Monday, May 1, 2017

The Homeless/Healthcare Connection

Healthcare is a big deal. It's probably a bigger deal these days than it's ever been. Or maybe that's just my age talking. Maybe it's always been a big deal but, for most of my life, I just didn't pay attention to any talk about healthcare. Certainly, young people, unless something bad just happens to happen, don't give healthcare a second thought. They just assume the health part and don't stop to think about it.

Which is not an indictment against the youth of today. I certainly didn't think about healthcare, ever, until after I had kids. Or, really, until we were trying to have kids and my wife almost died from a miscarriage. But, certainly, once we had kids, it was a big deal.

There was this period when we didn't have any health coverage. I was working in a church making next to nothing and with no health benefits. Our coverage came through my wife's job, then her department was dissolved, and we were suddenly without any kind of health insurance.

Which would have been fine except that my younger son, maybe a year and a half at the time, got sick. Not a little sick, either. He was running a temperature of 105-106, and we were freaking out, because we couldn't get it to come down. And, well, no one wanted to see us.

The first day he was sick was the last day of our coverage, so I took him to his doctor. They were worthless, gave us some ibuprofen, and told us to keep an eye on him and bring him back the next day if he wasn't better. The second day was when his temperature topped 105. I called them about an appointment, but they said they wouldn't see him because we didn't have coverage anymore. I took him to the office anyway (remember, freaking out), and they actually locked the door when they saw me coming in with him and told me to go away.

We ended up in the emergency room where they left me sitting with him for hours because, well, no coverage. They didn't want to see him either, but they couldn't actually tell me to leave, so, instead, they let me set with him while he burned up in my lap. For HOURS. While I sat and worried about brain damage. [This is the son who is super smart, the one I did the education series on a while back, so you might think, "Well, it seems like everything was fine with that, then," but I sometimes wonder if he would have been even smarter if they hadn't left him with that fever for so long.] Eventually, I kind of forced someone to bring him something for the fever, and, hours after that, a doctor finally saw him.

Not that they offered any better advice or anything to do other than keep his fever down. We didn't take him back again and, a couple of days later, he got better. We still don't know what he had. However, we did get a bill from the hospital for over $1000.00 when he saw a doctor for less than 30 minutes and all they did was give him some liquid ibuprofen and leave us sitting around for something like eight hours.

And that's what it's like not to have health insurance.

And it's the kind of thing homeless people deal with all the time when they're sick, because they have no other alternative. They have no other alternative because there is this sort of endemic belief that "those" people don't deserve healthcare. I mean, why should we pay their medical bills when they're just going to end up back out on the street with their drugs and their alcohol and sick again. They should just get it together, get themselves jobs, earn their keep, and be worthwhile human beings, right? Then they can pay their own medical bills. After all, that's what the rest of us do, isn't it?

Well, actually, no, but I'm not going to get into that, right now.

I'm also not going to try to convince you from any kind of humanitarian argument about how providing healthcare to people is "the right thing to do." Clearly, that argument has not worked and the people (Republicans) who do not want to provide universal healthcare are not going to be swayed by it.

So let's take one brief, very practical look at dealing with healthcare for the homeless.

One of the issues with the way we do healthcare is what are called "super users." This is the small percentage of users who use the system way more than everyone else, essentially using the most dollars from the system. These users tend to be older, chronically ill, and, yes, frequently homeless with no kind of healthcare coverage. This means that when a hospital sees one of these people (through the emergency room because they have no other option), the hospital passes on the costs to everyone else. I don't have the exact figures in front of me and I'm not going to look them up right now, but let's say (because this is a pretty close to correct number) these people spend 90% of all healthcare dollars.

There are two solutions to this issue:

1. Give everyone healthcare.
But let's toss that one away because, obviously, with the Republicans in charge, that's not gonna happen. (Why would they ever provide anything to anyone who "doesn't deserve it"?) But, also, that doesn't keep those same people from being super users. It does lower the cost of them being super users, and that's good, but it doesn't address they actual issue.

