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The Crazy, The Poor, and The Sick - The Unspoken Caste System in America Today a social commentary by Tonya Trummer

Preface: Delving into the variety of reasons for my own personal bouts with mental instability, would serve only to detract from the greater message here. There are millions of people like me out there, without a voice, without hope. The many and varied ways that they've reached the ends of their individual tethers aren't what I intend to address here. Instead, I wish to focus on our greatest failings as a Nation. We, the American people stand and state proudly our superiority as a first world country. The sad truth is that most Americans have no idea what is going on under their very noses and the few that do know, couldn't be bothered to effect any kind of lasting change. There simply is no profit margin in helping the disenfranchised. Until people begin to stand up and demand that their rights have equal value, there is little hope for the most hopeless amongst us.

I choose NOT to dedicate this work to an individual, but to the throngs of people throughout our great land who have had no opportunity to have their voices heard.

Chapter One - Who Is Affected?

There are all kinds of wonderful euphemisms and political correct names for craziness these days. People are 'bi-polar' or 'schizophrenic' or just plain mentally ill. The vast array of illness and symptoms range from agoraphobia to social anxiety disorder or attention deficit syndrome or disorder or whatever the latest trend is. The fact remains that literally millions of people in this country have valid mental health issues that require help, from therapy and/or medication. Even more suffer from actual physical ailments. The sad truth is even more suffer from nothing more than the medical profession's pandering to the pharmaceutical industry.

What then, of the valid illnesses? How are they treated? What rights do the mentally ill or physically ill actually have when it comes to their own treatment and in the worst case scenarios, what protection does society have from those who are dangerously ill? The facts may astound you. There are several different classes of mental illness and physical illness and the not-so-hidden truth, is that they are divided primarily monetarily.

The first class of mental illness or even physical illness is formed by the elite. These are the rare top percent of those who do not require any insurance for treatment. They often do not require any actual meeting with a mental health professional at all. They simply phone a doctor 'friend' who prescribes whatever medication the self-diagnosing patient feels they require. It is in this sad state of affairs that we find celebrity overdoses and deaths. Regardless of the utter inanity, I cannot foresee any way that this sad condition will have any substantive change. A great deal of money can purchase just about anything from those greedy enough to sell it. There is nothing intrinsically wrong with being able to afford the best health care money can buy. This particular lass of ill people only suffer in comparison the further down the financial pyramid you fall. It should also be pointed out, that if and when illness strikes, this first class of patient rarely has a genuine job to miss time off from and even if he or she did, there would be no consequences for taking months or even years off to deal with a catastrophic illness.

The second class are those who are relatively well-off financially. These are the CEO's and their families. Contrary to a lot of bad press directed at the upper echelon of companies these days, many are very hard-working concerned people who are working under some pretty tight constraints to keep their budgets under a certain bearable level for their boards. These people who pick and choose the health coverage the others in their companies are forced to live with their decisions. Sometimes they choose wisely, sometimes the bargains that they are dealt are quite Faustian.. They themselves, are covered by insurance to a great extent, but certainly have no trouble meeting out deductibles or paying out of pocket expenses for those items not covered under company plans. They often see the most well-educated and 'elite' physicians in the country. Their conditions are taken quite seriously and exhaustive testing is done to ensure that any other underlying ailments are quickly discovered and treated accordingly. This class of worker often has an almost obscene number of sick days or even indefinite leave to deal with an illness that is not speedily recovered from.

The third class are those who work for those industrious companies and their CEO's. These people may be given token choices between Plan A or Plan B, told they can choose their deductibles to reduce the amounts of their premiums, which can be quite high proportionate to their annual salaries. Often they are informed that they may NOT opt out of company insurance at all, unless they can show coverage under a spouse or parent's policy. Here the terminology of insurance becomes somewhat murky. All of a sudden you have to adjust to seeing an 'approved' physician under the plan. Then there are co-pays, which can sometimes be of great benefit, but at other times, only kick in after a large deductible is met. In effect, you get the lowest bidding physicians providing bulk care to employees for whom the company bottom-line is often 'get them back to work asap' or get them out of our workforce so we can replace them with someone healthy who won't run up a bunch of medical costs. What this equates to, is sub-standard care with the goal NOT the health of the employee, but the productivity of the employee in the workplace. It should be noted that often at a later date, when billing time comes around, the employee is shocked and horrified to discover that many of the items that they believed to be covered under their company's policy have been 'disallowed' and that no amount of arguing can relieve them of the burden of this debt, leaving the worker no option but to work longer and harder hours to try and meet the unexpected expenses. It should also be noted that these workers often have a very minimal number of sick days and can often be 'docked' or even fired for taking time off beyond what their company policies allow. In my personal opinion, this type of insurance and company cooperation smacks a little too closely to the 'company store' of old that held workers as virtual slaves to their places of employment, indebted to them to the point where they see no way out of the void their medical bills have left them swirling in.

