Fragility

Being poor takes time because you live in such a fragile world that you spend all day worrying about and dealing with things, tangible and intangible, breaking down.

I recently attended a daylong workshop on the program "Bridges Out of Poverty," taught by Phil DeVol. He's the one who made the above observation. He went on to define poverty as "the extent to which a person does without resources." Resources include financial, emotional, intellectual, physical and other quality of life factors.

One Bridges exercise is to evaluate one's own resources in the different categories and rate them on a scale of 1-5, 5 being the best. I have not done the exercise in full, but it came to mind this morning as I dealt with some healthcare matters ("physical").

On healthcare, I give myself a 5 (quality of doctors), a 2 (my overall health, which is pretty good except for incurable cancer), and a 0 (no insurance, no coverage, no nothing), for an overall score of 2.3. Because of the 0, I spent some of my morning visiting a financial counselor at the local hospital, which is where I see my oncologist (who is one half of the 5 score, my wonderful personal physician being the other half).

I went to see the financial counselor for two reasons. First, I receive a 35% discount from the hospital because I am uninsured. If I saw a counselor, that same discount would apply to all of my oncology visits at the hospital as well. That's about a $35 savings and given that I see my oncologist next week, I needed to do that. Second, I just had a very specific blood test done for next week's appointment and I wanted to know the cost of the test. (Note: Finding out costs at a hospital is surprisingly difficult, due to the labyrinth-like nature of hospital billing systems, which have been permanently warped courtesy of the insurance industry. We never did find that figure.)

So out I went, spent about twenty minutes with a harried but genuinely warm counselor, filled out some paperwork, and came home with more papers to retrieve and get back to her as soon as possible.

I need to get them back quickly not merely for my own benefit, but because it turns out that our local hospital, which was consumed several years ago by a BIG Columbus-based system, is closing its financial counseling office at the end of this month. Everything related to financial assistance will now flow through one central portal somewhere else.

The counselor made it clear, with a tone in her voice I could not quite decipher, that Corporate was calling the shots on everything. I would have to fill out financial aid papers, involving income declarations and proof of income, for the new system to evaluate my status.

Just hearing that brought me to tears. Admittedly, I was already on edge. Financial dealings having to do with my healthcare are touchy topics to begin with. Healthcare is my fragile world.

Being faced with paperwork was more than I wanted to deal with this morning. The counselor knew I was stressed. She probably talks to stressed individuals all the time. After all, we live in a country where we have historically chosen not to care whether medical care is available and affordable for everyone. (Thank you, President Obama, for saying that is so wrong.) In the midst of this Great Recession, my guess is that her cubicle is full of financial woes.

She all the same took the time to sit down with me, fill out the new paperwork, then list what additional proof Corporate would need.

I asked the counselor twice whether the 35% discount applied no matter what my income was. As sweet as it would be to get a larger discount, 35% makes a huge difference and I needed to hear, apparently more than once, that it applied to any uninsured patient. As it is, I can only afford to have some lab work done and see my oncologist once a quarter, which is shaving my healthcare needs very closely for the cancer I have. (I don't make huge sums of money, folks.) My repeated question is an indication of the fragility of my medical resources: tell me the discount I have will not be affected, because I am really, really counting on that resource to continue to exist.

I wonder if Corporate has considered the effect of eliminating the local office. People in hospitals tend to be people with lots of stress to begin with, regardless of their income levels. How to pay the hospital bills is only one of those stresses. People with chronic illnesses, like an incurable cancer, are constantly dealing with a fixed level of stress because they know that "chronic" means "always."

My stress level rises steeply when I have an oncology appointment approaching. If I had had to have the same discussion over the phone that I had today in person, I would have hung up and cried, then eaten all the rhubarb bread left over from last night's Legal Clinic. Instead, thanks to Susan the counselor, it took only three pieces to calm me down.

I will probably spend 45 minutes or longer gathering the paperwork that Corporate needs to determine if I qualify for more than the standard 35% discount. I will deliver it in person locally rather than ship it off into some unknown void, which is what awaits me after July 31.

Next week I see my oncologist and get my test results. I will try not to worry too much between now and then. The numbers are what they are and we will deal with it when I see Tim. I will also try not to worry too much about the cost of the test that was done yesterday. We need those numbers; I needed the blood test.

One thing I won't worry about is the financial paperwork that took up this morning. Ultimately I will get a determination as to whether I qualify for more than a 35% discount, but I know that in no case do I get less than a 35% discount.

What I don't know is what happens to the local financial aid staff when their office is closed at the end of next week. Has Corporate found places for them in the new department or is that function being outsourced? Has Corporate found other positions at our local hospital so they can continue to work in this community?

Or has Corporate given them a pink slip and shoved them into a suddenly fragile world?