Universal Health Care, It's for the Birds, the Really Old Ones

Mr. Smith is a friendly man in his seventies with soft, dignified manners. He is a retired machinist and was a preacher in the southern baptist church for a time. He removes his hat and glances down at his feet as he walks into the office, placing the hat gently in his lap as he sits down. He is here to have a deed prepared. His request, spoken hesitantly, is to convey a small percentage interest in a rental property he owns to his daughter. This seems an odd request to me, especially when he specifically says only a 1 percent interest. After several probing questions, Mr. Smith is still having a hard time verbalizing what he is trying to accomplish through this peculiar transaction. As I ask about his wife, his situation became crystal clear, and heartbreakingly sad. Mr. Smith's wife has dimentia and, a stroke last year has made it difficult for her to walk. He has been caring for her full time at home for the last two years. But her condition has deteriorated and he is no longer strong enough to help lift her out of her recliner. After months of grappling with the decision, Mr. Smith has finally decided that the only way his wife can get adequate care is for her to go to a local nursing home.

After Mrs. Smith's move into the facility it quickly becames clear that Mr. Smith's decision to move his wife is not only going to break his heart, it's going to break him financially as well. The cost of her care (which will not be paid by Medicare or health insurance), is $6,500 per month.

Now, the Smiths aren't paupers. Mr. Smith has a respectable pension of $1,200 per month. Mrs. Smith is a retired school teacher with a much smaller, but still helpful, pension of $600 per month. And their combined Social Security payment is $1,200. A few years ago they used most of their savings to buy the run-down house next door, fixed it up a little and began to rent it out for the rock bottom price of $700 per month, utilities included. Their combined total monthly income is $3,700 a month, just under $45,000 per year. Fortunatley, they still have about $50,000 from their life savings. Mr. and Mrs. Smith are the prototype for a middle-income, retired couple.

But one year of care for her will cost $78,000, even before paying the monthly $400 co-pays for her various prescriptions, let alone his. All of their savings will be gone in a year. And if Mr. Smith is able to sell the rental property in the present market, he will lose the monthly income from the rent and the entire purchase price will be gone in less than 2 years. At the very best, Mr. Smith can hope to provide adequate health care for his wife for less than 3 years before being forced to sell his home. They have decided to apply for Long Term Care Medicaid to try to avoid losing everything they have.

I can feel myself fighting back tears at the corners of my eyes when I ask Mr. Smith if he needs this deed drawn so that he can apply for Medicaid for his wife's care, and he hesitantly says yes, looking at the ground. When he looks up and meets my eyes he is looking for my reaction, he expects to see my disapproval.

And I am heartbroken. I am ashamed of my country for making this good, honorable man feel embarrased. I am ashamed of my country for ripping Mr. Smith's dignity away from him. He has never asked his country to do anything for him, and he is embarrased to be asking for a handout now, at 73 years old. I am ashamed that this has become the status-quo in the richest nation on earth.

Is this really what we intended? Did we intend to design a system that wretches every last penny away from middle-class families who have worked and saved their whole lives just like we told them to?

If Congress converts Medicaid to a block-grant funded program as Paul Ryan has recommended, states will be forced to decide which Medicaid programs will be cut to accommodate the drastic funding reductions. In 2004, 1/3 of all Medicaid spending in North Carolina was for long term care, and that amounted to a whopping $2.3 billion! It is impossible to think that this would not be one of the first areas of Medcaid spending to be cut, or at least to see its eligibility drastically reduced. And I suspect that just as happened with the stystematic dismanteling of our state mental health system, our streets will be flooded with the homeless, but this time they won't be crazy, they will be old, infirm and disabled.

Cutting entitlement spending sounds great when it is just a soundbyte that can be associated with the mental image of a welfare mother in tattered clothes with disheveled hair, a cigarette hanging out of her mouth and a baby wearing only a diaper propped on her hip. But when you have to actually think about the real lives that are affected by "entitlement reforms" and realize that some of those people might be your own parents or grandparents, it quickly loses it's appeal.

Balancing our national budget will not be done by eliminating entitlement spending. It must be done with a common sense approach that includes drastically reducing military spending; eliminating wasteful government spending (such as the USDA program devoted solely to procuring contracts for cheese manufacturers. I mean, seriously?); raising taxes on the mega-rich; raising the tax rate on dividends; and vastly simplifying the tax code. And we must return to carrying on civil debate with one another that involves actual facts, rather than bantying about catch-phrases and soundbytes without ever really discussing anything of significance.

I for one find the issue of whether or not millions of grandparents across the country will have to be homeless instead of receiving adequate medical treatment to be a rather significant issue that is deserving of more consideration than a 60 second snippit devoted to "entitlement spending" on a 24-hour news network. Ultimately, I believe my government is capable of carrying out justice. And it is certainly not just to watch the elderly middle-class be drained of its every last dime in order to continue living without additional physical suffering. Wake-up Congress! Your constituents are demanding that you act, that you show that you still possess a conscience, that you quit arguing and quit campaigning and start addressing the problem!