The fourth class are those who have lost their insurance for any number of reasons (one of which, is that their health costs have simply been deemed to expensive and the company in question has searched for and found a semi-valid reason to terminate their employ). This disenfranchised person is then offered by law COBRA. Now COBRA is intended as a stop-gap measure ostensibly to prevent people from becoming completely uninsured, especially when they already suffer from a pre-existing health condition. The primary problem with COBRA is that it is so exhorbitantly cost-prohibitive, expecially to those who are now recently unemployed, that there is simply no way for a person to afford this coverage unless they've managed to set aside a substantial nest egg that they can chisel away at to keep their coverage. Once COBRA is either declined or lost due to expense, the pre-existing condition then becomes un-insurable and the former employee then must try to pay for all medical costs out of pocket. Something quite impossible for almost every single American in that situation. I personally find this quite galling. As Americans, we should not and must not allow people to suffer and die because they hae suddenly become un-insurable. This is a travesty, people!

The fifth class of patients fall under the auspices of Medicare. Now a great many people who are on Medicare are also on Social Security. From personal experience, I can tell you that SSI benefits barely cover the necessities of daily life. Add to this, the government then taxes what income you receive from SSI. Even more appalling, they take out a 'premium' from your benefits to cover your Medicare plan. Whichever plan you are on, A, B, or D, there is a cost to be paid. There are deductibles and co-pays. There are specific doctors that will refuse to see you. The doctors who will see you, can and often DO bill you substantially more than your Medicare coverage will allow for, leaving you with a great debt that with a limited income you are quite unable to pay. Worse yet, if you are lucky enough to qualify for Part D, which covers prescriptions, an outrageous number of mental health prescriptions are simply not covered at all, leaving the patient to carry the burden alone or simply go without the necessary medication. All of those so-called crazy homeless people living on the streets, off of their meds and making you scared enough to cross well away from them when you pass? I'll lay odds that a good percentage of them could and SHOULD be helped with proper medical care and prescriptions, but for whatever reason, they have fallen through the cracks. This should shame you. I know it shames me.

The sixth class of patients fall under Medicaid. While I never mentioned the unbelievable amount of hoops necessary to jump through for SSI and Medicare, you can triple it for Medicaid. You are completely subject to whatever your 'case-worker' decides is best for you. Any forward thinking person should be able to make the correlation between the terms 'case-worker' and 'case-load'. These people may start out with the best of intentions, but face it, they have unbelievable amounts of work stacking up everyday and their primary goal is not necessarily the welfare of the person needing their assistance, but clearing their desk for the day. A case-worker can force a loved one to leave their own home with little or no justification for the decision. A case-worker can reject a request for a part-time nurse to help administer meds or assist a disabled person into and out of the bath. A case-worker can INSIST on placing a patient in a care facility, either on a day-care basis or on a full-time live-in basis. This person has almost complete authority over what happens to someone in this sixth class and it's controlled almost entirely by the government. If you don't find this at all disturbing, I worry for you.

Chapter 2 - Practical Solutions

Let's begin with what won't work. President Obama has been heard to call for 'health care reform'. Here is why that will never work as the system stands now. There are four - count them - FOUR major pharmaceutical companies that are basically in charge of every single medication out there today. Pharmaceuticals are BIG business, people and don't let these companies try to fool you into thinking that the high cost of medicine is due to research and development. They spend more then ten times the amount in ADVERTISING than they do on R&D. Ten times. Thanks to the WTO and other organizations like it, these companies have held a stranglehold not only over the United States, but world-wide. Until legislation is brought to bear that forces these companies to act not just fiscally responsibly, but ethically as well, no real change will ever be seen in this arena.

