do you know what it’s like on the outside?

I live in a town that is about thirty minutes from all my health care, except for one doctor: my psychiatrist. It is little coincidence that my psychiatrist is the only one unable to take Medicaid. He is effectively a one-man practice. Nobody out here seems to be willing or able to take Medicaid, so I schlep into the city.

Lately this schlep has gotten more difficult. The winter has been hard on my body; I experience motion sickness at a lower threshold than before. I wonder sometimes when I will be totally unable to access what little is available to me. I am already going to need to look for a dentist nearer-by than Strong. For all I enjoy Eastman Dental, with all the medication in my system after dental work, it’s all I can do to stumble to the car, let alone endure the ride home. I have a small chip that wants repairing and all I can do right now is hope it doesn’t lead to worse damage until I can find a closer dentist.

I take the regulation 25mg of meclizine (that’s Bonine over the counter). There are still times when my guard is so down and I am so weak that very little will bolster me until I’m home. It’s isolating, to say the least.

I contemplate the various health care options suggested by various politicians. I ask myself: which of these is going to bring my care home to me? We can’t sell. We’re not the zombie house (nope, that’s the one next door where the guy died alone) but we’re close, even with a good roof. The best we could do for a buyer is a flipper, and they’ll push us to sell at a loss, which you’d think we would have done years ago if we could. So no. We can’t move to the health care. It has to come back to us. And if doctors are allowed to refuse Medicaid patients, or force us to pay out of pocket, then we will all be funnelled into the same overloaded, low-quality, one-size-fits-all model of care.

So my first instinct is to remove that refusal. Install quotas. This percentage Medicaid. This percentage Medicare. But I think about why my doctor might not be taking Medicaid patients. He already runs his practice out of his house: it’s not for office upkeep. I think his wife works, but I can’t be sure. I know he has children; I’ve met the children, they’re a delight. I pay him for the privilege of local care because he is the most vital element. Everything else I can skimp on. This? No. I need someone I can trust to be in my corner. If that trust comes dear, consider what I was like before I had consistent, quality psychiatric care. Some of you might recall those ugly days.

If I insisted he take Medicaid, and he found himself unable to feed his family, he might pack up and buy into a practice farther from home, where the cost is more evenly spread among practitioners. I suspect that’s why the city practices can afford to take Medicaid and Medicare.

Fine. Reimbursement. How do we arrange for doctors to survive and still look after those who need help from the government? Perhaps it’s time those who can afford it are made to pick up the tab. If they won’t be taxed, then give them two options: take the same health insurance options as I have, or they can pay out of pocket — as I do in the one case that matters the most.

Perhaps it’s time Medicaid and Medicare became viable options for people who live where the buses don’t run, for people without cars. Don’t just throw us medical transport services. That does nothing to reduce the time factor, and if I think my thirty minutes is grim, I could have it exponentially worse. Ever seen Remote Area Medical? Yeah, no amount of medical transport solves that problem.

I suspect there’s a pervasive attitude in the United States that poverty exists chiefly in the cities, and that’s where one ought to concentrate efforts to help. Well, it doesn’t. The working poor, the underinsured, the uninsured, these live everywhere, even in and among the rich in bedroom communities. Surely I am not the only Medicaid recipient in the whole of Mendon. Surely I am not the only one too sick to work at the moment. (All right, I know I’m not, but he lives downstairs and is considered retired. And yes, he has to schlep a ways for his care, too.)

Put the onus on us to drag ourselves to and from your few offerings? I turn it back onto you. Live like this, medically speaking. Simultaneously loathe and appreciate that your family stayed together through the tough times, because at least you’re not at the mercy of some random driver who might be on time to take you to your appointment. Or might be early, so that’s two hours stuck in a waiting room. Or might be late, and you’re out of pocket and banned from the practice. Learn how to choose what is too complicated and what is doable when before you considered it all essential. You broke a tooth? ER’s in the city, two lines, all the waiting! Or you can grit the other teeth and go on until Monday, when the emergency dentist for your level of health insurance opens. Then you can hope the emergency dentist on call can numb you down enough to perform whatever procedure he chooses. That’s in the city, too, and it’s run like an ER, but just for teeth! And they won’t just take a look at you and send you home with morphine! They’ll treat the problem!

Budget for your own sanity. Your ability to function outside your house. Any hope of employment. Any hope of a meaningful life.

I envy the 1%. I wish I were the 1%. And if I were the 1% there’d be a fund for this sort of thing, out of my pocket, as I owe my fellow man.


2 thoughts on “do you know what it’s like on the outside?

  1. One of the problems with medicaid and medicare is the paperwork involved with taking care of patients. Much of it was installed to get rid of the rampant fraud that was costing the system too dearly some ten to fifteen years ago. In its way it meant well, but it also meant small practices couldn’t handle the workload anymore. A friend of mine left her practice in Rochester because of this. She spent more time doing paperwork than seeing patients. Big practices can hire clerical staff to take care of the extra workload, but the smaller ones just get screwed.

    • Well, then, hire ME to do the paperwork that’s so inconvenient! Hire the people on Medicaid and Medicare even part time and we can help.

      Instead we go on being unemployed and doctors leave the area.

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