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March 25, 2013 10:18 AM How American Health Care Really Works

By Aaron Carroll

Sometimes I lack the words. From the NYT:

Two nights a year, Tennessee holds a health care lottery of sorts, giving the medically desperate a chance to get help.

Yes, a lottery. That’s how the truly needy can hope to get care in the richest country in the world. More details:

State residents who have high medical bills but would not normally qualify for Medicaid, the government health care program for the poor, can call a state phone line and request an application. But the window is tight — the line shuts down after 2,500 calls, typically within an hour — and the demand is so high that it is difficult to get through…
“It’s like the Oklahoma land rush for an hour,” said Russell Overby, a lawyer with the Legal Aid Society in Nashville. “We encourage people to use multiple phones and to dial and dial and dial.”
The phone line opened at 6 p.m. on Thursday for the first time in six months. At 5:58, Ida Gordon of Nashville picked up her cordless phone and started dialing. Ms. Gordon, 63, had qualified for TennCare until her grandson, who had been in her custody, graduated from high school last spring. Now she is uninsured, with crippling arthritis and a few recent trips to the emergency room haunting her.
“I don’t ask for that much,” Ms. Gordon said as she got her first busy signal, hanging up and fruitlessly trying again, and then again. “I just want some insurance.”

Sometimes I can get snarky when I talk about health care in the US. But I try – really hard – not to get emotional. This article made that difficult. Is this really a health care system which we can be proud of? Seriously?

“At the end of the day, huge numbers of desperately ill people are being left out in the cold,” said Gordon Bonnyman, the executive director of the Tennessee Justice Center, an advocacy group for families in need that focuses on access to health care. “And that is a story in every state.”
Kelly Gunderson, a TennCare spokeswoman, said that the spend-down program had enough money to cover 3,500 people, but that only about 1,000 were enrolled at any given time because the screening process was so complicated. The screeners, she said, must examine medical bills and records, among other duties.
About 500 people are found to be eligible for the program each time the state opens the phone line. The line has opened six times since the program started in 2010.
Technical glitches can thwart callers’ chances. According to the Tennessee Department of Human Services, which operates the phone line, callers did not start getting through until 6:38 p.m., and 2,500 calls, the maximum, had been received by 7:23. The department is investigating what caused the glitch, a spokeswoman said.

It’s not enough that we force struggling people with significant health care needs to sit by a phone and push redial over and over like they’re trying to buy concert tickets. It’s not enough that they know most of them will fail. We can’t even make the phone lines work for them.

In her small brick home on the city’s north side, Ms. Gordon also heard the recording that enrollment was closed. But she, too, persisted, never looking up from the phone in her hand. Dusk fell and the room grew dark; she was too focused to bother turning on a light.
She had called about 50 times when, at 6:40, she got through. The woman on the other end of the line asked for Ms. Gordon’s name, birth date, Social Security number, telephone number and address. Ms. Gordon wrote down a confirmation number, thanked her and hung up. The application, she was told, should arrive in a few weeks.
“I still don’t know if I’m getting in,” she warned her husband, Arthur. “If it’s meant to be, it’s meant to be.”
If she is rejected for the spend-down program, Ms. Gordon said she would wait until next year, when President Obama’s health care law is supposed to make insurance more accessible to millions of low- and middle-income Americans.

Keep your fingers crossed, Ms. Gordon. There are plenty of people who are trying to stop that from happening.

Best in the world, my a**.

[Originally posted at The Incidental Economist]

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Aaron Carroll ,MD, is an associate professor of Pediatrics and the associate director of Children’s Health Services Research at Indiana University School of Medicine.