By Donna Smith

My sleep was restless last night except for the snippets of scenes where I was being tended to by my cancer doctors from some time ago.  In those dreams they cared for my body and comforted my fears as we worked together to overcome my illness.  Of course time had changed things a bit and their offices were interwoven with the sweet things only dreams can infuse, but it sure was nice to revisit a time in my medical life when the system was even a little less broken than it is today.  Don’t get me wrong, the bills were crushing then and some of the barriers daunting, but the slide to an even more difficult healthcare system for patients and our providers continues and deepens.

Then I woke up.  My reality jolted me back.  There were no doctors waiting to help me through the worry or read the newest tests that haven’t yet been done.  I was supposed to have three CT scans yesterday.  The prep I needed to drink was mixed, and the blood work completed to make sure that my kidneys were ready for the injected contrasts.  The scans were scheduled days ago after my primary care doctor called to tell me that some markers for cancer were elevated in one of the earlier tests she ran.  My symptoms match what the markers are showing, so I wasn’t exactly surprised when she called me.  But it is always an emotional shock to hear that anything cancer-related might be brewing.

But in my real world, the hospital called me early yesterday to say that my insurance company had not yet issued the authorization for the scans.  The insurance company wanted more time to talk to the doctors about the clinicals.  So, the tests were cancelled until the insurance company says they approve.  They were kind enough to tell the hospital that in 95 percent of the cases they will ultimately authorize the tests.  I do not believe that statistic, but if I did believe it, now I was left to worry not only about whether or not cancer has returned to my life but also if I’ll be one of the lucky people the insurance company decides is deserving of further evaluation.  I was not surprised, but I was sad.  I already felt physically pretty awful, and now I would have to wait.

The recent cancer scare for me comes as some issues emerged following the major surgery I had just five weeks ago.  I have been working hard to get better and stronger and get back to my work in helping advocate for a more sane healthcare system  one based on healthcare as a human right and one in which the care of my body is determined by me and my medical professionals and not the insurance company.  The insurance company had already booted me out of the hospital in just under two days following the surgery.  I had been stunned that the doctors seemed to want me to leave so soon until we arrived home that second day and the letter from the insurance giant was waiting to say the exact amount of time that had been approved for me.  Then it all added up.  No matter what shape I was in, the insurance company said I should go and few providers have the will to go toe-to-toe with the insurance companies they rely on for so much of their revenue.  The bills are just now starting to march in, so that its own trauma, aside from the physical healing I have worked to maximize.

In my post-surgical period, I have been exercising and eating well and growing stronger every day, but nagging symptoms persisted that led my doctor to the first round of tests that found the elevated markers.  It wasn’t the news I hoped for on the eve of my slated return to more work time.  I wanted not only to know if I actually have a recurrence of cancer but I also tried hard to get the exams scheduled so they wouldn’t interfere with my return to work.  Now, with another weekend looming, I get to worry longer about all of it.  I will go back to work with a cloud hanging over my head — all because the insurance company wants to second-guess my doctor’s orders and my body symptoms and markers.

It is such a travesty that so many people in this nation have to fight to get needed care.  But another travesty is that we are led to believe that the healthcare reform passed in 2010 will fix the kinds of problems so many of us face with insurance companies like mine.  It won’t.  In fact, it is likely that as other kinds of controls are tightened on the insurance giants that the sorts of abuses I am feeling will grow more common.  More care denials and delays.  More patients waiting and worrying.  More diseases advancing.  Or in the alternate reality of those who believe that somehow a totally free-market system will solve the problems, I still say dream on.  If many folks honestly think giving total control over to the same people who delay and deny care now while under some minimal control will improve things, they are so very wrong.  Those big, for-profit interests will not suddenly become kinder, gentler souls looking out for the health of each of their policy-holders.

Profit first is the wrong primary motivation for many things that make our lives better and our nation stronger.  Healthcare is certainly one of those things. We have to work together to move the system beyond the policy of greed and protection of Wall Street’s healthcare corporate interests to one that advances human health and doesn’t drain personal wealth, not matter how modest.  A single-payer model, with a progressively financed, single standard of high quality care for all is better for all of us and I like a system that is better for all.

So, while I wait for the final word from the insurance company on whether or not I’ll be having my scans as ordered by my doctors and as I continue working to transform this system from one of cruel intentional infliction of emotional and physical distress, I may just try to nap some more where my doctors from days gone by worry about and care for me.

