, or middle ear infections. These kids will flood the ER's of the state once their parents can't get in to see a physician once the child exhibits initail symptoms.
It's about to get ugly. And the city council here in Kansas City is retaliating. A local citizens group that boasts as a main founding board member City Councilman Alvin Brooks, is poised to take action. ACORN, a local grass-roots citizens group is pushing for a law that would require the hospitals in Jackson County to render free care to all residents of Kansas City (maybe the county - I need to do some more research) who earn less than 200% of the poverty line. The backlash is starting; this proposed legislation goes farther than any municipality in the nation has gone thus far to retaliate against cuts to and denials of service through the Medicaid program. But hospitals need capital to operate. I can't just give away my time. Kansas City Power & Light wants money every month, not my good intentions and a statement of hours volunteered at a community hospital or health clinic.
How many "values voters" thought last November as they pulled the lever or punced the ballot on the Rebublican side of the ticket that they were, in effect, voting to have a welfare recipient move into their home to be taken care of, physically and financially? Anyone think that more than a few people would have voted differently?
A Case In Point
I know a young woman who has not always made the wisest choices. She exhibited poor judgement in her selection of consorts, and she most definitely should have practiced birth control. But hindsight is 20/20. Just because I am bothered and disappointed by the choices she has made and the course her life has taken thus far does not mean I want her thrown to the wolves. She is 22 years old (She has time to get her act together) and she has two children, aged 2 1/2 and 9 months, with two different fathers, neither of whom pay child support. The court orders are in place, and the balance due grows monthly. But until one or both of these men get stopped for a traffic violation, or otherwise come into contact with law enforcement in a professional capacity, she will receive no child support from the donors. Her children will continue to be financially neglected by their fathers.
This young woman lives with her mother, works weekends in a restaurant as a head line cook when her mother can watch her children. She never received AFDC, only medicaid coverage. A "Welfare Queen" she isn't.
I do not resent that. Children once born, should not be damned. Especially when many of those children are here because their mothers were told when they considered an abortion that the state had provisions in place, and no one needed to terminate a pregnancy because of money. These kids, and thousands more who are already born and among us face an uphill battle without the setback they were dealt by the Republicans in Jefferson City this week.
Now that they are no longer fetuses, and they may cost us a couple of bucks, we want to change the rules and tell their mother that she just needs to suck it up.
But the same Republicans who want every pregnancy carried to term are the same ones denying the children already born access to health care. They are leaving the prenatal care guidelines in place at their previous levels. But what about the child once born? How will the child receive care? Who will be a pro bono pediatrician? The parents are told "tough toenails." I feel a huge schizophrenic disconnect here. It truly gives me a tension headache. I have to take a Fioricet now.
Am I the only one who sees this step as counterproductive? I don't think that we lift the next generation of children out of the swirling eddy of poverty by pushing their mother down a little lower; by denying them the basics especially after assurances of assistance were made to assured these children were born!
I am outraged that the state finds this woman and her children essentially expendable. Instead of offering a hand up, the state places a foot across her throat. She is floundering a mile from shore in deep water, and neither she nor her children have life preservers. But the ship of state, which clearly sees her there and hears her cries for help, does not throw out a lifeline, they just sail on by, callously ignoring her while enjoying the champaign and caviar at the deck party for the big Republican contributors. The rabble would ruin the ambience. Best not pull her aboard. (The Hancock Ammendment. What a concept!) She just has to sink or swim, and try to save her children in the process. She and her children simply should all have chosen better parents to be born to. It's really their own damn fault.
But What Can Be Done Now? Isn't it too Late?
Maybe not. It doesn't have to be.
One fact is indisputable: What is happening is unconscionable. The Missouri Democratic party needs to get their act together and their message across. And this is our message. They need to keep this issue boiling on a front burner. They need to beat it like a redheaded stepchild. This can be the issue that returns both chambers of the statehouse to the Democrats and lame ducks Matt Blunt in 2006, before he does much more damage.
He has been in office less than six full months, as of this post, and I will go on record now: If he runs again, he will not be elected. Missouori could very well have two sitting governors in a row lose primary challenges. Now there's a claim to fame!
Let's face it: Both parties have hit rock-bottom with our last two governors. Bob Holden, a Democrat, lost a primary challenge to Claire McCaskill, who barely lost to Matt Blunt in the general election in November. It is speculated that Missouri went for Blunt because it went red in the presidential race. If we as a state had gone for Kerry, he would have carried Claire on his coat-tails, but we aren't living in the past, we are struggling to deal with the present, and with a grim future.
Letters to the editor have appeared since the Republican agenda has been revealed, publicly appologizing to Claire for voting for Blunt instead or her, as the reality of his economic policies set in. Holden wasn't Evan Meacham bad; he wasn't criminal, he was just incompetent, some would even say stupid. I didn't say that, but I didn't dispute it, either. But that's beside the point. He was bad, Blunt is bad, and Missouri deserves better.
As a healthcare provider, I have a better idea than most about just exactly what it is that is rolling down the mountain, gaining mass and picking up momentum. When it hits bottom, it is going to level the village and a lot of people are going to die. (That's all metaphor up to the part about a lot of people dying. That part is sad reality. I wish it was metaphor, but unfortunately, no.)
Citizens of Missouri, I implore you: if it is within your ability, please contact the community health clinic or community hospital in your area and make a directed donation to their pediatrics department, even if it's only a couple of dollars. Ten people donate a couple of bucks, and you went together to buy a dose of childhood vaccine. Your help is desperately needed right now. If you can't make a donation, (and a lot of people can't in this economic climate) can you make a phone call, or volunteer a couple of hours?
Please call your local Missouri state senator and state representative. Demand that they roll back the cuts to Medicaid, or ceasse the hypocracy and surrender their own state-paid health coverage.
Once again, the edit feature is refusing to present a post in the format I chose. It is not showing my paragraph breaks after the subheadings. So I italicized, bolded, changed the color, and enlarged the first words of each paragraph in an effort to remediate the problem and facilitate clarity of point and reading comprehension...I gotta get a domain name!
