Thursday, September 23, 2010

Medicaid patients shall be checked for gold teeth at the revolving door

I saw this poorly punctuated bit of nonsense on Facebook the other day. Here's what this doctor supposedly had to say, although it is likely that this whole thing was fabricated to make a point.

Pictured is a young physician by the name of Dr. Roger Starner Jones. His short two-paragraph letter to the White House accurately puts the blame on a "Culture Crisis" instead of a "Health Care Crisis"..

It's worth a quick read:

Dear Mr. President:
During my shift in the Emergency Room last night, I had the pleasure of evaluating a patient whose smile revealed an expensive shiny gold tooth, whose body was adorned with a wide assortment of elaborate and costly tattoos, who wore a very expensive brand of tennis shoes and who chatted on a new cellular telephone equipped with a popular R&B ringtone.

While glancing over her patient chart, I happened to notice that her payer status was listed as "Medicaid"! During my examination of her, the patient informed me that she smokes more than one pack of cigarettes every day, eats only at fast-food take-outs, and somehow still has money to buy pretzels and beer. And, you and our Congress expect me to pay for this woman's health care? I contend that our nation's "health care crisis" is not the result of a shortage of quality hospitals, doctors or nurses. Rather, it is the result of a "crisis of culture" a culture in which it is perfectly acceptable to spend money on luxuries and vices while refusing to take care of one's self or, heaven forbid, purchase health insurance. It is a culture based in the irresponsible credo that "I can do whatever I want to because someone else will always take care of me". Once you fix this "culture crisis" that rewards irresponsibility and dependency, you'll be amazed at how quickly our nation's health care difficulties will disappear.



This kind of thing really irritates me for several reasons.

1) Medicaid is not automatically granted to all low-income people. There are eligibility requirements. In our state, at least, many Medicaid beneficiaries are families with young children. When I worked at the hospital, I met some of them. Sometimes the parents made me mad, like when I told them not to smoke in the house with the nebulizer machine and they looked at me like I was crazy and asked why. I didn't always agree with the choices they made for their children, but you know what? Denying people Medicaid coverage because they don't live up to your expectations leaves out the most important people: the children. What do you think would happen if we denied nebulizer machines or hospital stays to children who could barely breathe because their parents didn't do what we wanted? They could die. If the children were treated and the bills were sent to the parents who have no means to pay, the account would go to collections and the burden would fall on patients who are able to pay. They would just pay more for the services they need, because someone is going to pay to keep the hospital rolling and you can't squeeze water from a rock.

2) Why are poor people expected to be impervious to the pressure of our consumer culture?
Tricky marketing works on everyone regardless of economic status. Dr. Jones is on his high horse about this woman's "costly tattoos, shiny gold tooth, expensive tennis shoes and new cellular telephone." I agree that most of these things are silly, but why do people only look down their noses at people who are on government assistance? This "culture crisis" involves all of us, whether we can afford luxuries or not. As I've said before, we vote with our money. If you want to sneer at people who buy things you think they can't afford, the least you can do is not be a person who promotes a wasteful lifestyle. I can make up an interesting little character, too. It's a woman with blonde highlights which are regularly maintained at the salon. She pays full retail for all her clothing at upscale department stores (a new wardrobe every season!), wears a large, sparkly diamond on her recently manicured finger and drives a shiny, gas-guzzling SUV. She enjoys monthly spa days with her friends and sometimes even gets botox and other treatments to enhance her appearance. She goes out to eat several times a week with friends or her husband--and not at fast food restaurants but at Olive Garden or a steakhouse. Why is it culturally okay for this woman to waste money while it is not okay for the woman on Medicaid? Because she "earned" it and "deserves" all these things? Maybe she earns a lot of money, but maybe she is putting it all on credit cards and is behind on her mortgage. For the purpose of this argument, it doesn't matter. She, too, is contributing to the crisis of people wanting too much. I don't see any problem with a few luxuries every once in a while. I've gotten my nails done, too. I like going out to eat as much as the next person--probably more--and I love to shop, albeit for different things than most mainstream people. But regardless of your financial situation, if you are going to spoil yourself, how do you expect to sit in judgment of others who naturally yearn for luxuries too, given that they are living in this same consumer culture which you have helped to build?

