SURVIVING WHEN YOU CAN’T PAY FOR DRUGS – A GUEST POST

Case Management

When you are diagnosed with an illness for which there is no cure, but long time survival is possible, you quickly learn that the most important case manager you will ever have is yourself.  You need to learn everything you can to survive — legally and, if necessary, illegally.  You tend to drop your concern for law when your life is at stake, especially when you will “First, do no harm” (Primum non nocere), the oath of doctors and others helping people survive.

Support group members will urge you to not merely educate yourself about the disease, but to get a good case manager. After you understand all your treatment options and the decisions you will have to make, your case manager can help you navigate the maze of health care bureaucracy. This is important for everyone, whether or not they have a job or insurance. Anyone can be taken advantage of by the system.

Illustration: NBC News

Early after an HIV positive diagnosis, I was laid off from the job which provided my health insurance.  The fight to start COBRA coverage was immediate.  Many states have programs to help pay for continued health insurance under COBRA (Consolidated Omnibus Budget Reconciliation Act).  There may also be other drug assistance programs because the cost of medication, even with insurance, may be out of reach for those without jobs and even those with minimal jobs.

While state help was being lined up, my well-known insurance company was deciding whether to grant continued insurance.  Their basic argument was they were headquartered in another state and therefore were following other guidelines. The case manager got experienced lawyers familiar with this sort of trick to deal with the insurance company.  They finally offered COBRA and the state came through with payments.  This was the value of a knowledgeable case manager, but the process took time.

A Re-Purpose

The interval during the battle for coverage brought other concerns.  I knew I might be able to afford the multiple drugs for a month or two, but the extreme costs would quickly wipe me out.  That is when I learned about “other” assistance.  This kind of assistance is spoken of quietly by those who are desperate, but can be trusted.  It is the kind of help that takes place all over our region, and probably across the country too.

My case manager told me he might be able to help with some drugs, but not all.  When I came for an appointment one day, he told me to wait. He went to a pharmacy and came back with some of the medication I needed.  He took a black marker and carefully crossed out a name and gave it to me. He said it was mine now and not to say anything to anyone about this.  Ever. I left and kept quiet for years.  The agency he worked at is gone now, and I don’t know what happened to the case manager.

He had gone to a pharmacy that had secretly offered help.  When a patient did not pick up their HIV drugs for over a month, they did not put the item back in stock, but held it on the side for emergencies. If the item had been covered already by insurance, and the customer did not pick it up, they felt free to hand it to another. The drug company was paid and the insurance company was none the wiser.  This tactic is illegal, but many will run the risk to save lives.

Helping One Another

Not all managers are so resourceful or willing to run such risks.  Strictly speaking, it is against the law — dispensing drugs without a license.  There are individuals in support groups who are willing to assist with drugs, when no one else can.  For a while, there was an agency here that had acted as a go between to pass drugs from one patient to another.

In support groups, some would mention how they could bring unopened bottles of HIV medicine to the agency and they would keep it for those in need. Then if a member could prove they had a prescription for a particular drug the agency had on hand, they would give a month or two of the drug to the client.  That agency no longer does this or will even admit they did it for many years.  They could be shut down just like the agency referred to above.

Drugs are collected in many ways.  If someone who has gotten a three-month supply of medication, but then the drug was changed by his doctor, he would bring the unopened bottles to the agency to lock up in secret. If someone passed away, a mate might turn in unopened items to help someone else.

The fear of being caught helping to save lives has led many away from this type of help. Patients are left to do what they can for each other via contacts in support groups — or even “on the streets.”  Those fighting the disease can not imagine throwing out drugs that can help others.  Turning in drugs to be destroyed seems a bigger crime than “dispensing drugs without a license” for those who hold a prescription for a life-saving drug.

“Healing those who seek my help”

With the loss of agencies willing to help patients get drugs, legally or illegally, some doctors are willing to fill the void. There are those who collect back unopened drugs so others who can not afford them will benefit.  A doctor knows the prescription of a patient and will generally learn in private conversation who needs help.  If the drugs have already been bought and paid for, it seems a humane thing to do. In this country, this kind of help is unfortunately necessary.