Donna Smith

Just a few years ago, my dad died on February 13.  It was just one day short of he and my mother’s 49^th wedding anniversary.  Just three weeks prior, Dad was diagnosed with pancreatic cancer.  Though he was 75 years old, he was still working, and he was a force of love and life and laughter in our family and in his extended community.

Because my husband and I were waging our own war with the broken U.S. healthcare system, we didn’t even have the funds to fly me to California when the call came that he might not live through the night.  A dear friend drove with us to the Denver airport with her family credit card, and she put me on a plane bound for Oakland.  I sobbed the whole way to the airport, “Daddy, please don’t leave me alone here on this earth.  I cannot do this without you.”  On the plane, I sat next to a woman returning from a funeral for her older brother.  As I comforted her, I calmed myself down.

For eight days after I arrived there, our family fought the horrific fight so many families do in the final days of a loved one’s life.  All of us struggled to in our own ways against the impossible reality that our dad was going to die.  My mother knew it, and her children were fighting so hard; she could only stand so much.  But our dysfunctional healthcare system certainly added to the trauma for us all – and especially for my dad.

Even in the final hour of his life, after the decision had been made to stop all of the life support functions that had been keeping him just beyond death’s door, treatments and equipment were rushed into his room that only served to grab every possible ounce of revenue for the for-profit hospital where he was a patient.  So long as he was still hooked up and could show a heartbeat on the monitor, the money could still flow.  I asked one technician who came in to provide completely new tubing for my dad’s respirator just 15 minutes before it was shut off, why we needed it, and he acted as though I was an evil daughter for asking.  Though my dad was comatose, I told him he’d get a kick out of the irony in what was going on around him.  I had spent eight days talking to him as he lay motionless, and I tried to believe he could hear me somehow.

His death was ultimately peaceful less than an hour after his life support systems were turned off.  I would later find the card he had already bought for my mom for their anniversary tucked into his dresser, and I gave it to her right on time.

One of the ironies I know he understood was the fight I had to secure healthcare without going broke (though I had insurance) compared to the ease with which healthcare services were offered – even sometimes unnecessarily or at a determent to the patient —  to those with enough money or “gold-plated” insurance coverage.  He had always taught me to make sure I had the best coverage I could afford, and I did.

So the February 13^th anniversary of his passing always comes to remind me not only of his life but of how the death he endured and the rest of our family witnessed could have been so much more humane and natural if a more sane healthcare system had been in place.  On February 14^th, I remember the wonderful man who taught me to dance by having me stand on his feet when I was just 5-years old as the Lawrence Welk show played in the background.  And I remember how very much he loved my mother, his Valentine, even in the rough years that every marriage has that lasts 49 years.

But this year I am also thinking of another upcoming anniversary.  SiCKO, Michael Moore’s 2007 award-winning documentary about the broken U.S. healthcare system, will turn five this year in May. My husband and I, and about a dozen other brave souls, were featured subjects in SiCKO.  And I am betting all of us wish we were looking back fondly on the days when our stories were recorded or when we first saw the finished film before Michael took it to the Cannes Film Festival  and celebrating that we had helped move the nation to a more just and humane healthcare system.  I know I wish that was the celebration I was helping plan.

Instead, on this 5^th anniversary of the release of SiCKO, subjects like myself will come together again at one of the sites of the original U.S. premier showings to reinforce our shared commitment to the struggle that made us all such perfect fodder for such a documentary.  None of us were paid as actors – we were not actors.  We were patients and the loved ones of patients who had been harmed by the system.  We have been so thrilled to see the Occupy Wall Street movement (and many of us have participated where and when we could) call attention to the income disparities in this nation as the disparities in access to healthcare are a part of that picture too.

We, the American SiCKOs, all want a progressively financed, single standard of high quality care for all Americans without financial barrier.  We wanted it when we were facing the healthcare traumas that led up to our appearances in the film, and we still want such a system.  We never asked to be spared from life’s tough moments or even to have miracle cures or treatments administered that would not have been in our best interests.  We all had health insurance, and we all expected to have access to appropriate care when we needed it.  And until that is the reality in these United States, we will fight on.

Please plan to join us in late June for the SiCKO anniversary.  Details about location, dates, and times for our events will be coming in the future weeks and months.  Our preliminary plans are to hold our gathering in Philadelphia on Saturday, June 30^th.  So save the date.