2. Get rid of the homeless issue by giving them free housing and food.
Oh, no, I hear you already. If we're not going to give them healthcare, why would we give them housing?! That's crazy talk!
And, yeah, I agree that it sounds like crazy talk. BUT!
There have already been some experiments done with this and, from just a practical standpoint, this is the most efficient way to eliminate unwanted healthcare costs. See, just from providing housing to homeless people, it automatically makes them healthier people! No kidding. There are lots of whys and wherefores of this and you're free to go do the research if you'd like, but I'm going to let that statement stand and you can go do the research yourself. [Trust me; it's good for you.] For those with chronic conditions (like diabetes, which is very common), it allows for preventative healthcare (because we know where they are) rather than always having to resort to emergency care. Preventative care is always cheaper.

But what abut the housing costs? Sure, there are housing costs, but there are plenty of options for low coast housing, and all of them cost much, much less than what is currently being spent on healthcare for the same pool of people. Much, much less. Hundreds of millions of dollars less, even with the food costs.
"But they don't deserve it!"
Sure, and why don't you continue to stab yourself in the nose to spite your face, because now you're at the point of choosing to keep these people homeless as nothing more than punishment, and that's totally on you.

Look, if nothing else, you wouldn't have to complain about the homeless cluttering up your streets anymore. It's a win-win. Maybe even a win-win-win.


  1. As I once tweeted, I have this cool form of health insurance where I never go to a doctor and just pray I don't die.

    As I also tweeted, my dog gets better and cheaper doctor care than I do, so I'd like to formally declare my transition from man to terrier.

    Sure, the Republicans kept throwing lazy copies of Ryancare at a wall, hoping something would stick, and ending up with a very half-assed Obamacare-remix, but Obamacare hasn't been great, either. As a certain orange someone might say (nasally voice for effect), it's been an absolute disastah.

    Ever since The Affordable Care Act was put into place, I actually can't afford health insurance, which is hilarious if you're into ironic Schadenfreude. They want to charge me the cost of a small mortgage per month for basic bronze level insurance with an $8,000 deductible. So, in essence, completely unusable healthcare unless I get very, very sick or in a devastating accident, that would practically bankrupt me just to have it.

    I guess all of that is to say that Republicans and Democrats aside, it sure doesn't help that insurance companies can and will charge this much (and I can't do a damn thing about it), and that clinics/hospitals charge way more for services and surgeries and medications here than most other places in the world.

    If this trend continues, we'll all be homeless! I mean, I can only afford one mortgage at a time, but I can't live in a house if I'm dead, so I guess it's either a house OR health insurance for me... but not both.

    1. ABftS: Well, I have to say:
      The insurance costs and escalation of prices under the ACA was due to the Republicans and their attempts at undermining the whole thing. They're ones who made it possible for the insurers to raise rates the way they did. The original intent was that prices would go down because more people would be paying in, and that's what -should- have happened... except for the Republicans their support of corporations over people.

    2. So what you're saying is that you're not happy with the Obamacare-lite that recently got passed? Because it's like Obamacare, but it's BETTER, man. It's yuge.

      And now I feel REALLY confident that I can finally get healthcare.

      (I don't)

      But really, I guess what I'm saying is that the hole that's been dug is so deep that I don't feel like if Hillary was in office now, that healthcare would be any closer to being accessible for all. And no matter who's in office 4 years from now, I still don't see it getting any better unless we make major changes, and that includes to those greedy insurance companies that are raking in our money hand over fist while giving us the absolute bare minimum of coverage. Health shouldn't be a "business" in this country, and yet it is.

      I don't claim to know the answers to what will fix things, but both parties' plans just to tweak Obamacare reminded me of those old cartoons where there's a dike full of holes, spouting water and about to burst, and the character's solution is to plug one hole with his pointer finger and exclaim, "I think I fixed it!"