3) Why are people on Medicaid expected to take better care of themselves than everyone else? There are smokers and fast food addicts and non-exercisers and people who don't wash their hands after peeing on the same health insurance plan as my family. We strive to optimize our health and people who make the aforementioned bad choices cost us more money in the form of higher premiums. How would you like to have someone audit your lifestyle to be sure you're not costing me too much? Yeah, I didn't think you would. I wouldn't either. Annie
explains this concept so well, and in greater detail, here.

4) Things like this doctor's letter perpetuate a stereotypical view of those who benefit from Medicaid. A few people may be like this, but most are not.

If a doctor truly wrote this, I am alarmed, as I wouldn't want to be treated medically by someone so simple-minded. Dr. Jones does not offer any solution. All he offers is finger-pointing. Our consumer culture and the notion that we deserve the world on a silver platter was created over generations and is not going to be fixed overnight. Perhaps the funniest part is how he does not recognize that his salary is, in part, paid by the same Medicaid program that takes care of these people he thinks do not deserve it. Many hospital employees would not even have jobs were it not for the Medicaid program.

I can agree with Dr. Jones that we have a culture crisis, but it's not something our president can fix, and it does not apply only to people on government assistance. To fix this crisis, we all need to reject the idea that we deserve to be spoiled. Rich, poor, or in between, we could all learn a little moderation. It matters not if you can "afford" luxuries. It's easy to get all puffed up about what we have earned and forget that all the things we have, including a well-paying job, are gifts from God. I don't think God intends for us to blow all our money on ourselves. No one is perfect--I covet and sometimes get things I don't need, too--but if we pay a little extra in taxes and it means a woman can take her child to the doctor without fear of a devastating hospital bill, I'm happy with that. And I don't care how many gold teeth she has or how many cigarettes she smokes.

(Also of interest is this post from Judgmental Hippy, which inspired me to go ahead and publish my post even though it wasn't full of sunshine and rainbows. Her post does have some four-letter words in it, just in case you wanted to know, but it offers great perspective on a similar issue.)


Anonymous said...

I'm Canadian. This means that I'm legally required to have health insurance, but it's provided at low cost by the government to all people regardless of their employment status or lifestyle choices. And those who can't afford premiums get it for free. There are no co-pays or deductibles for medical care that's considered 'necessary'. This includes, among other things, midwifery care in childbirth. I have never had to pay to see a doctor or visit a hospital (other than maybe for parking).

Because this is what I am used to, the way that my country operates, I believe that health care is a human right. I believe that we should all receive the same standard of care, regardless of our life circumstances. Or our choice of body art. Yes, some people make decisions I disagree with. Yes, the health care system would be better off if we all took care of ourselves. But that doesn't change my opinion that, in the end, compassion and care for each other trumps our personal opinion about how you should spend your money.

Jenn said...

Love, love, LOVE. May I share this on facebook?

Jenny said...

Amber--I am jealous of Canadian healthcare, as a large chunk of our family budget consists of insurance premiums, health care we pay out of pocket until we meet our $700 family deductible, and copays we have to pay all year. The stupid expensive insurance plan won't even consider covering my midwife! It's a rotten deal but we need insurance in case we get in a horrible accident or something. I don't think people realize that with what we're paying for health insurance AND deductibles and copays, we'd be getting a much better deal and would be doing more good if we did it Canada's way. All people, especially all children, ought to be covered no matter what. I am hopeful that we are moving in the right direction. Very slowly though.

Jenn--Thanks! Go right ahead.

Anonymous said...

Well said, Jenny ! May I repost as well ?

Lauren Wayne said...

A friend of mine on Facebook posted that original icky thing, and I seriously had to stop myself from commenting, "Wow, that is astonishingly racist and classist! Thanks for letting me know how you really think."

It hurts me personally, of course, since I'm one of the people who would benefit from health care reform, being self-employed and all, and now I know she doesn't support my having equal and fair access to health care. Awesome.

I really like the points you made. I know I for one would not appreciate being audited for my every lifestyle and financial choice.

