Insurance, Discrimination,and Privilege

Now I am the first to admit that I am no scholar of Obamacare, or what other countries offer for state/national insurance. However, I do know that what we have is a culture in which those who rely on state-issued insurance (in NY, it's Family Health Plus, Child Health Plus, and/or Blue Choice Option depending on one's income level) are looked at as less than, and do not have access to equal and humane health care.

I am not a scholar of insurance, and I get bogged down in the SCOTUS arguments, but I do know that I have been using Medicaid and state insurance on and off since I was an adolescent and I want to relate my own experience of a parent who has had to watch her children get substandard care, or be refused medical care because we are not middle-class enough to afford private insurance.

There are a few things about this:
1. Many doctors refuse to take Medicaid patients at all, or have those less experienced in their practice or hospital care for those patients.

2. Private insurance companies AND Medicaid are able to negotiate fees with medical providers, whereas it is almost impossible for an uninsured patient to enter into those same negotiations, thereby having to pay much more for services than the provider would get paid through insurance.

3. Medicaid is a pain in the you know what to work with for doctors, so I kind of understand that they don't want to deal with the hassle of fighting to get paid for their services, so the state insurance system itself is partially at fault for all of this - but who suffers for it?

4. Private insurance is ridiculously expensive. The last time I had the opportunity to purchase it through my employer, it would have cost over $500/month to insure my family. And I was making just enough too much money to qualify for Family Health Plus. So we had to go without insurance.  This is not an isolated case.

5. The hoops you have to jump through to qualify for state insurance are confusing.  I have been told confidentially that they are purposely difficult. If you are self-employed, you can pretty much forget it for at least the first year. Paperwork gets "lost," phone calls are not returned, caseworkers are abusive.

6. My family has been refused treatment by a number of doctors, "misdiagnosed," and treated poorly by more office staff than I care to remember, by virtue of having Family Health Plus, rather than private insurance. Does that sound paranoid? I assure you, it's not. I have spoken with a number of trusted medical professionals who assure me that this is the norm, and I personally know many families who have had this same experience, both in Pennsylvania where I lived for 30 years, and here in NY state.

The last time I lived in Monroe County, my caseworker was so abusive and mismanaged our application and renewals so badly, that I tried to work with her supervisor. He never returned any of my phone calls, the caseworker's voicemail was always full, which bounced me into a neverending loop of "press 0 to talk to an operator," which went to another menu, which returned to original menu, which eventually hung up on me. I eventually ended up having my case managed through the County Commissioner's Office, because even the ombuds(wo)man was unable to untangle the knots of evasion and abuse that were happening in the Assistance Office.

Now, I'm white, college educated and pretty savvy. I can't imagine what it's like for the many city residents who are black or hispanic, uneducated, cannot advocate for themselves, and don't know how to bark up the food chain for fair treatment based on their income. I mean, I only knew to call the Commissioner's Office because my mom is a retired nurse and knew what the next step was. It's certainly not published anywhere easily accessible that this is an option.

This is only going to (and I'm sure has) become worse, as unemployment rates hover around 10%, businesses stop offering insurance benefits, and private insurance options have not caught up to Obama's vision of affordable health care. The system is surely flooded and overwhelmed, and is filled with untrained folks who have grown up in a culture of racism and prejudice against the "poor."

Since my husband is self-employed, and I've worked a variety of part-time jobs while finishing my BA and M.Div, we have been using state insurance in all its varieties (paying some, paying nothing, going uninsured) for almost 10 years now.  The latest frustration was that my daughter had a defect in her tooth, and getting it taken care of in a timely fashion, with competent medical professionals was a long, arduous, humiliating, and frustrating experience. I could not be more grateful to be getting health insurance through my chaplaincy residency in September. But wait! Even that won't cover the dental care two of my children need without bankrupting us with thousands of dollars in co-pays! So, I still have to go back in and apply for supplemental state insurance to assist with that.

There are very few dentists, and almost NO pediatric dentists that take state insurance in Monroe County, where we now live.  There are exactly ZERO dentists in Wayne County where we lived for 4 years, so those folks must travel to another county to get dental care. For a number of years, adult state insurance didn't cover dental care at all. A year ago was the first time I was able to go to the dentist for a regular check up in seven years.

