Those cute and cuddly little humans just lucked out: Washington State was prepared to slash the Apple Health for Kids program, a part of the Childrens Health Insurance Program (CHIP) but the federal government intervened and has promised to fund it for the next 4 years. But why would the state even consider cutting a medical program for low-income children? I thought politicians loved babies, they sure love those kiss-baby-on-forehead photo ops, especially if the child is from an ethnic minority. This program was on the chopping block because it funds medical coverage for undocumented children, and in a time of finger-pointing, scape-goating economic woes, those damn illegal aliens are clearly the ones to blame for everything.
Most of the state programs that provide services to undocumented persons are cut, and with $4.6 billion state deficit, it is rightly so. At the risk of becoming a pariah, this must be said: In times of economic recessions, we cannot continue to use state funds to help undocumented people.
But Sam, aren't you Mexican? Didn't your parents come here illegally?
Why yes, yes I am and yes they did. Lemme explain.
While a large majority of Americans claim that undocumented people are largely responsible for the economic hardships and a financial burden in our country, I strongly refute this. There is no proof of this, it is simply an ignorant claim to place blame on a powerless and voiceless portion of our population. I do, however, believe that providing certain services to undocumeneted persons is an incentive to come into this country illegaly.
Let's explore a hypothetical, but all too common situation. Undocumented women know that if they get pregnant in this country, medical services will be paid for. Their child will be a US citizen, making them eligible for state benefits; food stamps, Medicaid, social security, low income housing, etc. As long as the mother can find a legal resident to legally claim these benefits on behalf of the child, she is set for the next 18 years. What need does she have to become a legal resident if she has all her basic needs covered? None, there is no reason or incentive for her to pursue legal residency, especially since the process is costly and time-consuming. And if she is unmarried, unemployed and has more children, all the better for her. Do I think that we should cut maternal services for undocumented persons? ABSOLUTELY NOT. From a public health perspective, providing maternal services is an essential right for all people, regardless of legal status. Afterall, that unborn child is an American and you know how much we love our unborn children.
So how do we "fix" this hypothetical situation? If neither parent is a legal resident, we could say the child doesn't qualify to be a US citizen, and thereby eliminating any state funding for the child. But that would require changing the citizenship laws and is probably unconstitutional. Or we could deport the pregnant woman upon diagnosing her, but pregnancy is not a criminal offense (although in some cases it should be.) Maybe we could offer the woman money in exchange for aborting the child, thereby eliminating a long-term expense, but this is immoral, unethical and just plain wrong. Just how do we fix this?
We can't fix this, it must be prevented. Illegal immigration must be prevented, it is the most compassionate and humane way to address this issue. Building a 9-foot wall along the borders will be costly and ineffective and beefing up border patrol is futile. Let's look at why people come here in the first place: Work. Because they find work easily, employers will turn a blind eye to false documentation in order to hire cheap labor, so we are actually ATTRACTING illegal immigration by providing them with work. We are all too willing to criminalize illegal immigrants but can't criminalize employers who hire them? Don't blame the people, blame the system.
Some will say that I am being selfish, that since I am a product of illegal immigration I should allow others the same opportunity I had. Yes, I am being selfish and that's all there is to it.
Go ahead, be angry. I'm angry too. I'm angry that so many of my family members who immigrated here illegally from Mexico had the opportunity to become legal residents but chose not to during the Amnesty of 1986. I'm angry that my family members who have lived here for 30 years still can't read or write English. But most of all, I'm angry that my family has not taken advantage of all the opportunites available for us, their children who were born here, to succeed and thrive in this counry. Speaking from personal experience, half of my cousins have not graduated from high school, many are involved in gangs and drugs and many rely on state-sponsored programs like unemployment, TANF and food stamps for permanent support, instead of short term support as is intended. Please don't generalize or stereotype, poverty and crime is not unique to me or to my family or to Mexicans or to Latinos: It is a consequence of the immigrant experience, a social phenomenon whereby the diaspora finds their own way to survive in a new environment.
(I should mention that I also have very successful cousins who are serving in the Armed Forces, working in law enforcement and health care, paying their way through college and starting their own families.)
Apple Health for Kids, and any health program for undocumented persons, is a service and incentive for undocumented people to come and stay in our country. But because I believe health care is a right for all persons, I firmly support any primary care program that will increase access to all people, especially the most vulnerable. Access to primary care supports the foundation of our society: our ability to work, reproduce, learn, nourish, coexist and thrive depends on our good health. Our country needs healthy, productive citizens and non-citizens alike in order to function and while the problems of illegal immigration cannot be solved as easily as I have stated, access to health care assures that we are all physically and mentally able to do our part.
