On two Tennessees

We are moving towards two Tennessees. There are already different health care systems for the haves and have nots but the legislative task force created by Speaker Harwell evidently plans to codify that distinction into law to “solve” the problem of over 280,000 Tennesseans without insurance.

And it is beginning to look scaringly inevitable.

There already are but more than ever and directly as a result of legislative (in)action different realities for health,  safety,  and quality of life for those who live in rural Tennessee.   It is not just that rural hospitals are dying slowly by slowly.   It is that unless there is a radical change in legislative policy and direction they must die.

They must die.   Without a way to be paid for the uncompensated care that many of them are drowning in they eventually will not be able to financially exist.   The life span of any particular hospital may vary according to a lot of variables but the disease is terminal and the end is certain. And it should neither take a rocket scientist or a legislative inquiry to figure that out.

In the end it will not matter whether you have insurance or not. If you have no hospital it doesn’t matter if you can pay for care or not. Rural counties will more and more lack adequate healthcare. Some already do but with time that number will swell. Unless a way is found for uncompensated care to become compensated care it is inevitable. What you say to get a government to act who refuses to act due to some bizarre notion of “principle and responsibility” is beyond me.

I remember hearing a task force member talk excitedly about the possibility of charity clinics in local health departments. No one in my county went to the one we had. They went to the ER. At the ER you had access to testing and assessment that just didn’t exist at the clinic. The difference in level of care was extraordinary. Everyone knew…. they still know…. if you were really sick you did not go to the health department. Making something legal will not make it likely.

Although my hospital is not amongst those closing the quality of care had been compromised there also. They are trying to make it by with less staff because of the losses of uncompensated care. Fewer nurses are dealing with more and more people. Eventually mistakes will be made (if not already been made) and someone will die or be unnecessarily hurt. Again it seems to me to be inevitable.

I have heard about the plan to reach out to the mentally ill first in Tennessee. I have been a mental health advocate my entire life and this may seem like a radical idea but if they are so fired up to start with smaller groups first why don’t we start with the dying first or those that will die if they have to wait any longer. There is a medical term – triage – see people according to need. Should the purpose of medical care not be to save life? I have never heard that idea discussed in one single meeting by one single task force member. How is that rocket scientist material??

There is much yet to be discovered. The task force is not yet delivered their ideas but if where they are going is to be judged by where they have been dread seems to be an appropriate anticipation. With the money and plan to solve the problem on the table they have almost had the giddiness of children with a new toy talking about gimmicks and pilots they can implement rather than dealing with the realities at hand. When you only look for one thing you only find one thing and they have been absolutely steadfast in their determination not to look at the road ahead.

There is an election ahead and there will be a new president. Neither answer seems to offer much hope to me.

If Trump is elected Tennessee will wait for block grants and excuse the extraordinary cynicism on my part but it will then be legal for the state of Tennessee to kill poor people. It will be the task force on steroids.

If Clinton is elected is there any reason to believe, particularly after an election spent posturing about it, that the legislature will come into session determined to prove, even more than before, they can’t be pushed around by Washington. What are the lives of a few poor people when measured by the possibility of a renewed stranglehold of Republican power?

There is a real possibility that the next legislative session will not have a legislative proposal up for discussion that would really make a difference. There is a real possibility of a legislative session that would seek to make the coverage gap a forever thing and Tennessee may, in effect, put into law something of a notion that says some people are just too expensive and are, as a matter of bottom line reality, just dispensable.

There is a growing movement in this state that says no one should be left behind. The solution to 280,000 without insurance is 280,000 with insurance. Close the coverage gap. It is not simply about good economics although it is more than good economics. It is about being a good person and it is a decision that will mark every person in this state rather they have coverage or not. It is not about what we can afford to do. It is about what we can not survive not doing.

I believe, in the end, it may come down to what this movement is willing to do. It is, to me, becoming more and more clear that the question may be more than finding a legislative agenda they can support but in developing an agenda others will support.

I was there the day of the shoes at Speaker Harwell’s office. I saw how badly they wanted us to go away.

Will we stay??? And what will that mean??

Maybe that is the most important question.


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