We are lucky to have found a wonderful pediatric dentist who takes a conservative approach to dental care, and is kind and patient with my kids. However, my daughter's tooth required a root canal, and there are NO pediatric or other endodontists that take state insurance that she could refer us to. We could go to the dental clinic, but it's first come, first serve (requiring hours of waiting) and our dentist assured me that the head endodentist, while excellent, does not see Medicaid patients and that we would have to see a resident, first-come first-serve, which means that though they are supervised, they may have very little experience with the kind of care a person might need. I don't have anything against residents myself (being one), but I do have a problem with a supervising doctor creating an atmosphere of discrimination against Medicaid patients with their staff and residents.

I also know that one can get great care at the dental clinic - and one can get abysmal, dangerous "care" there, and that the supervising attending is not always present.

Eventually, after an all-night ER experience, where I had to fight for pain management for my child, educate the on-call ER dentist (who had very little pediatric experience) that whatever it was that he might choose for his child didn't apply to me because he had awesome private insurance and I don't - and by the way, he's now working in a city hospital with an economically diverse set of patients, so he might want to eliminate the phrase, "If it were my child," from his vocab until he goes into private practice - and eventually have an adult molar removed, because the damage was so advanced, we are now looking at the necessity of orthodontic intervention (again, with huge co-pays) to avoid other damage to her teeth because she couldn't get timely care because we have state insurance. (I apologize for that astonishing run-on sentence).

The point? My story is not an anomaly. As a matter of fact, my story is probably better than a lot of people that live in this city and state and country, because I'm a pain in the ass and can politely demand what I know is reasonable, humane, and ethical for my children's care without getting thrown out for my skin color, accent, or other identifying features. My point is that my story, while better than many others, still sucks. Health care in this country is a hot mess.

My other point is that it's not just "poor, white trash," or "blacks" or "hispanics," who are "lazy and milking the system" who are using state insurance. It's many, many people, of all races and means who have been effected by the global economic collapse, whose employers find ways around offering benefits, who fall between the cracks because they work part-time in the food service but still make too much money to qualify for assistance. It's time to stop making assumptions about "the system" and those who use it. It's time to start treating all people with respect and dignity - because we really don't know the whole story 99% of the time. And after all, we are the 99%.

Surrounded by light and dark

Thats what we deal with, each and every day. Moments of the divine; of joy, of light, of clarity of vision. Moments of despair; at the state of the world, at our own failings, at the little details that can overwhelm our ability to see the big picture. Home again, with a pile of dogs at my feet, waiting for breakfast; listening to Lucy sing quietly as she plays with dinosaurs and writes in her journal; these moments of homegrown bliss are held up next to a front page of news that brings tears to my eyes. Syria, shootings in Aurora, the global economy, just for a start. Last night my 16 year old was talking to me about how she couldn't really relate to a Bloom County book we had laying around. The Cold War is a piece of ancient history to her. I told her, how as a young girl, I used to lay in bed terrified that a nuclear war would start. I asked her what she is afraid of, wondering how it is to come of age post 9/11. She told me that most of her nighttime fears come from the effects of global warming. Will the ice caps melt? Will out of control weather patterns destroy our earth? My spiritual director warned me that this summer would be a tender time. She was right. There are so many tender spots in my heart that can now be examined. Prayers for all of those grieving from violence, discrimination, war; and prayers for all who love them. May we all find light and joy in the midst of difficult times and the fears we hold in our deepest selves.

Diving deep and getting tossed

10 days of what for me, is immeasurable sloth. I've done dishes and laundry, and even cooked, but it's a mimalist existence here with a few books, sand, saltwater, and typical boardwalk fare. The food is rich and happy-making.

I am sloughing off four years of academic rigor and study, stress of fellowship proceedings (to be reengaged with in the fall), loss and grief and joy and success. I'm purposely thinking of little, reading fiction that pleases me, watching trite TV, and enjoying teaching my kids the deep love of the ocean that I hold. The heat, the rhythm of the tides, the art of swimming, and how to lose one's dignity with laughter when you get knocked around by an unexpected wave or you time the crest wrong, or it was bigger than you thought. Digging in the sand to hold sand crabs and feel them ticle your fingers, or finding beds of uoung clams and laughing tomsee them swim in their fashion. The sustenance of blue crab and oysters and crab legs and shrimp and stuffed salmon that is fresher than anything they are likely to taste any distance away from the shore.

The seashore has a life and tide of its own and it takes years of vacations to learn it, but I now fall into it seamlessly. Washing endless towels, and rinsing feet, and waffles and ice cream. It's a break I look forward to every year and I don't think I would ever tire of this life, even if it were a permanent thing, not just vacation.