I am an Americorps volunteer at Neighborcare Health, a community health organization based in Seattle. After having relocated from Calfornia to Seattle to pursue a career in public health, I'm overworked and underpaid but livin' it up the Americorps way.
*The opinions on this blog do not reflect that of Americorps, Washington Service Corps or Neighborcare Health. Just Samantha's :)*
*The opinions on this blog do not reflect that of Americorps, Washington Service Corps or Neighborcare Health. Just Samantha's :)*
Tuesday, December 28, 2010
Thursday, December 16, 2010
"With great power comes great responsibility" Neighborcare: the Spiderman of health care
Governor Gregoire was interviewed about the proposed Washington state budget for the next 2 years, and with a quiver in her voice she says:
I wanted to write about something positive, something to dispel the negativity of the realities of massive budget cuts, but I've taken off the rose-tinted glasses (read Idealism Waning) and have embraced the nasty truth: This will hurt. It will hurt everyone, I'm not just talking about those poor people, those "welfare" recipients, those people who suck taxes from hard working Americans. It will hurt YOU. K-12 education, slashed. Higher education costs increasing with no end in sight. Are you a disabled Washingtonian? You might think about moving, if they don't take away your wheelchair or crutches first. Public transportation, corrections, state agencies, state parks are feeling the budget blows. And since we, the Washington voters, rejected tax increases from the recent elections, our state legislature really had no other choice. Geez, I guess on the positive end we aren't as f*****d up as California. Awww, we're gonna miss you, Ah-nold.
But cutting the Basic Health Plan of Washington? This program is not a hand-out, as many may erroneously believe, it's a state-sponsored insurance program that people PAY INTO. Again, PAY INTO, unlike Medicare, which typically has no co-pay or fees. But with the rising costs of healthcare and the decreasing budget, BHP of Washington was closed to new enrollees a while back but unfornuately, just didn't make it off the chopping block this time around. Now all those families (66,000 people) will need to find an alternative method to receive affordable medical.
In comes the health care hero Neighborcare Health, with a sliding fee scale for eligible families. Based on your income, you can receive medical, dental, laboratory and prescriptions at a discounted rate, up to 90%. (Unfortunately it doesn't cover hospitalizations) This isn't unique to Neighborcare,all community health centers offer a sliding fee.
Storytime:
Back in the 60's during the Civil Rights movement came an additional, less famous movement called the Free Clinic movement. Then came Medicare, HMOs, and my BFF Reagan and from here spawned the Community Heath Clinic movement. NOTE: the word "free" is nowhere to be found. LOVE YOU REAGAN! Communithy health centers are non-profit clinics that provide health care for low-income families. Mexico has Centros de Salud, a similar model but are 100% government sponsored. CHC's are not government clinics, they use taxpayer money, grants and private funding. While there is a range of classifications of CHC's, all of them have some government funding, target specific communities (ie- migrant, geographically isolated,rural or urban) and, like every non-profit, have a board of directors. Board of directors means TRANSPARENCY, every single dime spent must be accounted for, unlike private HMOs or PPOs who can charge whatever the hell they feel like. Neighborcare has been around since the Free Clinic movement, althought by different names, and is a long standing model of CHCs in the United States.
CHC's rely on government health programs, like BHP of Washington, for reimbursement for services. It's a catch-22, cutting BHP of Washington means more people will be uninsured, so more people will need our clinics, but without funding from BHP of Washington Neighborcare will have to cut hours, staff and services. Yeah it sucks, but we can tough it out. Neighborcare's 50 years of resilience is credited to smart budgeting, aggresive acquistion of grants and funding and high efficiency.
Efficiency in health care? Hm, what a concept. If we treated health care like we would a factory, we would see major changes in cost and better services. But that's another blog for another day.
I hate my budget. I hate it because in some places I don't even think it's moral. Who'd have ever thought that I would be doing this.
I wanted to write about something positive, something to dispel the negativity of the realities of massive budget cuts, but I've taken off the rose-tinted glasses (read Idealism Waning) and have embraced the nasty truth: This will hurt. It will hurt everyone, I'm not just talking about those poor people, those "welfare" recipients, those people who suck taxes from hard working Americans. It will hurt YOU. K-12 education, slashed. Higher education costs increasing with no end in sight. Are you a disabled Washingtonian? You might think about moving, if they don't take away your wheelchair or crutches first. Public transportation, corrections, state agencies, state parks are feeling the budget blows. And since we, the Washington voters, rejected tax increases from the recent elections, our state legislature really had no other choice. Geez, I guess on the positive end we aren't as f*****d up as California. Awww, we're gonna miss you, Ah-nold.