The High Cost of Drugs

HIV drugs come in several classes and a patient is likely to take one or more from each of 3 or 4 groups per day.  Few drugs have generics and even those are expensive.  The retail cost in the United States for three or four of these drugs could run 4 to 5 thousand dollars per month.  Patients receiving various assistance programs are terrified of health care “reform.”  Out of necessity, we help each other.

When I was in Germany and discovered I had miscounted a medication. Of course I was panic-stricken.  I went to a pharmacy, who sent me to a local physician who spoke English.  I told her of my plight. When she was satisfied I had demonstrated I had such a prescription (I always bring proof if I travel), she wrote a new prescription. I went back to the pharmacy, prepared to charge to my credit card an outrageous amount due to my miscalculation. I knew my insurance card would not be honored overseas. The drug was reasonably priced, about one tenth what it costs retail here.

Aside from one doctor I know of, many who would otherwise be willing to help with drugs and health care services have been driven away –or at least underground.  Americans do not have the protections other countries around the world offer. In the absence of legal support, we do what we can to help everyone — not just with advice, but with life-saving drugs denied to many because they can’t afford them.


People without insurance die.
This is not a political opinion. It is a fact. 

NOTE: Since the author isn’t available to answer questions, comments are “off.”  I can’t answer questions because I don’t have any answers, sorry.

LOSING YOUR JOB WITHOUT LOSING YOUR MIND – Marilyn Armstrong

A lot of people figure that everyone “retires” on their own terms in their proper time. That hasn’t been true in our world. Certainly not in Garry and my world. Garry lost his job because the company he worked for decided to move on without “the old guy.” I lost my job because my bosses son needed one.

Many of the people I know were “laid off” which feels exactly the same as getting fired, except there’s no legal reason for it. They just feel like doing it. In Garry’s case, it was clearly age-related. In mine, it was just smarmy.

I’ve known at least half a dozen people who got forced out of jobs they’d held for as long as 40 years. They had no preparations for retirement, no significant saving, and no plans. They all figured they’d work until they hit the official “date” … but it didn’t turn out like that. Not even close.


All the awards you want … but no pension you can live on.


Garry, after 31 years at channel 7, was shown the door in literally five minutes. When he came home, he looked like he’d been bludgeoned. I should mention that Owen lost his job during the same week. It was a hell of a week.

I hadn’t been at that job for very long, but the boss had me “showing the kid” how to do the job. Sneaky. I was in my 60s. There wasn’t another job waiting for me and I was ill.

For two years, we lived on what Garry got as his union payout. No medical insurance — and I kept getting sicker. He was miserable too. He was terribly depressed and demoralized — while I was wondering if I was going to die.

He went to rehab. I found a doctor who would treat me for free and actually invented a surgery to “fix” me because I was very broken. We had no money. To keep afloat for those two years before Garry got his pension and I got disability, we refinanced the house multiple times which bloated the mortgage payment to an impressive amount we couldn’t pay. There was the HARP Program — which Obama started. The problem? The bank didn’t have to let you into the program. Great program, but all you could do was beg. Weird, right?

I had been negotiating with them for months. When finally I got cancer in both breasts, I called and said, “Well, now I have cancer. Can we please get into the program?” I think I actually shamed a banker because a couple of months later, our mortgage payment dropped by $1000 a month. That was the beginning of survival.

I found a doctor who treated me for free. A hospital that never asked for payment. A bank program that cut our mortgage in half. Finally, Garry started getting Social Security and his (very small) pensions … and I finally got Social Security Disability. We went from having no money (blessings on food banks everywhere) to almost being able to make it through a month.

I remember the day when we no longer needed the food bank. It was a small, but meaningful triumph.

Garry stopped drinking. I didn’t die.

These days, when I hear how people are melting down over getting laid off from their jobs and basically losing everything. I’m sympathetic … but mostly, I figure they’ll get over it. Not immediately. Eventually.