There is much to be learned from the ocean - she is a great and fierce mother and teacher. I will take the feel of sand with me, the sound of the waves endless, the memory of dolphins playing past the edge of the surf. The heat of the sun I have soaked up into my bones, day after day, to,sustain me in the coming cold of upstate NY , though that seems faroff amidst record temps and no rain).

The peace and renewal I gain here will warm my soul as I hold hands and pray and grow as a hospital chaplain next year. It will sustain me as a mOther and wife, through joys and trials. I am so very blessed to have had this time to just BE with My family and with myself. To give myself permission to rest and read and write. To fill myself up and return to the service I love so much.

Finding the divine

This month has been the best of both worlds. A week in WV with JPD,SLD and OM youth working on a house that needed repairs also had the added benefit of taking me back to the Appalachian Mountains I grew up in. I get so homesick for the Allegheny mountains of PA and the ranges become even more stunning to the south. Now I am in my other favorite place- the Eastern Shore. my mom grew up in MD and my dad in southeastern PA, and I spent at least a week every summer in Ocean City, MD. As a college student I spent a lot of time there with a fellow student and friend, and as a young woman and beyond, I have explored the shores, eventually falling in love with the residential and slower pace of DE. We found a great apartment last year and re-rented it this year, for two whole weeks. I may never be able to afford such a luxury again, so I plan to enjoy every second. Rochester does nothing for me in terms of climate or geography, though i love the people, so this is a special treat Today has been amazing. Friends from my hometown who moved to the DC area last year happened to be in town and spent the day with us. We saw dolphins and pelicans and swam and sunned and ate well. Now there's a thunderstorm rolling in - and I love stormy weather. It'll blow over by morning, and we'll enjoy another gorgeous day. As a lover of the outdoors who is nourished by the earth and it's offerings, and an adherent of process theology, I am ecstatic to have this time in places that I feel are so filled with the divine. I have had people comment on my ability to move through recent life's challenges with grace, and I have come to realize that grace is available to all of us - it is unearned and unexpected. And for me, I have never felt alone. The sense I have of God is always with me. it is strong here. Coming to the sea is a ritual of renewal for me that started before I ever carried children in the ocean of my own uterus. I love being in the womb of the ocean, of being healed by the briny waves, of being carried by the swells and warmed by the hot sun. It is a place that demands respect because the ocean can kill, it's denizens bite,a nd the sun is fierce, but it's also a place of birth, of the moon, of tides, of the rhythm of life. The rain is coming down, the thunder rolls, and I am complete.

We are going on vacation. I haven't gone on a 2 week vacation ever, so I am excited at the prospect of two weeks of beach time, with plenty of time for sand, sun and sea; and plenty of time for child-friendly pursuits like Assateague Island, Frontier Town, miniature golf, water slides, and lots and lots of fresh seafood.

Since internship ended, and graduation I have seesawed between maniacally cleaning everything in sight, and sitting on the couch obsessively watching Netflix and catching up on old Dexter and Burn Notice episodes. My spiritual director observed that this summer of rest may be a tender time - it is the first time I can sit down long enough to process all of the life events that had to be put on hold until seminary was over. My father and brothers' deaths, as well as my mother-in-law; the house fire, Soren's surgeries, Emma's depression and hospitalization, my mother's deteriorating health...and I miss my internship congregation too. It has been tender. I've embraced the chance to find joy in the many wonders of each day. it is a gift to spend this summer with my children and prepare for their next school year ahead of time. Emma started taking community college classes in 9th grade, but Soren isn't quite ready to delve into that yet, so I'm wracking my brains to come up with a right-brained approach to her education that lifts up her artistic and musical side.

The older girls and I went on a service trip with CERG and worked on a home in West Virginia with 19 other youth and 3 other adults. It was a great experience, and challenging. We got caught in that nasty storm on the last evening.

So I've been quietly journaling and reading many books on theology and prayer and also some mind candy fiction - I've been rereading the Game of Thrones series for one, and am taking Shawn Colvin's memoir with me to the shore. I've been mentally preparing for my upcoming hospital residency, which will start in September and run for a year. 3/5 of us will be UUs and I'm excited to work with two local UU candidates that I know fairly well.

When I get back from vacation, I'll re-engage with Connect & Breathe, and I have stayed involved with my congregation's Pastoral Care Team, which I'll continue on with. I'll also be facilitating a Wellspring group again this coming year, with my dear friend Libby. And of course, cramming UU History and Polity and reviewing bible history.

All in all, I'm amazed at how much I just need to SIT and do pretty much nothing. So that's what I'm doing.