Thursday, July 31, 2014

We're in trouble. And I hope it is not too late.

When I was about eight years old, my father took me on a fishing trip to Montana. On the way, we stopped at Yellowstone National Park. This was absolutely fascinating to an eight year old boy who had never been anywhere so amazing.

On the way to Old Faithful, the traffic became backed up several times. My father called it a "bear stop." Yellowstone bears would stop traffic. People would take pictures. Some would feed the bears. 

My father, having grown up in that part of the country, was prepared for the bears. He opened a can of sardines. In front of me, right out the window, he fed sardines to hungry bears. Wow that was fun. It seemed so innocent at the time and the right thing to do.

Today, Yellowstone Park doesn't allow this. Bears had become so habituated to human handouts that they didn't forage on their own anymore. It was just too easy to get a handout from the humans every day. Yellowstone wasn't a petting zoo, it was a preserve and refuge for animals. Rangers worked hard to stop the behavior to protect the animals. That was actually the right thing to do.

Listen to me: I don't want to hear any whiny liberal crap about how you shouldn't judge or you don't know the story. I do know the story. My microcosm of the world is a glimmer of everywhere.

We're in trouble. And I hope it is not too late.

I'm talking about government entitlements, specifically Medicaid. When you give something to someone "for free" without any consequences or limits, they become dependent on it. I've seen it over and over. I have so many patients on Medicaid. Some have really low income. Some have average income. A few drive expensive cars and are on Medicaid. I have a doctor in an expensive neighborhood with two boys that get their Vyvanse at no charge to him. He's a doctor, but his kids' meds are free. I have other patients that are on government assistance... have been for years, and do nothing to get out of the hole. Nothing.

I don't have an abnormal cluster of Medicaid patients. This is the same all over. Just like the Yellowstone bears, people have lined up and have become habituated to the government paying for their medication. They get their medication at no charge or "nearly free." 

I'm really sorry if this offends you, but this is a very clear signal for trouble ahead. When the public becomes dependent on government assistance, they lose the drive and tenacity to pursue income on their own. Why would you work hard for something if it is just going to be given to you? 

I am not a heartless bastard. I understand that people run into financial problems. I've been there, believe me, I absolutely know what it is like to start over from scratch. No one wants grandma to suffer or go without her medication. No one wants children to suffer. BUT there has to be a limit!

Government entitlements: It's just like feeding bears in Yellowstone, it seems so innocent and feels like the right thing to do. But it isn't. To expect the government to take care of you... no, it's just not acceptable because it creates dependency. 

Wake up, people. Wake up.


Anonymous said...

Aw, c'mon. They're getting medicines, which may very well be the result of prior bad life choices, but are nonetheless necessary to keep chronic conditions under control. If nothing else, free medicines avoid the need for expensive hospital stays. It's the same reasoning that Medicare uses to make hospice somewhat attractive: Avoids more expensive hospitalization for end-of-life conditions.

Second, you're probably right that more people than should are getting disability, medicaid, food stamps, etc. But if you have meager skills, if the economy is awful so there are no low-wage, low-skill jobs, and if the amount such jobs pay IF you could get them still doesn't allow you to live properly, what choice do you have? Maybe there should be programs that encourage and support people so they stop needing assistance but you can't cut them off at the knees. The bears have a choice: they can forage. What choice do people have? Theft?

And if there are people like your doctor example that seem to be gaming the system, then, yes, there should be attempts to investigate and prevent such things. But my guess is that the bulk of the people getting assistance of one sort or another are incapable of getting a good job, unable to live on the kind of job they might get, and, yes, have given up even trying because it's easier--and if you want that to stop, you have to make it possible for these people to find work that will be more lucrative than their assistance. The economy still sucks and employers are still complaining that they can't afford a higher minimum wage (despite the current one being ludicrously low). How do you propose to fix that?

Unknown said...