We are starting our fundraising now for the anniversary.  We’ll not only be raising travel funds for the subjects who are gathering who cannot afford the costs, but we’ll also be trying to help other people who want to be there and need help to do so.  We’ll update the world on our situations – the healthcare and financial traumas didn’t stop with the release of the film – and we’ll form our SiCKO plan of action that includes moving ever forward to the moment when healthcare is a human right in this nation.

By Donna Smith

Every year for the past four years around this time, Nataline Sarkisyan’s parents build toward an unimaginable anniversary filled with sorrow and pain.  On December 20, 2007, they lost their only daughter, 17-year-old Nataline to corporate greed and insurance company cruelty.  Nataline died after the insurance giant CIGNA initially denied coverage for a liver transplant then reversed the decision when protest pressure (from the family’s extended Armenian community, the California Nurses Association and an on-line firestorm of outrage) and the potential for public relations damage grew too much.  But the reversal came too late.  Nataline was dead.

Wendell Potter, who was a high-level CIGNA employee at the time of Nataline’s death and who became a whistleblower about the health insurance industry following that time, wrote about Nataline in his award winning book Deadly Spin.   The first time Nataline’s family came face-to-face with Potter was shown on Dateline NBC in December 2009.

The family’s struggle to make sense of this atrocity and to make sure other families do not have to bury their children due to these sorts of insurance company decisions led to the formation of the Nataline Sarkisyan Foundation. Rather than sinking into the despair that could easily have come from such a loss, Nataline’s mother, Hilda, has almost single-handedly lifted Nataline up as her “angel” guiding the advocacy for the changes that might have saved her daughter.

But every year, that anniversary day – that horrible day – just keeps coming back to open the scars and tear at the heart.  Nataline is dead.  She is not coming back, and the memory of her beautiful smile, her stunning eyes (just like her mother’s) and her dreams of giving beauty to the world must wash over the hurt and comfort those for whom no comfort without her can ever be enough.

So, on this anniversary, Nataline’s mom will be as she has been for the past four years on December 20^th – quiet and alone with her thoughts and her memories.

But in the fashion that has become Hilda’s style since then, she will turn tragedy into action again just two days prior to that anniversary.  We can all help with that.  We can use these moments to pause with the Sarkisyan family and remember why we all fight against corporate greed, and we can help.

Let’s Occupy Love and Occupy Joy with this family.   For Nataline, for Hilda and Koko, and for all of our children.

Nataline’s mother sent me the release below:

On December 18, 2011, The Nataline Sarkisyan Foundation is hosting a toy drive benefiting Children’s Hospital LA.

“My daughter, Nataline, passed away at the age of 17 due to our corrupted health care system. She was denied a liver transplant by our insurance company. They chose profit over life.

“Nataline’s 4th annual memorial is just days away. In her honor, we like to make a child’s Christmas Merrier. Putting a smile on a child’s little face who is suffering with all kinds of illnesses during this Holiday season is what would make Nataline proud. With the support of our family, friends and community, we have collected hundreds of toys. We look forward to helping make hundreds of children smile. ‘Tis the season for giving and we shall give to all.

“The following are the details of the event.

Date and time: Sunday, December 18, 2011, 10:00 a.m.-1:00 p.m., then at 1:00 p.m. Caravan to Children’s Hospital in LA.

Location: 162 N. Sierra Madre Blvd in Pasadena, CA

The Hye Riders are partnering with us serving food and drinks before the caravan takes off.

Looking forward to hearing from you soon. If you cannot attend, please donate.  Thank you.”

Regards,

Nataline’s mom.

Occupy Portland teams up with health care reform groups for rally, march for universal health care

Keith Swallow explained to his 8-year-old daughter, Katie, that they were marching along Southwest Salmon Street to Pioneer Courthouse Square on Saturday because that is how you tell your government you want change.

On his shoulders, daughter Sophia, 6, smiled as he started a chant now familiar to anyone who has come in contact with Occupy Portland: “Show us what democracy looks like,” Swallow, of Portland, yelled. He was joined by the about 500 protesters marching in support of universal health care.

The health care march was flanked elsewhere by an Occupy event for protesters and their dogs in Southeast Portland and a couple dozen people drumming and chatting in the South Park blocks.

The march started with a rally at Tom McCall Waterfront Park, featuring speakers from single-payer advocacy groups, many of whom are health professionals or students.

