05 Apr

In the Great Recession, Even Death Is Too Expensive for the Poor


In the Great Recession, Even Death Is Too Expensive for the Poor

 Written by Sanjay Basu

Rita is only in her 30s, but she knows all about death.  What she didn’t   know until recently is how expensive it is, especially now in the Great   Recession, for the poor to die.

Rita’s parents, her only  relatives in the U.S., died in a car crash during  her sophomore year in  community college.  Rita dropped out of school to earn a  living as a  shipping coordinator at a Bay Area package company. A few years  later,  she found herself coughing and coughing.  She was always short of   breath. Tests revealed that Rita had a rare and fatal disease of unknown   origin–one that leads to the slow closure of the blood vessels feeding  the  lungs. She will suffocate to death before the age of 40.

“I  know the end is coming,” she tells her doctor and nurses; after many   meetings with her chaplain, she is, she says, “at peace.” At the medical  clinic  in San Francisco’s General Hospital, Rita tells anyone who will  listen that she  has two goals.   She wants to continue living with her  cat in her one bedroom  apartment in the Mission District of San  Francisco. And she hopes to continue  receiving the few medications that  mitigate her symptoms.

There are currently more than 1.2 million  Americans like Rita who are facing  a terminal illness. The health care  providers who treat them routinely have to  ask:   How do you wish to  die?  Some of the dying–wanting to keep death at  bay–repeatedly ask to  participate in the latest pharmaceutical trials. Others  have drawn up a  “bucket list” of adventures for their final days. But more  people have  two simpler requests: to die at home instead of in a hospital, and  to  eat a decent last meal.

In this recession, even these simplest last wishes have become nearly  impossible for many to fulfill.

Two  years ago, Rita fainted on the job. Her boss had noticed her   diminishing level of performance; he said that Rita was just too winded  to  work. Unemployed, she initially received disability coverage. But  like the  other eight million Americans unable to work because of  illness, she was  required to apply for a continuation of benefits after  one year.

Rita’s problem–the clinic’s social worker  explained–is that like most young  people who are ill, Rita is dying too  young to have paid significantly into  Social Security. This meant Rita  would receive “Supplemental Security Income” (SSI): $830 a month and  California’s Medi-Cal insurance.

Initially, Rita thought she  could stretch these funds. She would have to  give away her cat and move  into a studio apartment–something smaller and  cheaper than the average  studio in San Francisco. She would also buy food in  bulk, saving at  least $200 a month for her prescription co-payments.

But the  politics of budget cuts stifled her plans. Over 65 percent of SSI  claims  have been denied during the recession, a record high number. A series   of the governments reviewers of her case interrogated Rita, and one  without any  medical training misinterpreted her medical chart. Despite  the fact that Rita  had “pulmonary arterial hypertension”–severely  increased pressure in her  lungs–he wrote that Rita suffered from  run-of-the-mill high blood pressure.  Rita was denied.

The  clinic’s social workers tried to intervene. They were told that Rita   would now have to wait for an “appeals hearing” after 90 days–possibly  longer  that she had left to live. She would be without income for her  last months of  life.

Due to new state budget cuts, Rita’s  Medi-Cal coverage was also limited to  six medications.  Her doctors had  to decide which pills they could take away  without suffocating her  immediately–a deadly guessing game since there is not  enough research  to guide doctors in forecasting a regimen.

When clinic workers  discussed the dilemma, Rita joked: “I should have been a  banker instead  of an ordinary taxpayer. Then I could have been bailed out.”

Rita  lost her apartment. She slept for a few weeks on an ex-boyfriend’s   couch, until he threw her out, suspecting her cough was from an  infectious  disease. She had signed up for welfare, at the usual rate of  $422 per month  plus food stamps. But without an address, the only way to  get a roof over her  head was the City’s “care not cash” program for the  homeless–$59 a month, and a  shelter bed.

Rita’s inhalers were  stolen on her first night in the shelter.  Her shoes  were stolen on the  second night.  So she began to sleep in the parks, her  symptoms  worsening.  Finally her doctors convinced her to check in to the   hospital.

In the hospital, Rita was stoic.  Her face had assumed the tough sheen of  ceramic.

When  a social worker asker her whether she would be willing to modify her   plans, let the clinic find her a hospice bed, Rita said she had written  it all  down.  She couldn’t discuss her thoughts with any more clarity.   And besides,  going over her problems would only make her cry.   And  crying made it difficult  to breathe.

This post was originally published by New America Media.

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