Really hildegarde? Ive been trying to find full time even regular part time for 5 years...I cant get hired for minimum wage because im too freakin over qualified...I've been told since I'm a pharmacist, my past wage history is too high and even though I am willing to work minimum wage, they deny me a job because they dont want to waste their time with training etc because they know I will 'bolt' as soon as a job in my field opens up. And thats the ones who even reply to my sending in a resume, 99% dont even bother to reply or acknowledge they recieved my resume/application. Its all done via online now. No one takes applications in person I have engineer friends out of work just as long. Relocation is out of the question as housing market is down and being out of work my credit is in the basement. I get occasional temp jobs which im grateful for but id rather be working regular. BTW since I own my house and my car is not a POS, I dont qualify for any govt services. We survive on my husband low wages and what family can help with. Not everyone has given up but I will say when I worked retail a majority of my medicaiders had absolutely zero desire to work or even look for work they preferred to live off the dole and bragged about it

Anonymous said...

Bears are wild animals that can forage for themselves.

Grandma can't. Your kids? Can't.

We have these things called elder abuse and child abuse. They're pretty bad.

You're telling me that you want grandma to suffer because she can't afford her medicine. You're saying that you want single mom over there to have to pick between buying food, and buying medicine. You are advocating the perspective that results in people going "no, it's not that bad. It'll go away." .. I've known people who had broken bones who said that. I had a friend who's gallbladder very nearly killed them because they didn't want to go to the hospital because htey couldn't afford it.

No. you're talking about symptoms. Here's the problem: People are given help based off of a form they fill out. And Doctors.. don't always do a fantastic job of taking care of people. That same friend with the gallbladder was told she had heart burn. So yeah.

The problem with the system is from the ground up. You're just pointing out some of the flowers.

Cian said...

People get broken out of that habit a lot quicker than bears would though.

The social insurance scheme here has gone from no co-pay to a modest one in three even more modest jumps and despite much gnashing of teeth, "you have to give it to me! I'll die otherwise..." complaints (overheard that line being used for many, many things where fatality wasn't a possible result) and similar; people just pay it now. There's a few old generics where it's cheaper to buy a six month private supply than pay six co-pays meaning some are even getting weaned off the social insurance entirely.

Anonymous said...

Im sooooo tired of all the excuses given in defense of Medicaid. Especially since the beginng of 2014, the number of people now on Medicaid is staggering. I'm especially tired of "Do you want grandma/young child/(insert group of choice here)to be without their medications???" I have been a tech for over 15 years, and I have never seen "free" medications keep people from having expensive hospital stays. People with private prescription insurance have expensive hospital visits too. Where do people come up with type of rationale??? Most of the people I have dealt with on Medicaid DO feel entitled, and are constantly at the ER for coughs, headaches,cold symptoms, etc., and expect their Tylenol and robitussin rx's to be covered, while purchasing make-up, soda, candy, cigarettes, etc. And like CrazyRxMan, I constantly see people on Medicaid driving near to brand new cars, expensive cell phones, salon hair/nails, etc. There is at least 2 customers on Medicaid I can think of off the top of my head who drive luxury cars (Mercedes, BMW) carry designer bags and constantly want early refills on their rx's *because they are leaving the country to go on vacation* !!!! I haven't been able to afford a vacation for a long time, I don't have cable, a still have a landline, I drive a 10 year old car, am uber careful with my spending habits, and I REALLY REALLY resent having to be careful with my money and having to make choices and go without certain things so these abusers, slackers, etc. can have their free meds and healthcare.

My company offered such lousy insurance that I couldn't even afford to use it, I had to really pick and choose when I could see the doctor and then pay out of pocket because depending where I went I could get a cash discount.

Welfare was created to help people who really needed it, the poorest of the poor, the sickest of the sick, and those families with young children who were temporarily in need. And again like CrazyRxMan, I see able-bodied people who have been sucking off the government (you and me) for *years and years*.

I have yet to see "grandma" go without medication; a lot of seniors on Medicare part D have seen their copays skyrocket, while low-income seniors pay moderate copays, and some get a free ride. The seniors and veterans who have been paying into the system for a long time are the ones getting screwed, and the ones who can't speak English pay pennies on the dollar or nothing.

