Yesterday on twitter, I was involved in a long conversation about health care reform and the problems with both the Baucus plan and some Latin@ “leaders” who were willing to give up coverage of undocumented workers in exchange for health care reform in general.
The Baucus bill is inherently flawed:
- It charges fines up $3800 per family for failure to ensure but only funds a “non-profit” health exchange with government money for 1 year
- It offers tax breaks to help pay for health insurance in a time when some groups in this country are experiencing up to 35% unemployment and the national unemployment rate is above 9% – if you are unemployed you don’t get a tax break, if you fill out on EZ form a tax break will likely no bearing on your return
- while it puts an end to exorbitant deductibles it has no cap for premiums or premium hikes
- it has no prohibition against current health insurance providers from starting so-called “co-ops” as off shoots of their existing service and subsequently over-determining price in the “health care exchange”
- IT INCLUDES THE END OF SCHIP which currently covers the majority of at-risk youth in this country and folds their care into the bill in ways that would once again exclude certain marginalized children most in need
- it requires documentation for service, removing the prohibition on interrogating ppl abt their legal status & opening the door for racial profiling
- it fails at basic economics: supply + demand = price; if there is no regulation of the “health care exchange” but the demand is artificially increased by mandatory coverage how does this hold prices down?
- while it omits specific reference to abortion, under the same basic conditions listed above, the failure to cover reproductive choice means that those women unable to pay out of pocket for abortions will be forced to make other, potentially dangerous, choices while there are no prohibitions on the raising of prices for abortions due to the raise in demand from uncovered workers in need
Another critical part of our conversation had to do with the stigma not covering undocumented workers creates for Latinos in general, U.S. citizen children of undocumented workers, and for hard working undocumented people.
Currently there are 4 million children, who are U.S. citizens, living in dual status households. How exactly are these children going to survive when their undocumented parents or grandparents become sick and are excluded from care? As we spoke or re-tweeted parts of a Latin@ hcr conference call, especially about these issues impacting children, I kept going back to a story from my advocate days:
One of my staff and I took a group of female survivors of domestic violence and their children to a community based holiday meal. The meal was held in a large meeting room with painted concrete floors. As we sat down to give thanks for the meal and this time together free from violence, one of the children leaned too far back in her seat and lost her balance. We all heard the sound of her still developing two year old head hit the floor. She didn’t move. And only one single cry, truncated in her throat, before she went silent.
As my staff person and I split up the task of calming the women and checking on the child, I remember thanking g-d that my staffer was also an on call translator for the health care system and had done extensive hospital translation work at both of the nearest hospitals to the dinner. I was also grateful that a close colleague of mine was a LCSW who worked at one of the two hospitals closest to us as well, though her shift was long over. Based on this information, I triaged the child, checking her head for bumps, running the basic tests to see what her level of consciousness was (she had re-opened her eyes and begun to silently cry), and whether it was safe to move her, and then told my staffer to take her and her mother to the hospital while I called for relief staff to stay with the women so I could follow.
By the time I reached the hospital an hour later, I expected that the child in question would have been seen and an initial diagnosis or info about when an initial diagnosis was coming would have already been done. Instead, I found the child lapsing in and out of consciousness in the arms of her frightened mother, stashed in a corner by a pale and angry looking staffer.
“What’s going on?!” I demanded, pulling her aside. In a torrent of frustration, she told me they had checked in over 45 minutes earlier and then been left in a corner. No one in peds had come to check on them and when she had tried to flag people down, they had simply nodded at her and kept going.
I don’t remember what happened next, only the feeling of my hand tightening on the arm of the nurse rushing past us with threatening intensity. The woman had passed us twice, while my staffer explained what was going on and each time given us a disdainful look. This time, she looked at me with a mixture of fear and disgust.
“Why hasn’t that child been seen?” I demanded, quick to let go of her arm but not her eyes.
In a condescending voice she said back “As I’ve told your friend, you will have to wait. We’re doing the best we can.”
I looked around, there was only one other child in the entire area. That [white] child, had come in after we had and already received care for a minor cut on her leg. She was currently being entertained by 3 nurses and given a lolipop by the physician on the floor. The intern was eating a sandwich at a closed area of reception having gotten the stickers/lolipop box out for the others early.
My eyes fell pointedly at the over-staffed room in which the second child sat as I asked, “And what exactly is it we are waiting on?”
The nurse rolled her eyes and started to walk away without answering, so I raised my voice another decimal and said “I need an internal phone so I can call the medical social worker on call tonight.”
Suddenly, the fun and games stopped in the room with the other child. The doctor came out, looked at me, and then made a point of going over and offering a sticker to our Latina mother before coming over and asking if there was a problem.
I told her that as far as I could ascertain, a [brown] child had been brought in with a clear head injury, possible concussion, and/or internal injuries that could lead to hemorrhage and/or death. She may have a fracture or break in her right arm as indicated by the limp and odd angle at which the arm rested against the child. And that as of now the course of treatment recommended had been a “hello kitty sticker.” And then I explained that since it took 4 staff people to treat one [white] child’s minor cut and there were only 6 people in the area, 1 of whom was doing nothing, that I felt perhaps the [brown] child would be better served if the LCSW were brought in to help better explain medical procedure to all of us as well as the complaint form procedures.