You have to get over it. It’s a terrible time. We went for two years without any income. None. Zero. Nothing. Whatever little we had put away disappeared. Somehow, we survived and damned if I know how. I got any help I could from anyone who gave help. I don’t even know how I did it.  We are both alive — and we still have the house. At some point, Mass Health (our version of Medicaid) kicked in. It was the idea on which Obama built his medical plan.

It was designed by our Republican governor. That’s one of many reasons it baffles me that the GOP has been so against it. It was their program.

When this was taken, I weighed 93 pounds. An XXS was too big for me. I wore a size zero and it was loose. It was not an attractive look.

Most people don’t get to retire like in the movies, with or without the gold watch. We get ditched, usually around age 59, typically 6 months before pensions fully vest.

For all of you who got dumped because you got “too old,” yes it was illegal to let you go. It’s call ageism, but it’s done all the time. You can sue, but unless you’ve got money to live on while you sue, by the time you get paid off — and you will get paid off — you’ll be up to your lip in debt.

Did we have mental meltdowns? Sure we did. That’s why Garry needed rehab. I would have been more melted down, but I was trying to save my life and it was sheer luck I bumped into a doctor who introduced me to another doctor who took me in. I was days from my demise by then.

I developed a sort of yellow-green complexion. Which was also not very attractive

If you have had a life calamity and everything gets taken away, it will take a couple of years before you pull yourself together. It’s not just your finances that take a hit. Your soul gets maimed. Your self-esteem goes down the tubes.

When anti-medical care legislators say “no one dies from lack of medical care,” that’s bullshit. Lots of people die without care. They don’t get written up because they aren’t in the hospital or seeing a doctor. They just die. Kids, old people, and all the others in the middle.

Why am I talking about this?

Because those of us who had this terrible disaster overwhelm us need to know we aren’t alone. It wasn’t just us. It’s lots and lots of people many of whom used to be solidly middle class before their world collapsed.

So try to remember one thing:


It gets better. Somehow, some way, it gets better.


THE TIMELINE – Marilyn Armstrong

Finally, last night, I figured out that I’ve got between 10 and 12 years to live. It would be great if it were longer, but that’s pretty much what I’ve got and I want to live them well.

The math isn’t complicated. Hopefully, I’m finished with cancer. As much of my gastrointestinal tract has been removed as can be removed. My spine is completely calcified and most of the time, I can barely move.

The valves and Pacemaker they put into my heart are stamped and dated. They have time limits and the clock is ticking.

I’ve got two replaced heart valves: the mitral and the aortic.. Both are made from animal parts (valves?) and have an average life of 15-years. I’ve had them for nearly five years. They can last a little longer — sometimes as much as 17 years or as few as 12. Four down, let’s say ten to go?

Then there is the Pacemaker. The battery runs out in about 10 years, at which point they will want to open me up, remove the old pacemaker and replace it with a new one with a new battery. I think maybe since they have made major improvements in Pacemaker technology since they put this one in me four-years-ago, I could have this one replaced with one of the newer ones. Better batteries. And not metal.

That way, I wouldn’t have to wait until my eighties when I doubt I’ll want to go for heart surgery, minor or major.

My post surgery heart pillow; You grab it and hug it when you need to sneeze or cough, it is supposed to make you feel better. It doesn’t.

The valves are a larger problem. I know they are making progress designing replacement heart valves which last longer and work better, but whether they will be ready for me – in this lifetime – remains to be seen. As it stands right now, I have about 10 years. Maybe 12. After that, it’s time to say goodbye.

Unlike most people, there’s an actual clock ticking in my chest. Optimism will not make a difference. The timeline was created the day they did the surgery — five years this spring. The best I can do with it is pay forward on the Pacemaker (if they let me) and hope for the best with the valves.

Meanwhile, I am coming off a two-week remission of pain and misery using Prednisone.

