Mercy -- and a hint of justice

The Tennessee Healthcare Campaign alerted that on the 21st of the month for just a few hours there will be a crack in the wall allowing a few more thousand people in the state to get covered under TennCare. From 6pm till 8:30 pm the phone lines will open for the lucky poor who get their call through. Reminds me of the Buffet song about how the whole world lies waiting behind door number three. But this is truly life and death.

This is our version of Medicaid, the government program for the poor, but you have something similar--and similarly restricted-- where you live. The brutality of the vulnerability is simply medieval. 

Wealthy politicians swagger and blather about how we should quite worrying about the the poor. So it is helpful to look at how vulnerable you have to be to get covered: You must be either 65 or officially disabled AND have medical bills about the same size as you monthly income AND have no more than 2,000 savings (3,000 if married).  The phone lines are expected to jam within an hour as thousands of people fitting that profile in just one state compete with each other to get through the eye of a needle.

It is not surprising that someone with an account at Tiffany's or the Cayman Islands may be a bit out of touch with the fact that there are so many people like that. But you'd think they'd at be curious about it.

This is the human reality behind the accountable care act that President Obama has brought to life in the face of rabid opposition. Granted this is not artful legislation. It was a highly compromised before it was even submitted and getting more compromised as it is written into rules and then into real programs on the streets. It is not beautiful, but don't imagine it is not necessary.

The political dwarves are too easy to criticize; they can't help themselves. The fact is that I can't relate much better than Newt to this desperate vulnerability. If you are reading this on your home computer, you are probably out of range of understanding their reality, too. But the poor are not from another planet; their lives are knowable by anyone who cares to know.

This is much on my mind as 28 health systems with a high level of care for the poor will be gathering under the auspices of the White House and HHS offices for Faith Based and Community Initiatives later this week. Every one of us carries tens of millions of dollars of cost for providing care to people who have no money and no coverage for their care. This is for people who don't even qualify for TennCare--another whole notch more vulnerable.

Systems like Methodist Healthcare provide mercy and are proud to do so. But often the request for mercy is so delayed that the care is too late to be effective or very useful. We know that what we give is rarely given at the time that 21st century medical science would want it available. And the poor tend to get their mercy, such as it is, at the Emergency Room, which is the opposite of a sustained relationship with a medical provider trained to manage care over a lifespan.

 Most of the "emergencies" we treat are entirely predictable, if not preventable; they are usually conditions that have a long trajectory easily managed with modern science--but through regular access to a medical provider and access to pills and supporting services. In our weird economy those things are quite simply out of reach of millions of people unless they are covered under a decent insurance program (such as TennCare). 

It is amazing to me that two-thirds of those asking us for mercy last year only needed it one time. The poor are tough and proud.The Tennessee Healthcare Campaign wages a daily, grinding struggle to help our democracy do the right thing for people who need mercy even if they cannot really hope for justice. Your state almost certainly has a similar band of prophetic mercy-makers and justice-seekers. If politics permits and the accountable care act survives somewhat intact, in a bout a year a half there will be millions--not just thousands--of people able to get covered under some level of insurance. That process will be ragged and difficult, too. But don't imagine that it will not be live-saving.It is not even close to justice, but it is a start toward decency.