And children? I have yet to see a child that needs Vyvanse to live. I resent women having babies upon babies they can't afford to take care of, and are rewarded with more welfare (again, paid for by us, the taxpayers) feed their children sugary junk food and drinks that end up so hyper doctors prescribe expensve ADD meds. I DO see constant scripts from the ER for OTC medications and antibiotics that the taxpayers *are* paying for, again, while mom is buying the afore-mentioned crap and non-neccessities.

I'm so fed up with our government, and people like some of the commenters here, and welfare slackers. I'm tired of working my ass off and not getting to enjoy the fruits of my labor so that a huge part of the population can get a free ride.

Medicaid needs a complete overhaul. The criteria and proof of eligibility needs to be much more stringent. For all of you who think otherwise, feel free to tell the government you'd like them to take out an even bigger chunk of your paycheck to support Medicaid.

Anonymous said...

It always makes me sad that emergency programs like medicaid get completely taken advantage of by shitty people.

Medical care is expensive, and even though I'm a poor college student, I also have a job and have to save my money up to make sure I can go to the doctor when I need it, etc. (I have one of those types of insurances where you have to pay out a large deductible before coverage kicks in) This year, I had to save up the cash/borrow a bit from family to get a much needed surgery that cost about $1,500. As a result of this, I make sure to only go to the doctor or use medication when I really need it.

On the other hand though, I know a few people I went to school with years ago that are on Medicaid and as a result, have a new bullshit medical issue every month, and have had tons of minor surgeries and other procedures. This one girl I know who is my age (25) has like four different specialists for different pain problems! According to her, she has all over joint pain, knee pain, and back pain so she can't work... Yet she can go to an amusement park all day or party all night at a rave..

It just blows my mind. I had to save up for six months to pay cash for the one surgery I've ever had. I guess when someone else is footing the bill though, you never think of the huge impact it has.

Anonymous said...

I agree with you, 100%!! These government programs are being used and abused lately. It's changed the moral fortitude of an entire generation!! People who are on these programs shouldn't be going out to restaurants, but they are. They shouldn't be buying pre-made meals on food stamps, but they are. Back in day (yes, I'm probably considered old by some), it was embarrassing to be on public assistance, now I hear people saying, "When I get my check" or "When I get paid", they aren't getting paid, they are getting a handout!! And don't even get me started on the ones who have free or subsidized housing!! Oh gosh! And the food-stamp president is right. The people who are exploiting that is off the charts! And their cupboards are much fuller than ours and we're paying for it, now how does THAT make sense? We pay $1,200 a month for our insurance premiums and our co-pays are high. For many of our medicines, the co-pay is $15 but lately some of them have been $35, $50, or $75! I live close enough to Mexico that I may start driving down there, except it's dangerous to go there. But what is the answer?

Anonymous said...

It's a complex problem, because on paper you can't separate the people who are truly in need from the ones who are gaming the system. We've received various bits of aid since my husband's business went under in the crisis, and we've never stretched the truth on an application or taken a penny more than we truly needed. Hell, right now I'm eligible for medicaid and I kept my private insurance instead (for reasons that aren't worth going into here). We worked our asses off to get out of the hole we were in, and were almost out of it when Life Happened and knocked us right down to the bottom again. So we're climbing as best we can...

I think the problem is substantially structural. A lot of benefits aren't lost on a sliding scale; one day you qualify, and the next you don't. So we faced things like a promotion that earned me an extra $100 a month adding $200 a month (and sometimes more) in medical expenses because the adults lost medicaid. Where's the incentive to climb out of a bad situation when you can't afford to? I shudder to think of what it would have done to the budget if the kids had lost it, though I would have been damned proud to make it out of the system if it had ever happened.

Not sure this all makes sense and make of it what you will, but the tl;dr is that this current benefits recipient is both damned grateful and thinks that the program desperately needs restructuring to make it viable/preferable for people to get the hell off of it.

Anonymous said...

Preach Crazy RxMan! One thing I'd like to see is all Medicaid recipients get drug-tested periodically to remain eligible for aid. So many druggies out there leeching off the system. Also I'm sick of hearing all these euphemisms. Medicaid is PUBLIC AID, not insurance. I hate it when they complain about $3 copays or get angry about a medication that isn't covered or requires a PA. So many times I have to bite my tongue when I really want to say, "Seriously?!"