Alongside these BIG pharmaceutical companies, you have the FDA. The FDA is ostensibly a government agency that oversees the safety of the food and drugs that are brought into the marketplace. In the past decade or longer, the FDA has begun to pay little more than lip-service to drug testing, food testing, or quite frankly any preventative measures that are put in place to protect people from being hurt by the things big business puts on our store-shelves. There are far too many examples to list here (and I certainly don't want to get sued), so let me just remind you of the enormous number of bad pharmaceutical recalls in recent history. When and why did our government decide that selling out to big business was the best thing for the American people? And why didn't we get a vote on it?

Then, there are the clinical tests. These so-called blind studies are bought and paid for by the pharmaceutical industry themselves. Just look at the fine print on the multiple page booklets that accompany any medications brought to market today and you should be shocked and horrified that people are being given these drugs at all. The tests themselves are often stacked with researchers from the big companies and the doctors that oversee them are bought and paid for, perhaps not with actual cash, but with trips and golf-outings, awards, and dinner banquets. There have been documented cases where physicians' names have been attributed to drug studies that they never even were aware existed.

Now, how do we fix something so very, very, broken? First we start with the pharmaceutical companies. We legislate the living heck out of them until they fall into line. No more excuses about lack of funding for R&D. No more exclusive patents. If another company can manufacture a medication for a more reasonable rate, let them.

Then, let's clean up the insurance industry. Put caps on premiums and deductibles. Stop allowing them to disallow pre-existing conditions. Let patients see the doctors that they choose to see without penalties.

Next, the doctors and hospitals. Let's make them accountable for their costs. Allow them a REASONABLE mark-up for inflation and even a bit of profit, but cut them off, if they try to charge more than what the fair market value is for their equipment and services. It's nice to see a doctor driving away in his brand new BMW, but it's even nicer when my mother can afford her chemotherapy treatments.

Clean up Medicare and Medicaid. Privatize it, if necessary. Just because someone is poor, does not mean that they deserve sub-standard care or no care at all and NO ONE should have the right to send someone to a home for the aged, if there is no medical basis for it. NO ONE.

As a side-bar, it's imperative that patients become smarter consumers. Know what your insurance coverage is and how it affects you. Take advantage of free or cheap preventative measures provided. Get a prostate exam or a mammogram. Know your rights as a patient to refuse or question care. Get second or even third opinions whenever possible. ASK QUESTIONS. Find out what medications your doctor is prescribing and how they might interact with other medications that you may already be taking. Find out what happens to your insurance if the worst should happen and you lose your job. If you are on Medicare or Medicaid, get to know your case-worker. Don't become such a pest that he or she begins to feel irritated by you, but try to be sociable and ask questions of him or her that keep you HUMAN in his or her mind. Get to know your local pharmacist and try to use only one pharmacy. When you get your prescriptions refilled or filled for the first time, ask questions. Find out if he or she thinks that you may have a drug interaction. Doctors are NOT perfect and it cannot hurt to check before taking any medications. Ask if it would cost less or be less effective to use a generic version of the same medication. If a dosage seems wrong to you, ask about it. Doctor's aren't known for legible handwriting and typos can and do happen. Whatever you do, try to never give up hope. A positive attitude can often do more to aid the treatments you are given than anything else. Don't stop treatment to follow a homeopathic remedy, but don't be afraid to try something new in conjunction with a prescribed treatment, as long as there are no anticipated side-effects.

Remember, I'm nobody. I'm you. Not a doctor, not a pharmacist, or insurance adjuster. Just a human being who has to rely on the same flawed system that you do. The only way we can exact change is together. When the President held is 'Open Forum' simultaneously with online questions being fielded, I watched time and again as anyone who asked a single question that did not serve as a public relations tool was ignored. Not a single question of mine was even acknowledged or addresses other than by other online participants who seemed as frustrated as myself. There seems to be a very large segment of this government who seem more interested in de-railing sources of the truth in favor of political propaganda. This troubles me greatly. I am just a layman with an editorial opinion here. We are allowed to have vastly different opinions on a variety of different topics. That's what makes democracy work. When that debate is refused a forum, we're all in such poor shape, that it will take a miracle for things to improve. A single voice can capture the attention of a few, an entire choir commands the attention of all within listening range. Let's be a choir for change, together.
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