Saturday, July 26, 2008

A (seriously) non-partisan post about Health Care in Delaware

One of the statistics I recall, I think from Jack Markell's healthcare plan but it could have been elsewhere, is that roughly 27,000 Delaware citizens are not signed up for the Medicaid benefits to which they are entitled.

I don't know about you, but when I heard that it brought up visions of poor people suffering and not going to the doctor because they didn't know they actually qualified for state-sponsored health insurance. And I believe (but it's Saturday night and I'm way too tired to go check) that both the Markell and Carney health plans involve, as one element, making it easier to find these people and sign them up.

But I no longer think that's necessarily the case.

Keeping in mind that I understand it is usually dangerous to reason from the specific to the general, I want to tell you a story.

My eldest daughter is 26, unmarried, with a five-year-old son and one of those "full-time/part-time" jobs at a local assisted-care facility (which means they carefully keep her hours at just a tad under that which would require them to offer her benefits).

She's too old to cover on my health plan, so she and my grandson have Medicait (specifically, Delaware Physicians Care).

Every three months DE Medicaid sends out to my daughter (among a voluminous number of other pieces of useless correspondence) a notice that her status is to be reviewed. There is a page of questions to be answered about your job, your address, etc. The page is sent essentially without explanation, and--trust me--it is very difficult for a person with limited reading skills to decipher. Only in the fine print does it tell you that if you don't return this form within two weeks you lose your insurance.

If you don't return this form (or, if you return it and they lose it), you get one--count 'em--one notice that your insurance has been canceled, and an explanation of an appeals process that is more complicated to follow than Einstein's Theory of Special Relativity.

Periodically--let's say twice every three years--my daughter is summoned to appear before a case worker [whom she has never actually seen, given that Medicaid is the only State service she accepts] with her son carried along physically, because she must prove he still exists. The day and time for this is set by the bureaucrats without consultation with the clients--you either show up or they cancel your insurance on the spot. If you have to miss a day of work to verify your insurance, tough shit. This one is also delivered in an unmarked envelope and phrased in language that would have confounded Paul Dirac.

Ok, so we got used to all that. Then last week the bureaucrats running the State's Medicaid system showed us a new trick.

My daughter went in to pick up a refill of her depression medication, only to be told that her health insurance had been canceled, and that would be $248 for the Wellbutrin, please.

She called the current case worked [it required two calls just to find out who her current case worker was]. The case worker told her to call Delaware Physicians Care. DPC was sort of astounded by this, as they told her that the order canceling her insurance had not only come from the case worker's office, but had been signed off by the case worker in question.

Back to the case worker. Now, she says, "Oh, because you make too much money, and your status hadn't been reviewed in two years, your coverage has been dropped. There's an appeals process, but I don't think it'll do any good."

She said my daughter could come in and discuss it, but that she only worked until 3:15 pm every day. My daughter, I told her over the phone, works until 3:00 pm, and it would take her at least half an hour to get there.

"Well, then she'll have to take off work if she wants her insurance back."

So she did. Fortunately, I haven't raised any cowards. My daughter went down there to discover that the records were so out of date (despite her returning her required forms every three months) that they showed her simultaneously working all three different jobs she's held over the past four years, and thus making three times the amount of money she's really bringing home. (Exactly how they thought she was working three forty-hour weeks each week is beyond me.) She showed them her pay stubs, corrected their records, and they told her that her insurance would be restarted some time in the next 2-3 days.

During this conversation, she asked them if she had missed some notice about this review. No, they told her, for this kind of review they didn't send out notices [so you only found out your insurance had been dropped when the card bounced at the doctor's or the pharmacist's officer].

They also told her that these reviews were part of a regular, systematic attempt to purge people from the system in order to keep costs down, but they told her not to tell anybody that, "because that's not supposed to be public knowledge."

As a footnote, they told her that her insurance would be restarted, as promised, in 2-3 days, but it would take a week or more to get her new card. Without your card, you can't pick up prescriptions or be seen in a doctor's office, so I'm not real sure how you can say the insurance has been reinstated if you can't actually use it.

The point of all this: I no longer think there are 27,000 people sitting around Delaware unaware that they qualify for Medicaid benefits.

I think that possibly a large number of people were on the rolls at one time and have been discontinued by a system that seems intent on finding as many ways as possible to force people off. And I think most people in that category, who don't have advocates [and, by the way, the DE Medicaid workers go to great lengths to try to keep advocates from getting access to any information], just go away....

I think of people who don't read or write that well.

I think of people who actually believe what the bureaucrats (who go home at 3:15pm) tell them is the truth.

I think of these people now going to the emergency rooms at Christiana Care, or St. Francis, or Bay Health, and costing us extra thousands and millions of dollars each year, because they can no longer access the insurance to which they are entitled by law.

I am not going to do a Libertarian rant on government bureaucracies here (though I reserve the right to do so in the future).

What I'm doing here is a father's rant, and an attempt to explain to people that the problem with health care in this State, and in this country, is far more complex than any single, sweeping solution will fix.

Food for thought.


Brian Shields said...

My disabled father in law gets those letters every three months, and it is a hassle every time he gets them. My in laws, love 'em to death, but they over-react on the simplest of things. Every three months they think they are being forcibly removed from the system, and throw a storm of phone calls into the case worker, and anyone else they have phone numbers to, until someone calms them down and tells them to fill the form out and send it back.

One time he had to show up at the case worker's office to prove he was still disabled. He told them that his leg still hadn't grown back since the surgery a year ago, but he was glad to show the stump to the woman if she would like to see it.

My in-laws are who I think of when they throw in the single-payer heathcare, wonderful world of healthcare for all fluffy kittens and cuddly puppies bullshit story.