Standing over her family as they helped stick 558 crosses in the ground at Waterfront Park to symbolize the Oregonians who died last year from lack of health insurance, Swallow’s wife, Marsha, said she was repeatedly denied individual insurance because she has rheumatoid arthritis. Her husband must keep a job that covers their four children now.

“If we had single-payer for everybody, it would encourage entrepreneurship,” Keith Swallow said, because he knows many small-business owners worry about covering employees.

At Pioneer Square, organizer Dr. Paul Gorman , part of Mad As Hell Doctors , asked the marchers to talk about why they were mad as hell. A father lamented that he chooses between $400 monthly multiple sclerosis medication for himself or food for his four children. A 4-year temporary worker at the Oregon Zoo still doesn’t have benefits. A former medical transcriptionist never had health care through years of working in the health care industry.

“It’s outrageous that while the 1 percent make record profits, the 99 percent are an illness away from bankruptcy,” Gorman, an OHSU doctor, said.

“It’s time to get the 1 percent out of the way so we can get the health care every Oregonian deserves.”

State Rep. Michael Dembrow , D-Portland, who sponsored a single-payer bill in the Oregon Legislature last session, complimented Occupy Portland protesters for standing their ground in the face of public criticism and confrontations with police. He told the crowd that states need to take the lead in passing single-payer health care because change in Washington, D.C., is slow.

He plans to reintroduce his bill next session, and said it would give patients the ability to choose their doctor, make decisions about their treatment and would ensure better accountability in the health care system.

“We are seeing the health of Oregonians compromised because companies have to look at their bottom line,” Dembrow said.

Police were noticeably absent during the march. Sgt. Pete Simpson, a Police Bureau spokesman, said the march was monitored but there were no issues.

However, at least 20 officers took down the beginnings of an Occupy Portland camp in the South Park Blocks at Southwest Park Avenue and Jefferson Street. About as many protesters lingered there for much of the day after the tarps and tents were peacefully removed.

Across town, protesters and their four-legged sympathizers were invited to Dogcupy Portland . About 10 dogs and their owners marched along Southeast Hawthorne from a Bank of America branch to Wells Fargo and U.S. Bank branches.

The article reflects a correction published Nov. 20.

Dr. Paul Gorman said, “It’s time to get the 1 percent out of the way so we can get the health care every Oregonian deserves,” at a health care rally Saturday. A story in Sunday’s Metro section incorrectly attributed the quote.

From the Med City News, a timely question that we have been thinking about.

^[1]The populist anger and frustration fueling the Occupy Wall Street ^[2] movement has thus far focused most of its animus on just one industry: financial services.

But it’s not farfetched to think that as the “Occupy” movement gathers steam, it — or perhaps another future movement like it — could set its sights on the healthcare industry, and there are signs that it’s already begun. Health insurance companies, in particular, would seem an inviting target to Americans frustrated by rising health costs that far outpace inflation, but drug companies, and perhaps to a lesser extent hospitals, could become ensnared in general public frustration about skyrocketing health costs ^[3] in the U.S.

Understanding why healthcare corporations and hospitals are potential targets of populist rage isn’t difficult. Simply look at two numbers that reflect the affordability (or lack thereof) of healthcare to most Americans: Since 2001, average premiums for family health insurance coverage have increased by 113 percent ^[4]. Yet U.S. median household income increased only 17 percent from 2001 to 2010 (the last year for which data was available), according to the U.S. Census Bureau ^[5].

Something’s got to give because those two trends are simply unsustainable.

It’s easy for the public to focus solely on insurance companies as being the primary driver behind rapidly rising health costs, but a little research shows that hospitals ^[6] and drugmakers ^[7], and no doubt plenty of others, have also contributed. Still, any public protests against the health industry are likely to focus on insurers, whether justified or not.

Already, a notable former health insurance executive is calling for protesters to target the Washington, D.C., office of health insurance trade group America’s Health Insurance Plans ^[8]. The ex-executive, Wendell Potter ^[9], helpfully included the office’s address in an article on HuffPost ^[10].

An AHIP spokesman didn’t respond to an inquiry about whether any protesters have showed up outside the group’s offices.

And health reform advocacy group Health Care For America Now ^[11] has taken things a step further, calling ^[12] for protests outside the headquarters of big health insurers Aetna, Cigna, WellPoint, Humana and UnitedHealth.