We were then told that the mother did not speak English and none of this information had been adequately explained to staff. At which point, my staffer, who was white and born in the USA but wearing a shirt from Oaxaca for the dinner celebration, said that was untrue, that she had explained the situation when she arrived and was handed a bunch of forms and seated in a corner. She also explained that no one came back for the forms and she had to flag someone down to re-explain the urgency and get them to take the paper work.
I said to the Dr, “Clearly we are having a miscommunication. My concern is that [the child] could develop life threatening complications while we sort the miscommunication out. As it is, her failure to retain consciousness for any extended period during this ‘confusion’ indicates that she likely has internal injuries that if not life threatening could ultimately impede her brain development if left unattended. As the physician on the floor that would be your responsibility. So …”
The young doctor did not wait for me to finish my pointed comments, instead she cried out “Well I can’t do anything! We called the pediatrician who speaks Spanish and he hasn’t returned his page.” She shoved the phone log into my hand and said “See, we’ve called him 3 times since that child got here. It’s not my fault! I need consent to do anything.”
At the exact same time, my staffer and I demanded “And why didn’t you call the language bank if there is no one on staff to translate?”
No one said anything, but later the LCSW would inform me that the language bank cost 3xs the price at the hour we entered the ER and the hospital likely did not want to pay them. It had also cost the ER several 1000s over budget to treat undocumented workers & they were “unofficially” under instructions to minimize the care they gave them in order to cut costs.
In the silence, my staffer asserted “I work for the language bank. Why didn’t anybody ask me if I could translate instead of assuming none of us spoke English.”
The hospital staff had obviously assumed my staffer was a white appearing Latina who despite all indications to the contrary could not speak English or worse, b/c she was perceived of as “brown” she was considered too dumb to be helpful.
As we all stared at each, the bilingual doctor arrived, exiting the elevator with a clean shaven cologne smell and flirting with the nurses. When he saw me, he asked if I was the mother, making yet more assumptions based on skin color. When I explained that I was the director of a social service program with medical training and that my staffer was a language bank employee, and that we had been waiting 1.5 hours for emergency care, he looked from us to the doctor on the floor and asked “So why’d you call me? You should have checked this child already.”
While he went and re-did the intial assessment I had done earlier, I called my colleague w/ the LCSW, who arrived for extra clout.
We got lucky that night. The child had a minor concussion and the major swelling had started to go down (no doubt b/c of the cold compress from the emergency kit in my car I had handed to the staffer before they left the dinner). There was no permanent damage. She had bruised the muscle and the bone in her arm but not broken it. Her time unconscious did lead to other concerns but they were ultimately resolved.
The hospital got lucky too. They had intentionally ignored a patient presenting with multiple potentially dangerous symptoms because she was Latina. They failed to engage either the child’s mother or the advocate I sent with her b/c of assumptions about their language skills and/or intelligence based on their race. And they refused to call the language bank and delayed needed treatment to save money.
This situation obviously predates the national level sanctioning of excluding undocumented ppl from health insurance. It occurred in a state that once funded both language services and medical bill grants specifically for undocumented workers and had a policy of not asking for documentation. In other words, it was in a liberal state with the same or better protections for undocumented people than the current hcr bill offers. And yet, a two year old child could have died for the crime of being brown. No one even asked if she or her mother were citizens, they just assumed they were not. And with that assumption came the belief that that child’s life was worth less than that of other children.
Existing treatment of immigrants and the communities from which they come, who are already racially profiled, is not the only example of the medical industry choosing not to provide needed care to marginalized people. As Anderson Cooper reminded us a few years ago, the homeless are also rejected by providers for being too expensive to care for and too marginalized to matter:
When we talk about why we need health care reform, these are the people everyone seems to have forgotten. Mainstream media, on both the left and the right, has failed to interrogate what the Baucus bill will mean to people at the margins who our government thinks can be left behind. Not only does the bill prohibit undocumented workers from receiving health exchange insurance but denies their right to buy into the program. In other words, in a capitalist democracy, a group of people is being denied coverage even if they pay for it on the basis of their country of origin. The bill will also leave 250 million people without coverage. And while the Baucus bill includes exemptions from fines, those exemptions have not as yet been outlined nor has the cost of administrating either fines or exemptions been considered. More importantly, it is unlikely that those qualified, like the homeless, will have the skill set needed to advocate for themselves do get those exemptions. Just look at the way that Latina family was treated with one or more advocates on their side the entire night. Instead, this bill will likely ensure a perpetuation of unnecessary medical complications and complication related deaths as stigmatized populations continue to be afraid of seeking needed care.
Many felt that Obama took the moral high ground back with his health care speech. And clearly many, including in the Latin@ community, felt that some sacrifices had to be made for the greater good. But having been an advocate in a health care system, I can’t help but wonder what existing inequalities the proposed plans will leave in tact and/or exacerbate. To quote Reverend Cortez, “The ugly politics of appeasement are trumping common sense.”