I know Prednisone has a lot of side effects, especially for a woman my age with heart issues. Nonetheless, this two weeks using Prednisone has been the best two weeks I’ve had in years. I’ve been able to walk upstairs. Down is harder because it’s a balance issue, but I can walk upstairs. Slowly, but I can do it. I’ve been able to sleep in a comfortable position … which means I’ve been able to sleep.

I can get out of this chair without pushing myself up with my hands. I didn’t have to limp between the kitchen and the bathroom. In short, I have felt like I’m really alive. Now that I’m down to my last four tablets, I have been doing serious thinking about how I want to spend these next ten years.

I probably can’t take a full run of all-the-time Prednisone. That would more than likely wind up ending my life sooner rather than later … but maybe intermittent Prednisone? Like two weeks on, a month or six-weeks off? If I’ve got a limited lifespan, I would like to live it. Enjoy it.

I want to be able to move and not spend most of my life fending pain.

I’ve run out of options. I can’t take any NSAIDs. I am already taking narcotics light and I don’t see heavier doses as a direction I want to take. It doesn’t make the pain go away and it makes me stupid. What’s more, I’m allergic to most of them.

So, following the holidays, it’s time for a long, complicated talk with the doctor.

I can hope science will make a great leap forward that will change my future. Otherwise, I would like to make sure I don’t spend the remainder of my limited time battling pain. And you never know. They might find the miracle I need. It could happen.

Sensible ideas are welcome. I have choices to make and it’s time to make them.

MY COCHLEAR IMPLANT: THE 3-MONTH AUDIOLOGY EVALUATION – Garry Armstrong

LEARNING TO HEAR by Garry Armstrong, 
Photography: Marilyn Armstrong

Sing “Hallelujah” softly and this year, I will hear you. Crystal clear!

One of many hearing tests

That’s the lead on a delightfully mild Monday as I look back on today’s evaluation of my Cochlear Implant at UMass Memorial Hospital.

It was like getting an A on your first major exam in college.

Nicole Seymour, audiologist on the job!

Last week, I got excellent grades at the surgical evaluation of the Cochlear procedure. All the stuff placed inside my brain was line-dancing with the receiver parts atop my head and right ear. No unseemly scars, bumps or rashes. Even my fast receding hairline appears to be flourishing.

Is this a side perk?

Garry in the booth, listening to the test signals

Today was a detailed session of testing and adjustments. I sat in a small room that looks like Interrogation Room 1 on NCIS, but with more electronic equipment. I went through a series of tests administered by my audiologist. The tests involved various levels of single-word recognition, complete sentence awareness, and range of tone comprehension.

It’s harder than you think.

Putting the equipment on again

If you’re hearing-challenged, which is to say, deaf, you have problems with all these things. Single words that rhyme – led, dead, bread, red are easily confused. Whole sentences are often misinterpreted, sometimes leading to misunderstanding and embarrassment. High and low tones aren’t audible. I couldn’t tell the difference, so statements and questions sounded the same.

Consultation

I sat tensely – my body coiled – as I sat for decades during my TV news career. Struggling with interviews, courtroom testimonies, and pivotal political speeches. My breath came in rushes because I wanted to be successful.  A lot rides on the cochlear implant. At age 76, this is a major turning point. 


I can experience clear hearing for the first time in my life.

I clearly heard many of the words, sentences, and sounds.  But some of it was guesswork, just as it was throughout my working years. I could feel my body tighten as I wondered how well I was doing.

Nicole setting the levels on the implant headset

Progress or not?  I’ve been working hard with the cochlear implant. I wanted progress very badly.

Tools of the trade

When it came time for evaluation, the audiologist gave no facial hints. I was tense and nervous. She slowly and clearly told Marilyn and me that my progress was substantial with major improvements in all the areas tested. Some of the improvement was huge, some more moderate. But everything was better.

I smiled inwardly which turned into a broad smile that could have lit the room.

Filling in the forms

My cochlear implant and the hearing aid in my left ear were adjusted to give me more audio on 5 levels. She expected I would probably not want (or need) the strongest (loudest) level, but it was there, just in case. The new “bottom” level was the top of my previous levels. Go, Garry!