“Health insurance companies’ relentless pursuit of profit and callous disregard for people offers another window into how big corporations have abused people and twisted the economy to serve their own interests,” the advocacy group said on its blog.

In addition, Health Care For America Now analyzed more than 500 posts ^[13]on the “We are the 99 percent ^[14]” Tumblr, and found that nearly half mention health concerns, ranging from cost of medication to foregoing treatment to treatment denials. So it’s clear that healthcare is already a top-of-mind issue for many Americans drawn to the Occupy movement.

Of course, all this is happening amidst the backdrop of ongoing reverberations from last year’s controversial “ObamaCare ^[15]” health reform law, with most of the law’s provisions set to take effect in 2014. ^[16] Plus, the Supreme Court ^[17] could decide as soon as next year ^[18] on the constitutionality of one of the law’s key components, the individual mandate that requires people to buy health insurance.

Ironically, if the individual mandate is struck down as many health reform opponents hope, it could set off a chain of events that holds potential to fuel an “Occupy Healthcare” type of movement and ultimately give progressive activists exactly the sort of health system in the U.S. they’ve always wanted.

Here’s why: Insurance companies demanded the individual mandate in return for extending insurance coverage to millions more Americans, and no longer denying coverage based on pre-existing conditions. Take away the individual mandate, and insurers have little choice but to jack up their prices to offset the shortfall caused by some people dropping coverage, and others waiting until they get sick to purchase coverage. If health costs continue their seemingly inexorable rise, then cue up a nasty (and some might say, long overdue) backlash from the American public that would set the U.S. on the road to undoing its private health system.

It’s not difficult to imagine a time when many Americans, after years upon years of unsustainably rising health costs, simply throw up their hands ^[19] and say, “To hell with this health system that so few of us can afford. We demand a single-payer, government-run, Medicare-for-all type of health system like most of the world’s other industrialized countries ^[20] that, oh by the way, enjoy higher-quality ^[21] and lower-cost healthcare ^[22] than we do.”

And that likely would be the best healthcare-related outcome the Occupy protesters could hope for.

From our friends at the New York Times who confuse the motivation in the first sentence (This exemption applies to local property taxes not state income taxes= no budget impact) He gets the rest of it mostly right.

State Challenging Hospitals’ Tax Exemptions

By BRUCE JAPSEN

Facing a budget deficit exceeding $11 billion, the State of Illinois in recent weeks has begun challenging the property tax exemptions of some of its best-known hospitals, saying they should pay more because they are not providing enough charity care.

The Illinois Department of Revenue moved last month to strip property tax exemptions from Prentice Women’s Hospital, a sparkling new medical center in Chicago’s tony Streeterville neighborhood; Edward Hospital, a rapidly expanding medical center in the western suburb of Naperville, and Decatur Memorial Hospital in central Illinois.

If successful with those three, the state is expected to look for other not-for-profit hospitals with low percentages of charity care, with an eye toward challenging their property tax exemptions, too. A Department of Revenue spokesman said the agency was reviewing parcels owned by 15 hospital systems, but declined to say if the tax exemptions would be challenged in each case.

All three of the hospitals the state is focusing on provided free and discounted medical care that ranged from 0.96 percent to 1.85 percent of patient-care revenue, according to the revenue department. The state also said that each one had been operating as a “for profit” business when the state’s Constitution says that “only charities are entitled to a tax exemption.”

In anticipation of new tax challenges, hospitals in Illinois are preparing a lobbying push that would seek to redefine the qualifications for tax exemptions. The new definition would go beyond just charity care and expand to include patients’ unpaid debts, costs of medical care not covered by Medicare health insurance for the elderly, Medicaid coverage for the poor, as well as direct costs that teaching hospitals pay to train doctors and conduct research.

In interviews, executives of the Illinois Hospital Association told the Chicago News Cooperative that they had discussed with state policy makers a plan to draft a broader legal definition for hospital tax exemptions. The lobbying group — which is adding staff members to bolster its effort — would also figure into a hospital’s tax exemption the cost of subsidizing money-losing services like emergency care, trauma care, burn units and neonatal intensive care units.

“We strongly believe that charity care should not be the sole determining factor for a hospital’s nonprofit, tax-exempt status and respectfully suggest the legislature establish clear standards for tax exemption,” Dean Harrison, chief executive of Northwestern Memorial HealthCare, the parent company of Prentice Women’s Hospital, said in a statement.