But cutting the Basic Health Plan of Washington? This program is not a hand-out, as many may erroneously believe, it's a state-sponsored insurance program that people PAY INTO. Again, PAY INTO, unlike Medicare, which typically has no co-pay or fees. But with the rising costs of healthcare and the decreasing budget, BHP of Washington was closed to new enrollees a while back but unfornuately, just didn't make it off the chopping block this time around. Now all those families (66,000 people) will need to find an alternative method to receive affordable medical.
In comes the health care hero Neighborcare Health, with a sliding fee scale for eligible families. Based on your income, you can receive medical, dental, laboratory and prescriptions at a discounted rate, up to 90%. (Unfortunately it doesn't cover hospitalizations) This isn't unique to Neighborcare,all community health centers offer a sliding fee.
Storytime:
Back in the 60's during the Civil Rights movement came an additional, less famous movement called the Free Clinic movement. Then came Medicare, HMOs, and my BFF Reagan and from here spawned the Community Heath Clinic movement. NOTE: the word "free" is nowhere to be found. LOVE YOU REAGAN! Communithy health centers are non-profit clinics that provide health care for low-income families. Mexico has Centros de Salud, a similar model but are 100% government sponsored. CHC's are not government clinics, they use taxpayer money, grants and private funding. While there is a range of classifications of CHC's, all of them have some government funding, target specific communities (ie- migrant, geographically isolated,rural or urban) and, like every non-profit, have a board of directors. Board of directors means TRANSPARENCY, every single dime spent must be accounted for, unlike private HMOs or PPOs who can charge whatever the hell they feel like. Neighborcare has been around since the Free Clinic movement, althought by different names, and is a long standing model of CHCs in the United States.
CHC's rely on government health programs, like BHP of Washington, for reimbursement for services. It's a catch-22, cutting BHP of Washington means more people will be uninsured, so more people will need our clinics, but without funding from BHP of Washington Neighborcare will have to cut hours, staff and services. Yeah it sucks, but we can tough it out. Neighborcare's 50 years of resilience is credited to smart budgeting, aggresive acquistion of grants and funding and high efficiency.
Efficiency in health care? Hm, what a concept. If we treated health care like we would a factory, we would see major changes in cost and better services. But that's another blog for another day.
Monday, December 13, 2010
Idealism waning
It's been 89 days of my year of Americorps service and only now do I have enough to write about in a blog. Up til a few weeks ago, my position and duties have been vague, which was nice because no pressure or responsibilities fell on me, but dull because I like to stay busy and get those service hours in. Service hours, Americorps jargon for slave labor, is 1700 hours of service in 10.5 months, which if you do the math right is 40 hours a week without any time off, like, not at all. But since I'm busy now, those hours will fly by even though I'm quite exhausted (hence the witty title"service corpse")
Every week I have a meeting with my supervisor, Michele, and we discuss what projects I'm involved with and what's going on. With the massive state budget cuts going down, she informed me that adult dental services are pretty much totally eliminated. What does this mean, you ask? Well, since our organization is a community health center, we rely on federal and state funding to provide services to our patients and keep our clinics afloat. The majority of our patients are uninsured, unlike private clinics whose revenue is based on insurance reimbursements or cash for services and so we rely on government funding to pay for services provided. Medical coupons, AKA state Medicare, will no longer cover adult dental services, so basically we cannot see Medicare adults at any of our dental clinics,wiping out a large chunk of our already diminishing revenue.
When I was hired, we (Emily and I, another Americorps volunteers)were told our job was to increase the integration between medical and dental patients, try to get pediatric and OB patients to receive services for both. And the idealistic Sam-I-am believed we needed to do this to provide our patients with overall well-being, to make them healthy from every orfice top-to-bottom, for preventive health, to protect the vulernable,to help the neediest of our community! But really, there is solid grant funding for these services, and the more preggos and kiddos we get into the dentist, the more funding we can secure and keep all the programs and employees in our organization running. While the service to the underserved element still exists, the harsh, cruel reality of a time of budget crunching is this- we need money and we will target YOU to get it. Whom is providing the service to whom?
Then Michele shared her experience with her first major disillusionment after she graduated nursing school.Reality is not our ide-ality, as much as our idealism motivated us to get through college, get through gradute school or med school or nursing school, it just doesn't fly in the real world. There is suffering, there is immense poverty and budget cuts everywhere you look and affecting everyone, and to quote the 2010 #1 You Tube viral video star Antoine Dodson "Hide yo' kids, hide yo' wife, hide yo' husband cuz they be rapin' e'rbody."
