The other day, two L.A. friends of mine visited the Hollywood Forever cemetery and stopped dead in their tracks when they noticed a gravestone with this epitaph: "My son had no medical insurance, that's why he's here today." They went back with a camera, and brought me the photo to the right. Clearly the solitary death of one 29-year-old man had hit home with one grieving family.
But uninsured death evidently has a different impact when it goes collective and statistical, meaning "we don't know the victim personally." In spite of all the uproar about California slashing its health services, many Americans have blandly ignored the fact that hundreds of thousands of people have been dying prematurely for many years because they had no health insurance and were denied access to free healthcare. Apparently it's okay for any state government -- and California isn't the only one -- to wipe out a whole raft of human lives with the stroke of a pen. And the inflation of health costs by the medical and insurance industries, which massively contribute to these deaths, have also been "okay."
The other day, Sarah Palin weighed in on Obama's healthcare plan, alleging that it called for "death panels" that would decide which persons should die. What rock has this woman been living under? Government has already been making those death decisions, going back to health-related cuts that started during the Bush era.
Faces Behind the Figures
Uninsured deaths usually fit into one or more of the following categories: poor, elderly, homeless, unemployed, disabled. Often they're non-white and/or female. Adults and children alike die of untreated life-threatening medical needs, including HIV/AIDS. Already in the early 2000s, deaths of AIDS patients were noted in West Virginia and other states when ADAP started narrowing the availability of treatment to low-income PWAs.
In 2002, the Institute of Medicine admitted to an estimated 18,000 uninsured Americans nationwide who died that year. By 2006, the IOM's estimate had risen to 22,000, with an estimated total of between 137,000 and 165,000 dying between 2000 to 2006. In California alone, an estimated 19,000 died during that time.
Today, my guess is that the real-life total of uninsured deaths exceeds the estimates, and may now be topping 30,000 a year. For comparison, the CDC estimates that around 36,000 Americans die every year of flu-related causes. Right now the nation is in meltdown over 436 confirmed deaths from swine flu. But the deaths in that administrative epidemic called "no health insurance" are evidently way less important.
In California, Families USA looks at the numbers and says, "California has the highest average number of people dying due to a lack of health insurance of any other state." The organization estimates that around 3000 Californians a year die from lack of healthcare -- compared to a total of 3467 killed in combat in Iraq since the war began in 2003.
Today these death stats are driven higher, faster, by economic crisis that has put countless thousands more Americans on the street. There is no accurate head-count on the number of homeless people, or the percentage of them who die of untreated health problems. Our only clue to homeless deaths are the nameless bodies collected weekly from the streets, back alleys, public parks, etc, leading to local headlines like "Homeless man found dead in San Antonio River." Another clue is the rising count of bodies left unclaimed at the morgue by poor families who can't afford to pay for the cheapest kind of funeral. At the Los Angeles County coroner's office, where corpses are really piling up and must be cremated at public expense, the rate is up by 36 percent since last year.
I also question whether the IOM statistics include suicides of people who can no longer bear the burden of untreated medical pain or depression.
Thirty-thousand-something is a lot of people to cross out with the stroke of a pen.
Kuehl's Report on California
For more clarity on the lethal impact of California budget cuts, it's worth looking at a recent report by former State Senator Sheila Kuehl, an open lesbian who -- while in office -- distinguished herself for courage, honesty and dedication to human issues. In her news-list, Kuehl's outrage comes through loud and clear as she analyzes the last-minute health-related budget cuts that were done personally by Governor Schwarzenegger:
"All in all, [the Governor] shaved an additional $489 million dollars from the budget he was signing, and these were the cruelest cuts of all, because 250 million of the cuts took the programs in the arena of Health and Human Services into newly dangerous and anemic waters.
"He took nearly $80 million dollars more from the fund that pays for workers who deal with abused and neglected children. This cut could not come at a worse time, since so many counties are experiencing the tragic consequences of their inability to field sufficient workers to identify children at risk. He cut $60.6 million from funds used to pay for MediCal eligibility workers at the county level.
"He took an additional $50 million dollars from the Healthy Families program, further devastating the one program that allows poor parents to get any kind of health care for their children ($179 million had already been cut in the budget amends and, with this additional cut, more than 900,000 children could be affected, statewide). The Managed Risk Medical Insurance Board (affectionately or not called Mr.MIB), is meeting to figure out how to deal with these cuts and may begin disenrolling tens of thousands of kids each month.