The hospital industry’s push is at odds with the changes under way at the Department of Revenue, which is acting in the wake of the State Supreme Court ruling last year upholding the revocation of the property tax exemption for Catholic-owned Provena Covenant Medical Center in downstate Urbana, in Champaign County. For that hospital, the value of care provided to indigent patients amounted to less than 1 percent of its revenue in 2002.

The Department of Revenue cites the state’s Constitution that allows tax exemption only on property used exclusively for charitable purposes. In the Provena case, the state had argued the hospital should lose its tax exemption because only 302 patients received charity care worth $832,000, or just 0.7 percent of the hospital’s $113 million in revenue that year, state records show. In the Supreme Court ruling, justices noted that 13 percent of Champaign County’s more than 185,000 residents had incomes below the federal poverty guidelines.

Since the revenue department moved to strip the three hospital tax exemptions, State Senator Iris Y. Martinez, Democrat of Chicago, has intensified her effort to pass a bill that she and others introduced earlier this year requiring hospitals to provide 3.5 percent of their annual revenue in charity care. The level advocated by Ms. Martinez would still be far less than the 8 percent that the Illinois attorney general, Lisa Madigan, proposed five years ago.

“Hospitals think they should get tax exemptions for merely what they do in the community,” said John Colombo, a professor of law at the University of Illinois at Urbana-Champaign who has followed the issue of nonprofit hospital tax exemptions nationally.  “It’s problematic: The overall number that each of these hospitals is reporting is abysmally low. Given the state of the economy, one would expect the charity services going up.”

Services like prenatal care may be expensive for hospitals, Professor Colombo said. “But  in reality the prenatal care can be a mint to them once it results in women coming into the delivery room to have their babies.”

For the year 2007, Northwestern Memorial HealthCare showed charity cases as 1.85 percent of its $1.18 billion in net patient revenue. Edward Hospital showed charity care at 1.04 percent of its $448 million in net patient revenues that year. Decatur Memorial reported costs of charity care at 0.96 percent of its $252 million in net patient revenues in 2006, the year revenue department officials evaluated the hospital’s recent ownership change.

The hospitals argue that their contributions are significant, even though charity care is a small percentage of their business. Community benefit provided by Northwestern’s flagship, Northwestern Memorial Hospital on Chicago’s Gold Coast, has increased more than 10 percent since 2005, to $255 million, according to Mr. Harrison. And Edward Hospital said it treated patients “24 hours a day, 7 days a week, regardless of their ability to pay.”

Mark Deaton, the Illinois Hospital Association’s general counsel, said hospitals “in some fashion relieve the burden of government” because of the community benefit they provide.

But analysts say hospitals that pay taxes provide community benefit in other ways. Provena’s Urbana hospital now pays about $1.2 million annually in taxes.

“A million dollars in revenue will fix pot holes, help schools and infrastructure and make the city safer,” Professor Colombo said.  “Those tax dollars are a pretty big community benefit.”

The Chicago area has seen a rising number of for-profit hospitals that serve the poor while still paying taxes on their property. For example, Vanguard Health Systems , the for-profit hospital operator, has bought five former nonprofit hospitals in the Chicago area, two of them former nonprofit hospitals near the poor Austin neighborhood on the West Side. Vanguard pays taxes on the properties.

“The relative amounts of charity care provided by not-for-profit tax-exempts are not materially different from the amount provided by for-profit hospitals,” said Jim Unland, a longtime analyst of Illinois’ health care industry and president of the Health Capital Group, a consulting firm in Chicago. “This raises the issue of whether the tax-exempts are getting prejudicially favorable treatment.”

The battle comes during a period of high unemployment and related loss in health benefits by hundreds of thousands of Americans that analysts say are in greater need for discounted and free medical care.

Hospitals say they will challenge the Department of Revenue in court. They intend to respond by mid-October to the denial of their tax exemptions by the agency’s director, Brian Hamer.

by Donna Smith

Twice in the past week, those of us who live in the metro Washington, D.C. – Baltimore corridor have seen reports about murder-suicides that had at least some component of causation related to the dead families’ money problems.  In one instance, a single mother who was also a psychologist killed her young teenaged son before killing herself; in another incident, a husband killed his wife and her two children – his step-children.  In both cases, recent financial stresses were cited as potential triggers.  And in both cases, grieving neighbors and loved ones either denied the seriousness of the problems or seemed not to know.