Setting the new levels on gear

In the coming weeks and months, Marilyn and I will be attending several large events where there will be many people, lots of background noise including live music — the dread of anyone who has trouble dealing with background noise. These events will be powerful tests for my implant.

More tests

What’s more, these are exactly the events that I dreaded before the cochlear implant surgery.

Now, I am eagerly looking forward to them.

Hallelujah! Time to celebrate!

UNAWARE OF THE CONTRAST – Marilyn Armstrong

It’s amazing how subtle changes to your body can be. The best way I can make sense of it is to contrast the way I feel now compared to how I felt this time last year.

It’s an enormous difference. I’m constantly exhausted and I barely have enough energy to get up from the sofa and get to the bathroom, which is barely a dozen feet away. And all of this because I’m anemic and I can’t take iron pills. They make me sick. I should have known that because recurring anemia has been part of my life since I was a teenager.

The problem is, it didn’t make a big difference in my life when I was a lot younger. I had a natural amount of energy which these days, I lack. So I’ve been dragging myself around for a few months, but I realize that anemia in a person nearly 72 is not a minor anemia in a 22-year old. It’s bad for my heart which has had quite enough to put up with and it makes things that hurt even more painful.

So instead of taking pills, I’m going to have to arrange for intravenous iron. The good news? Probably just a few infusions and it will all be set right. The bad news? Do I have a vein anywhere that will accept the needle?


You know they’re nuthatches because their natural position is upside down.


I’ve always had difficult veins, which my unlucky granddaughter has inherited. For her, the very idea of an intravenous anything is so terrifying she’s ready to leave town. I don’t have the choice of running for cover, so I hope that they have someone who is really good with a needle and can find a vein — NOT in my hand or feet, thank you — that will accept an infusion. The last few times, they wound up using my throat and that was not fun at all. I’m hoping it won’t come to that.

So, I made a doctor’s appointment. I’m hoping that if I get over this hoop, that maybe I will feel more like a human and less like a sack of rocks. You kind of know when the first thing your husband asks you is “How are you?” that you haven’t been looking well. I do not feel lovely.

I made an appointment for tomorrow and we will sort it out. I don’t have to be happy about it, though.

RDP Thursday – UNAWARE

FOWC with Fandango — Contrast

WHO IS RUNNING FOR GOVERNOR IN MASSACHUSETTS? – Marilyn Armstrong

I had to look it up. I actually didn’t know who else was running for governor. Shame on me.

Shame on us!

We were watching the millionth advertisement for Charlie Baker, our current governor. He’s a Republican, but not the kind you find in Washington D.C. Massachusetts’ spawns very liberal Republicans. They are so liberal, it’s can be hard to figure out to what party they belong.

Our Republican governors run on everybody’s money — Democrat and Republican — because he manages to be nice to everyone, or at least nice enough to keep them on his side, more or less.

Charlie Baker is not a bad governor or a bad guy. He has basically followed the path of previous governors, except he has been more parsimonious. He hasn’t done anything very different from other governors or “Republicanized” our laws. He briefly waved at supporting Trump and the Commonwealth of Massachusetts came down on him like a mountain.

He backed off faster than a speeding bullet. This is the bluest state in the U.S. and a really red Republican was not going to do well here.

Since then, he has streamlined the budget until we now have a billion dollar surplus in the state treasury. Golly! That’s a fair bit of change. I have nothing against dealing wisely with finances. But where is the money coming from?

On the surface, a billion buck surplus sounds great, right?

Except in order to accumulate that billion dollars, he simply stopped doing stuff which urgently needs doing. The roads have gone unpaved. The rails are downright unsafe. Bridges are crumbling.

We are short 13,000 nurses statewide and many hospitals have closed. There are large areas without any local hospitals and barely any doctors.

Fall at UMass Amherst

The University of Massachusetts is as expensive as many private universities — and that is for people who are Massachusetts residents. The curriculum has been cut, too.