"He slashed an additional $50 million (284 million was already gone in the budget amends) from services to developmentally delayed children under the age of three, the best time to get services to these kids for a lifetime of functionality.
"He virtually killed a number of domestic violence shelters around the state, especially in poor, rural areas, by cutting an additional $20.4 million dollars from 94 domestic violence shelters and services centers, putting women and children all over the state in even greater risk of harm. Many shelters are making plans to close. He took an additional $6.3 million dollars from services to our poorest senior citizens.
"He devastated AIDS/HIV services in the state by completely eliminating local assistance funding, slashing $52 million from the state Office of AIDS budget, in addition to the $30 million reduction in the budget amends. This means an 80% cut in HIV-related educational services, an 80% cut in prevention services, a 70% cut in counseling services, a 70% cut in testing services, a 50% cut in primary medical care, a 50% cut in home care and a 20% cut in housing aid. He terminated every dollar of the office of AIDS' therapeutic monitoring program, leaving 35,000 working and middle class people with AIDS with no payments for viral load testing and drug resistance testing.
"Remember, these were his own blue-pencil cuts, never agreed to or heard by any legislator. In many cases, these were the services that an exhausted Sen. Steinberg and Speaker Bass were convinced they had saved earlier in the week."
A special concern for the LGBT community is how the California cutbacks affect people with HIV/AIDS. The cuts are sparking fierce protests by AIDS activists up and down the state. Especially hard-hit are black and Latino gay and bi men, whose situation is revealed in Jeffrey King's moving post yesterday. In his recent protest letter to Governor Schwarzenegger, Assemblymember Tom Ammiano opined that the proposed cuts "could kill most of the more than 150,000 HIV-positive Californians."
What Are the Legal Remedies?
Fortunately the law-dogs were quick to start barking their alarms. On Friday, August 7, the "exhausted" Senator Darrell Steinberg, who is President Pro Tem of the State Senate, announced that he would be suing Governor Schwarzenegger. He contends that, in July, the Governor violated his constitutional authority in making line-item vetoes to portions of the Legislature's budget revision.
"We elected a governor, not an emperor," Steinberg said. "In making these line item vetoes the Governor forced punishing cuts on children, the disabled and patients that he couldn't win fairly at the bargaining table. And in doing so, he overstepped his constitutional authority."
Senator Steinberg was citing an opinion by the non-partisan 93-year-old Legislative Counsel Bureau, which had just announced that the Governor had no right to unilaterally undo the budget agreement -- that he was violating the checks and balances contained in the California constitution.
Steinberg is so furious that he says he'll use his own campaign funds to pay for the lawsuit, which will be filed in San Francisco Superior Court. According to the announcement by Steinberg's office, other plaintiffs may be added. The Governor's office responded with a statement that Schwarzenegger's cuts were entirely legal.
So the battle is shaping up -- and it's clearly a re-run of last year's dismal budget battle, when the California legislature opted for deep cuts in Medi-Cal. As a result, a whole phalanx of health-industry and patient-advocate organizations sued in state court. And they won -- getting a court order that restored the cuts.
If Senator Steinberg wins this new lawsuit, how will California scratch up the dough to continue covering healthcare for these many thousands of potential casualties, including people with HIV/AIDS?
The state is foundering on the verge of bankruptcy, with banks already refusing to honor the IOUs that state workers are being given in lieu of paychecks. And so far, California has refused to take actions that would raise significant new revenues, like the proposed tax on offshore oil exploration that the Governor declined to impose. Foremost among funding opportunities is legalizing and taxing marijuana, which would bring in an estimated $1.4 billion of new tax revenues. After all, pot is already the state's #1 cash crop, and California has already legalized the use of medical marijuana. Earlier this year Tom Ammiano introduced a bill that would legalize pot and regulate it in the same way that alcohol is regulated.
But so far, no breakthroughs are happening on the cash-flow front. So for the moment, a certain number of uninsured people will continue to die.
We need to take that headstone in Hollywood Forever cemetery and multiply it across the landscape by roughly 30,000 if we are to get a visual picture of a vaster tragedy that -- so far -- has no epitaph of its own.
(Photo by Tyler St. Mark)