These instances are on the rise during these hard economic times – we all may know that and not need much additional explanation or much of an imagination to glean why.  But rather than become sound bites about our shock and disbelief in local news reports about dead neighbors, it might be wiser for us all to truly consider honestly that some of our own are troubled to the point that a tipping point to a horrific act isn’t far off.

First, the stories I referenced above can be found discussed here.

Let me say at the outset that this will not be the most cheerful piece I have written, and I know the subject generates great controversy even among those who deal with suicide prevention or family interventions on a professional level.  But I won’t pull any punches about what I felt and still sometimes feel when I look back at and forward to a life of financial struggle.  We cannot reach into our communities to do much helping or healing if we continue to force ourselves and our neighbors to suffer in shame and in silence.  And financial problems create great big heaping loads of both.

While we espouse a belief that there is nothing wrong with being working class or poor, most Americans are indoctrinated very early on that our cultural worship of the almighty dollar and everything it affords us is what is truly sacred.  The stuff of wealth is the stuff of power and influence.  We say we honor those who do an honest day’s work but then we make sure those same people know full well what their rank is in our social circles, in our communities and well beyond.  I was taught to care for the poor; I was also taught to aspire to wealth.  The unspoken and direct pressure of that aspiration-demand was every bit as powerful as the Christian messaging to love my neighbor as myself – even if that neighbor was poor or working class.

Fast forward to adulthood when I worked hard and tried to make good all that was expected of me financially.  In good times, the pressure to maintain and increase those good times often drowned out the cries for what I really wanted to do with my life.  I longed to love and cherish my children more directly and to spend more time with them.  Often, I worked long hours and when I was home I was crabby and distant rather than being the mom I always thought I would be.  That created depression and anger for me.  Sometimes I thought of suicide.

In the bad times, when I was not working a great job or when my machinist-husband was struggling to work (whether for health reasons or shifts in the economy and the need for his trade) or when I had cancer, the strain of dealing with financial obligations taken on responsibly in good times but unmanageable in bad ones became horribly pressure-filled.  I couldn’t simply back off, change my lifestyle, move and satisfy creditors.  The calls don’t stop from the collection agencies.  Moving takes money.  Employers don’t cotton to employees with weaknesses like financial, family or health troubles.

The world closes in quickly.  Depression must be hidden, but it is felt.  Suicide is considered.  I know I considered it.  The thoughts of ending it all are hard to fight off – and it was only the thought about those left behind and the costs they would have to cover that stopped me (and I suspect others) from carrying out gruesome plans considered in the dark, wee hours when the collection calls cannot come and others are sleeping.  Mental health help seems a joke at those times – even with health insurance, out-of-pocket counseling costs are high and good counselors are hard to find.  The time to get help takes away from the time to work and earn money.   It compounds the problem causing the depression to seek help.

Oh, say some of you, what about friends and family?  Think about how we all often judge those in our own families with money trouble or job trouble or health trouble.   Suffice to say, from the condescending behavior of those in the more well-heeled classes around us to the judgment of those in our own families, working class and poor people stand not only alone but often harshly condemned unless they can act to all the world as though nothing at all is wrong until that horrific moment when those who judged exclaim they had no idea about our suffering.  I also believe there are persons in our society responsible for so much suffering and economic pain that they are accomplices to these awful acts and should be held criminally responsible, but that’s probably a bridge too far for many.

I used to hear people say that suicide is a permanent solution to a temporary problem, but in my deepest and darkest moments, I knew that the stain of having gone broke in America was very close indeed to a permanent problem. Going broke often means – as it has meant for me and millions of others – losing the love and physical closeness of people we fought to protect. It isn’t that we cannot adapt to less stuff, and it’s more the crushing pain that we cannot adapt to less love and no support.

America has a whole lot of people hurting very deeply. From the poor among us to the working class and those who are hiding all manner of financial strain in this difficult economy, few options seem viable or potentially helpful. I was pulled from the wreckage of my silent reverie (thanks, Sarah, for that gorgeous line) by the dignity of having my story told in Michael Moore’s SiCKO and finding out, finally, that it was not my fault. And the nurses offer, always, that refuge for their patients – and now for those who are suffering in an America that has strayed a long way off course for millions of people. Join the nurses. Tell them where it hurts. Let’s heal America.

This is cross posted here