Thursday, February 22, 2018

The Itch of Inequality

A woman visited my office today and she had not started a drug I had added to her diabetes regimen because Blue Cross refused to pay for it and it would have been $900 a month out of pocket. But, she said brightly, "I just got Mass Health."  So she asked me to re write the prescription; it'll be covered now.


Mass Health is Medicaid.


This is a common story in Massachusetts, but not in New Hampshire, where the people's representatives do not believe in government.  In Massachusetts, the government sponsored health insurance covers just about every drug. In New Hampshire, you're lucky if your doctor's visit is covered.


Reagan's welfare queen 


I don't know how many times a week I hear someone, usually a white person with no more than a high school education, if that, grouse about how her company sponsored health insurance would not cover a drug or a procedure, and then add indignantly, but my neighbor, Juanita Diaz, she gets it for free from Mass Health.


If that white lady found her drug was covered by her own health insurance, likely she not feel angry at all that Ms. Diaz got her drug paid for by Medicaid. What bothers the white working stiff about Ms. Diaz is the sense that Ms. Diaz is getting something unfairly, when the working stiff is being denied it.  


What really riles the patient, that white lady, working two jobs--one cleaning offices and one at the car wash-- is that while she works hard, she manages to earn just enough to disqualify her from Medicaid coverage, while Ms. Diaz sits homem watching TV, and gets the drug paid for.


So it's two things:
1/ The inequity: she gets it when I don't 
2/ The idea that by working hard, I pay the taxes to pay for Ms. Diaz and I don't get what my taxes pay for Ms. Diaz is getting--the worst of both worlds.


Did she not rape the system?


Of course, there are layers here:
1/ Why does the white guy's health insurance not cover the drug?
2/ Why is the drug $900 a month in any universe?
3/ Why does Medicaid get a sweetheart contract for the drug but not Blue Cross?


In our for profit, profit driven American health care system, the drug company can charge whatever it  wishes, whatever the market will bear. 
The best health care is consistently provided by the government run programs and the commercial programs are niggardly.
The working stiff never directs his resentment toward the inadequacy of the commercial programs; he is only angry at the perceived profligacy of the government run program.



It's the old Ronald Reagan "welfare queen" driving her Cadillac, wearing mink, raping the government welfare programs which were  supposedly devised to assist the poor and needy but instead get exploited by the lazy, undeserving "poor" who are growing rich and fat on the government's teat.

Why is she not a welfare queen?

If we had healthcare for all, Medicare for all, if everyone got the same basic benefits (with perhaps a little extra for people who added company health insurance on top of what the basic government plan offers) then we would likely hear no complaints about Ms. Diaz who is getting her drugs for free, because everyone gets them for free.


Of course, as Lester Freeman of "The Wire" noted, "Ain't no such thing as free in this country."


But at least we'd all perceive the situation differently. It's not bad if you don't have something until you see someone else gets it when you are denied it.


Perception of inequality.



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