What's next, you gonna tell me Santa's not real or that puppy kisses don't cure broken hearts? Most of us who are called to service, be it the Peace Corps, Americorps, the seminary, are motivated by some altruistic voice in our heads; a desire to right the wrongs in this already f****d up world. With all the suffering in the world, and perhaps due to the suffering we faced ourselves, we feel an obligation to serve and relieve the innocent from unnecessary suffering. Personally, I find health and social justice to be a teaching of Jesus Christ, to serve my brothers and sisters by making sure they get their flu shots and prostate exams.I guess "medical coupon" is something the Gospel according to Mark lost in its translation from Hebrew to English, or maybe Jesus just straight up forgot to mention it while performing His miracles.
Still, I'm not completely broken. The world keeps chugging along, people come into our clinics and get their care, manage to pay (or evade payment and get a call from collections) and we all live as best as we can. Is it fair that we should aggressively seek children and pregnant women to get their money and redirect it to the office coffee service? No, but at least we got them into the clinic, gave them an excellent, high-quality level of care and we'll see them again in 6 months for another Well-Child check or after another OB visit. Someday we'll be able to get adults back into our dental clinic, but who knows when that'll be and we can't really worry about that now. It's not that we dont care, we do care, we really, really do, but we how can we care if we don't have a job with which to care through?
Every week I have a meeting with my supervisor, Michele, and we discuss what projects I'm involved with and what's going on. With the massive state budget cuts going down, she informed me that adult dental services are pretty much totally eliminated. What does this mean, you ask? Well, since our organization is a community health center, we rely on federal and state funding to provide services to our patients and keep our clinics afloat. The majority of our patients are uninsured, unlike private clinics whose revenue is based on insurance reimbursements or cash for services and so we rely on government funding to pay for services provided. Medical coupons, AKA state Medicare, will no longer cover adult dental services, so basically we cannot see Medicare adults at any of our dental clinics,wiping out a large chunk of our already diminishing revenue.
When I was hired, we (Emily and I, another Americorps volunteers)were told our job was to increase the integration between medical and dental patients, try to get pediatric and OB patients to receive services for both. And the idealistic Sam-I-am believed we needed to do this to provide our patients with overall well-being, to make them healthy from every orfice top-to-bottom, for preventive health, to protect the vulernable,to help the neediest of our community! But really, there is solid grant funding for these services, and the more preggos and kiddos we get into the dentist, the more funding we can secure and keep all the programs and employees in our organization running. While the service to the underserved element still exists, the harsh, cruel reality of a time of budget crunching is this- we need money and we will target YOU to get it. Whom is providing the service to whom?
Then Michele shared her experience with her first major disillusionment after she graduated nursing school.Reality is not our ide-ality, as much as our idealism motivated us to get through college, get through gradute school or med school or nursing school, it just doesn't fly in the real world. There is suffering, there is immense poverty and budget cuts everywhere you look and affecting everyone, and to quote the 2010 #1 You Tube viral video star Antoine Dodson "Hide yo' kids, hide yo' wife, hide yo' husband cuz they be rapin' e'rbody."
What's next, you gonna tell me Santa's not real or that puppy kisses don't cure broken hearts? Most of us who are called to service, be it the Peace Corps, Americorps, the seminary, are motivated by some altruistic voice in our heads; a desire to right the wrongs in this already f****d up world. With all the suffering in the world, and perhaps due to the suffering we faced ourselves, we feel an obligation to serve and relieve the innocent from unnecessary suffering. Personally, I find health and social justice to be a teaching of Jesus Christ, to serve my brothers and sisters by making sure they get their flu shots and prostate exams.I guess "medical coupon" is something the Gospel according to Mark lost in its translation from Hebrew to English, or maybe Jesus just straight up forgot to mention it while performing His miracles.
Still, I'm not completely broken. The world keeps chugging along, people come into our clinics and get their care, manage to pay (or evade payment and get a call from collections) and we all live as best as we can. Is it fair that we should aggressively seek children and pregnant women to get their money and redirect it to the office coffee service? No, but at least we got them into the clinic, gave them an excellent, high-quality level of care and we'll see them again in 6 months for another Well-Child check or after another OB visit. Someday we'll be able to get adults back into our dental clinic, but who knows when that'll be and we can't really worry about that now. It's not that we dont care, we do care, we really, really do, but we how can we care if we don't have a job with which to care through?
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