I've also noticed in my interactions with a wide variety of people at around the same income level that what each person chooses to spend money on varies so much. One person might consider eating out a luxury, whereas another person might think owning a house is above and beyond. So the homeowner who doesn't eat out sees the restaurant going as frivolous, and the person who eats out thinks the homeowner is secretly much richer. That's just an example, but you know what I mean?

P.S. I liked how the letter mentioned the "popular R&B ringtone." I've never actually bought a ringtone, but aren't they, like, a couple bucks?

Jenny said...

Lauren--That is so true about the ringtone! After I wrote this I realized that even if this woman never spent money on any of that stuff, she STILL probably wouldn't be able to afford health insurance. The only reason we can afford it is because my husband's job pays for a lot of it. I can't imagine what we'd be paying independently, probably several times as much.

It hurts me too when I realize my friends don't support health care reform. My parents both have expensive health issues (mom is a cancer survivor) and when these new changes took effect I was thrilled, because they can no longer be cut off by their plan when they've received $1 million in benefits. I just don't think some people realize who their selfishness hurts.

Momma Jorje said...

When I read the original doctor thing on FB, I got this feeling... that feeling that it was easy to get riled up by that article and just repost it. "We're all being wronged here!" sort of thing.

But then... I just felt it was wrong. I didn't take the time to take it apart and I appreciate that you did here! I've linked this on FB!

Lic said...

I don't claim to know everything about the health care system, but I do believe all people deserved good medical care. It is too bad that some people don't take their health more seriously until they're really sick, or that they splurge on things they can't afford, but I've been poor before. I know what it's like. It's really hard to spend ALL OF YOUR MONEY on insurance, and not have a single luxury.

And yeah, that letter's gotta be fake. I couldn't imagine any doctor writing a letter like that.

Lisa C said...

Sorry, made a typo on my name and then accidentally hit enter.

Olivia said...

This doctor's argument is completely ridiculous. Tattoos and gold teeth may be expensive, but they are no where near as expensive as health insurance. A person could ostensibly save up for a tattoo, but there's no saving up to buy insurance since it is an ongoing expense.

My husband and I have been without health insurance for over four years because we have not had access to it thru employment, and the only plan we can afford on our own would cost $250/month with a $3,000 deductable. That's $3,000/yr in premiums before the insurance even kicks in!

We simply can't justify giving away that much money "just in case", since on average we each visit the doctor 2 times a year at a cost of $150-$200 per visit. So we pay cash and hope for the best.

Our daughter does received Medicaid, and I'me very thankful my tax money (and everyone elses) helps take care of children in our state.

Molly said...

Anyone ever read "Rich Dad, Poor Dad?" or anything like that? People who have money continue to save money and budget money and have "cushions" and prioritize expenses in such a way that they are used to thinking about buying various forms of insurance or investments. People who DON'T have money just don't think like that. When you normally don't have money and you get a little bit, or maybe if someone gives you money to treat yourself, the first think that you think of is probably not, "Let's invest this and get some dividends" or "You know, I could really use some extra insurance, or maybe I can put this in savings." And that's a cultural thing too--if you grow up in a family that lives paycheck to paycheck, then that's what you learn.

Similarly, if you grow up in a family that eats a certain way and teaches you that way, then that's what you do. And school lunch and health programs do an abysmal job in that department. Except in wealthy schools, where it isn't as much of an issue.

This diatribe by the doctor does bring up a valid point, applicable not only to Medicaid patients but to everyone else--people are not living the healthiest lifestyles and could really stand to improve their outlooks, and as such, we'd go a long way toward improving the status of health care in this country. And people probably don't spend their money or budget their money in the best way possible.

It would be nice if people would take better care of themselves and their children. It would be great if no one smoked at all, much less around kids. It would be wonderful if everyone lived exactly the right type of lifestyle appropriate to whatever they do and whomever they are, whatever in the world that means. But we can't dictate that, much as some people wish we could. We can continue to provide education and healthy options and incentives of some sort to do the right things, but we can't fix people, and the fact that someone receives government assistance does not make their lives any of our business.