Meanwhile, our public schools are not improving. In another effort to financially cut back, MassHealth, our state’s version Medicaid has been slashed. A lot of people who have no other medical insurance now are forced to pay some dollar amount monthly.

It usually isn’t a lot in gross amounts but it can seem an awful lot to a family who depends on it. Still, compared to other American states, it’s about as good as American medical care gets. It even includes some care for eyes and teeth! It used to have more, but each year there’s less.

So then, I asked Garry which Democrat is running against Charlie Baker? He said “Someone with a Spanish last name,” but he couldn’t remember the actual name. Jay Gonzalez hasn’t had any television ads — or at least we haven’t seen them. None.

Basically, we have a choice of voting for Charlie Baker or someone about whom we know nothing because he apparently has no war chest for getting out the vote.

This bothers me.

I should at least know who else is running. It shouldn’t be that one guy has all the money, all the advertisements, all the endorsements, so naturally, we all vote for him. That’s not how it’s supposed to be.

The thing is, with all the advertisements about the great things Charlie Baker has done, he hasn’t done anything in this part of the state. The bridges are as bad as ever. The roads are worse. The schools are mediocre, ranging to pathetic.

BOSTON, MA. – SEPTEMBER 26: Gubernatorial candidate Jay Gonzalez speaks to media at The Massachusetts Statehouse on September 26, 2018, in Boston, Massachusetts. (Staff Photo By Patrick Whittemore/Boston Herald)

All public schools teach is how to pass required tests. Students learn nothing. They memorize what teachers expect to find on the exams. Good memorizers get good grades. Not such good memorizers do poorly.

Bad teachers, not enough teachers, huge classes. A lot of kids fall by the wayside.

When money goes to “help” schools, it always goes to some “charter school” in Boston or suburban Boston where the leaves are green and so is the money. And, because the population in Worcester county doesn’t come close to Boston or any of the areas near it, we can vote our hearts out, but unless it’s a local representative, we don’t have much effect on the election. Essentially, unless it’s a very local representative, our votes don’t count. Not nationally or regionally.

Areas with very with small populations don’t get much say in American politics.

So I’m voting for the other guy.

Because when I look at Charlie Baker’s slick advertising? What I I see is Boston. I see him cutting the bottom out of our upper and lower educational systems, failing to help improve our medical facilities, not helping the nursing schools engage students or helping hospitals pay for more nurses. I’m sure we can get him to pass a law about it, but that won’t solve the problem and will probably make it worse because the rest of the issue is that we need nurses and the money to pay them. And a law isn’t going to make that happen. Laws need funding and enforcement and some concept of the potential side effects of the law.

We have a habit in this state and this country of passing laws and then trying to figure out how to make it work. On a national level, sometimes this works, but mostly, it doesn’t work anywhere. Passing laws is not a single-layer job.

Even though I’m voting “no” on mandatory nursing ratios, it’s not because I don’t believe our nurses deserve a better deal but because I live in an area where there are very few decent hospitals. If mandatory nursing ratios force another 200 hospitals to close and any of them is in Worcester County,  it’s going to be hard to get into a hospital. I’d rather have overworked nurses than no place able to care for me.

For some of us, this is a life or death set of issues in this election and I’ve decided I want to live.

WHEN THEY CLOSE YOUR HOSPITAL, POLITICS DON’T MATTER – Marilyn Armstrong

We don’t seem to be having much luck talking national politics. We have rigidified our views in these areas, so there is no conversation possible. Nonetheless, there is stuff to talk about and a lot of is hits much too close to home.

Entry

Each state has its own unique ballot questions. While these issues are statewide, the subjects involved affect many places not only in this country but worldwide. While no two places have precisely the same issues, many problems are similar enough. The states watch each others’ ballot issues — both on how they are fought and to see how the solutions do or don’t work.

This year, Massachusetts is trying to vote on government-mandated Nurse Staffing Ratios for hospitals. The Nurse’s Union put the issue on the ballot because nurses in many hospitals are greatly overworked. Not only are the nurses exhausted and underpaid, but tired, harried nurses make mistakes. Some of them are fatal.