    3. ABftS: What we really need is to get corporations of out of government. Despite what the Republicans would like us to think, corporations are not people, and they should not get any kind of say in what happens. Of course, now, we have what basically amounts to a corporation as president... and look how that's working out for us.

  2. Honestly, I can't imagine republicans going for that either. I can just hear them screaming about people needing to "pull themselves up by their bootstraps!" Then talk about some occasion when they were homeless, and by that I mean had to move into their parents' attic after college because they didn't have an apartment and that's the REAL homelessness.

    1. Jeanne: Oh they probably would never, BUT, if you appeal to them from a financial basis, you can sometimes trick them into the right thing.

  3. What's the thing that went viral on Twitter today (besides Rumplethinskin not knowing what the Civil War was about or when Andrew Jackson died)? "People who 'lead good lives' and do things 'the right way' should pay less than those with pre-existing conditions." Because apparently pre-existing conditions are God's wrath, or something...

    I can't. I just can't.

    1. Whoops, that should have been Trumplethinskin...

    2. Liz A: Oh, I know all about that stuff. I worked in a church once where the pastor said, from the pulpit, that miscarriages where a punishment from God for sin in your life. God won't give babies to sinners.

      A few years later, his daughter had several miscarriages. I wasn't around, though, to see how he spun that.

  4. I've read studies like that, too, and been in favor of and argued for providing housing and health care, etc. for everyone. Both because it's cheaper and because it's a humanitarian thing to do.

    The problem is deeper than you say. There are people who will always say "pull yourself up by your own bootstraps," and will be offended when others say (as Obama did) "you didn't build that." Smart people recognize the help they got, but most people don't think about it that way.

    Another problem: people say "what about the cheaters? What about people who COULD work but don't and then they get a free house while I have to work?" I've had this argument with my own kids, and my response is "so what?" It's not like it's a GREAT life. I'm willing to pay some higher taxes so everyone can have a 1-bedroom apartment with a fridge and a tv. I'm NOT willing to give up my house, car, iPod, laptop, health-club membership, etc etc just so I don't have to work and can get a free 1 bedroom apartment. There will be people who do that, who could work but won't. Big deal. It's not like those people would contribute that much anyway -- people working because they have to are almost always less reliable than people working because they want to -- and if some people drop out of the system others might be able to get back in. We can't have full employment anyway; our system depends on 3-5% unemployment being a constant.

    The other problem is that it's harder to measure. When we attack crime by putting more cops on the streets and kids in jail, those are easy stats: 50 new cops = 500 more arrests = more prison, and people never notice if the 50 new cops actually CAUSED (or even was CORRELATED WITH) a drop in crime.

    But take the cost of 50 new cops and 500 arrests and all the jail time, and instead invest that money in schools and homes for poor people, and... how do you measure that? By graduation rates? THAT'S 18 YEARS FROM NOW HOW WILL WE KNOW? Test scores? Drops in crime? Satisfaction of life? It's hard to quantify.

    The problems of homelessness and crime and poverty and education and health care are all linked together, and don't offer easy fixes IF YOU WANT TO FIX THEM. They offer easy fixes if you want to HIDE them, by locking up the homeless and overburdening emergency rooms and correctional systems with people who aren't criminals and wouldn't be sick, or by harassing homeless people until they move somewhere else, and those are the fixes we pick.

    1. Briane: Yeah, I know it's a deeper problem, but it's too much to get into in a blog post.

      It's like shoplifting. There's always going to be some. Smart stores account for it and come up with ways to optimize for it. Then there are places like Toys R Us, at least when I worked there many many years ago, who so much wanted to have 0 "shrink" that they were willing to lose more money on efforts to stop shop lifting than they were losing to the shop lifting, AND they were still having shop lifting. So, sure, yeah, some people are going to work to cheat the system (and put a lot of effort into it in some cases). Big deal. Most people, by far, are not going to do that.

      We really need a paradigm shift in our cultural view of our own society.