My diabetic, amputated, cantankerous, loud old fart of a man who is my father in law, who can see ok on some days, but not on others depending on his diet because he barely understands how diabetes works. These are the people that this system is supposed to help. This is the system that lets these people slip through the crack because the bureaucracy is created to allow these people to slip through the cracks to minimize costs.

Thank goodness he has a family around him to help him through such things. Others aren't so lucky.

Josh83 said...

You may not have raised a coward, but you certainly raised a damn fool.

There is something seriously wrong with any 26-year-old who cannot support himself or herself.

There is something seriously wrong with anyone deciding to have a child she cannot support, especially any 20-year-old. I cannot imagine anything more absurd.

The issues you have raised here have nothing whatsoever to do with the state and any perceived shortcomings of the state. The issues here, pure and simple, involve massive failures of personal responsibility, on many levels, including your own. These failings will now be perpetuated through at least three generations, at untold cost to taxpayers.

The state has nothing whatsoever to do with these failings, and yet the taxpayers of Delaware are now called upon to provide for your daughter and her son--and you are bitching and moaning about paperwork and bureaucracy, and lamenting the state of national health policy!

I cannot imagine anything more ridiculous. Your rant is positively offensive.

The solution here is for you and your family members to get your act together, but I somehow doubt that such a solution ever occurred to you.

Placing the blame for your own family's shortcomings on the government, and not upon yourselves, is reprehensible.

Coming from a so-called Libertarian, it is also dumbfounding.

Steven H. Newton said...

Dear Josh
I am going to treat you to a technical term that I don't use very often: you are fucking idiot.

If you were a regular reader you would know that my 26 year old adopted daughter is disabled and works as much full-time as is possible, and refuses to take any other hand-out from anyone than she has to other than to provide her son health insurance.

Now don't you feel like a real man?

Josh83 said...

Unthinkingly, you are reinforcing my very point: what in the world could possibly possess a 20-year-old disabled girl to have a child?

The very notion is mind-boggling.

Steven H. Newton said...

No. josh, you who rush back into the breach are the one who is unthinking.

People make mistakes.

And when they are your children, you deal with it.

I'm not sure what world you live in, but people don't always make the right choices.

My grandson, with the exception of health insurance, has been raised without a penny of government assistance because our family took responsibility for him.

My daughter, who was adopted by us out of long-term state custody, has ceased to be a drain on the public resources and is working as hard as she can to support herself. Again, with the exception of health insurance, which I am not proud of needing but will not lie about to suit your fantasies, we have not taken a penny of government assistance.

You, sir, have the unfortunate affliction that you see the world in simple shades of black and white, and feel free to make sweeping moral pronouncements. I doubt seriously that your own life, examined, would turn out to have been filled only with correct choices.

Josh83 said...

For the record, the text of your post states that both your daughter and your grandson are receiving medical assistance from the State Of Delaware, not just your grandson.

No doubt I have made zillions of mistakes in my short life, and no doubt I shall make zillions more in coming years.

However, I sincerely hope that I have the decency to accept personal responsibility for my mistakes, and not to blame my own mistakes, past and future, on the government, and expect the government to fund them, and offer endless blather about the government's shortcomings.

Steven H. Newton said...

Again, Josh, you need to read before you jump in.

Delaware has been contemplating single-payer health, which I have been opposing for a long time. Our Gubernatorial candidates have been making a big deal about 27,000 people who qualify for Medicaid but aren't getting it. The point of the post was to discuss the fact that one of the reasons people aren't getting the service is that the government has designed a system that throws them off, while pretending to assist them. The sub-text involved in the Delaware debate is that this is the kind of behavior you could expect from a government-run system.

You, however, are more interested in condemning people rather than discussing issues. Since I am sure that a person of your obvious moral integrity has never accepted a penny of assistance in any form from the government for any reason (albeit that's virtually an impossibility these days, since I can guarantee you that something in your life has been subsidized by the government), your halo appears to be choking you.

So be it.

Feel free to have the final word; I'm done with your pretentious attitude.

Drew80 said...

Steven Newton:

There is no need for you to get nasty with Joshua.

You wrote a ridiculous post, you made ridiculous arguments, and Josh called you on it, in spades.

You were unable to address his points, which were unanswerable, so you responded with a stream of invective.

That was unworthy of you and your readers.


Anonymous said...

It's sometimes hard to read these stories. But I believe every country has some horror stories dealing with health care, we here in Canada have some too - stories about delayed treatment, about people transported to USA because of lacking capacities...
The question is just how often such story occurs. I am Toronto life insurance broker so I am fan of private insurance, however, can you call it insurance, when you actually not insured?
Wish you a good health insurance policy soon!

Anonymous said...

Josh and Drew - you are prigs of the highest order. In your circle jerk of conservatism I am sure you two see red everytime some is, in any way, using public assistance. As men, it is possible that you could be in a similar situation (if you were ever thought attractive by a woman) but you would have the advantage of being able to run away. I don't know if that is the case here, but neither do you.

When corporations can control their costs by cutting people's hours, they are avoiding personal responsibility. Just how many failures of personal responsibility does it take to make assistance OK in you small minds?

I really love how a pair of law students under the age of 30 think that they have this whole thing figured out. You are both pathetic wastes of skin.

Anonymous said...

Oh, I see now. You two are a pair. No chance of accidental pregnancy in your relationship. DINKs for life. Great.

I do wonder if Drew's parents are planning to use medicare and collect social security or if they will simply switch roles at some point, and they will start to sponge off of you two? That would be good personal responsibility.

Drew80 said...

Liberalgeek, our retirement plans, as well as those of my parents, involve a move to Delaware and an application for public assistance.