According to a recent study by Johns Hopkins, more than 250,000 people in the United States die every year because of medical mistakes, making it the third leading cause of death after heart disease and cancer. — Feb 22, 2018

No one could reasonably argue that nurses are not overworked. Except for Intensive Care Units where nursing ratios are tightly controlled, Massachusetts does not have mandatory nurse-to-patient ratios. In the U.S., the only state that has state-mandated ratios is California.

From inside looking out at UMass Memorial Hospital

The problem is, that Massachusetts doesn’t have enough nurses. Forget, for a moment, whether or not the hospitals could afford to hire enough nurses. We don’t have them to hire.

Almost anyone who wants to go into nursing can get a full scholarship. The shortage of nurses has been an issue for many decades. Nursing was a popular choice for women when I was a kid, but by the time I was an adult, women were beginning to think that if they were going to do the work, they might as well become doctors.

In an attempt to get a better grip on the subject, we had a conversation with our doctor. Garry figured he probably had a pretty good sense about it.

He thought for a while, then he said “It would probably mean closing at least 200 hospitals around the state … most of them in areas like this one where we don’t many hospitals.” Rural areas have very different issues than big or even medium-sized cities.

There’s the fundamental problem.

Milford Hospital from the Dana-Farber

Nurses — when we have recent graduates — want to begin careers in places where salaries are better (who doesn’t?), facilities are more advanced, and there are reasonable opportunities for professional growth. They don’t choose little hospitals in the middle of Worcester or Hampden counties.

“The hospital closures would,” our doctor commented, “make it very hard to find places to put patients.” Like me, I thought.

It’s not that he doesn’t think nurses are overworked. We all think they are overworked. I don’t think that’s even an issue. The problem is (1) where are we going to get all those nurses, and (2) how are we going to pay them?

What’s the answer? We are missing approximately 13,000 nurses. If we vote for government mandated nursing ratios, will the government also provide the nurses and money to pay them? A lot of hospitals are operating on a shoestring already. It wouldn’t take much to push them over the edge.

We have the same problem with teachers, police, firefighters, and medics. They work hard and they don’t get paid well. We are short of libraries and librarians and a lot of other things, too, like functional railroads and bridges that won’t collapse. Roads that urgently need paving.

It’s not like we don’t know about the problems. It’s just that we can’t always fix them by passing laws. There are secondary and tertiary problems that result from “just pass the law and work it out afterward.”

In rural areas — like ours  — if you close one hospital, there’s a very good chance there will be no place to go if we get sick or have an emergency. Boston is more than 70 miles away through very heavy traffic. Some of our “local” hospitals are not places you’d want to be if you had a serious problem.

As I am coming to realize in our personal lives, you can’t always fix the problems. Even when you know what the problems are and what needs to be done, that doesn’t mean you can make it happen. Unlike the federal government, states can’t just raise the deficit.

Putting aside all of our national problems, we still need to bang our heads together and figure out sensible solutions to problems that face us personally.

When you live in the country, these problems are at least twice as difficult to manage as they are in Boston. Hospitals are big business in Boston — and yet even there, they are merging many of the biggest and best facilities to stay solvent. Or nearly solvent.

Out here, we don’t have many hospitals. They have already closed most of the smallest ones. Unlike Boston where they make their budgets by giving parking tickets to any car that pauses too long at a stop sign, we have to live on property taxes that are already very high … too high for many of us. We don’t have enough police and if there’s a big fire, all the towns have to get together to fight it because no town has enough professionals

We have a Fire Chief, but firefighters are 90% volunteers. And some of the smaller valley towns don’t have a fire department at all. Uxbridge has a pretty good fleet of fire trucks and a new firehouse in town … but we don’t have a professional staff. For this, we — and our nearby neighboring towns — depend on volunteers.

But sick people? We have a plenty of them.


For more information, see Nurse staffing ratios: What is the 2018 Massachusetts ballot question all about?