Health care, and why fraud-prevention is suicide for someone else

2012-03-13 18:45

So, a friend of mine is on government-provided health care. And while it’s great that this exists, I’d like to point out just how horrendously broken the system is.

My friend is… not functional. Autistic, transgendered, and with several other severe problems. Long story short, not consistently able to feed herself. I don’t mean “not able to hold down a job and pay for food”. I mean “if food is available for the asking, she cannot consistently get adequate nutrition, because preparing food and asking for things are too hard.”

So obviously, she’s qualified for some sort of support, right? Well. It turns out to be exceedingly hard to get support if you can’t win arguments over the phone with bureaucrats. Even for reasonably healthy and functional people, this stuff could be hard. The every-6-months update absolutely must not be signed or sent prior to the last day of February, and must be received by March 7th. Given how long mail delivery takes, that’s already hard.

Then you get a note saying your coverage was cancelled because you didn’t fill it out, and another note saying to ignore that note because the automated system is running slowly.

Today, March 13th, we got a letter dated March 3rd announcing that coverage had been terminated. Note: Past tense. Already terminated. Why? Because she disclosed that she received a gift from her parents, but did not provide “proof” of this. The health people want a signed, dated, document stating the amount her parents gave her and the date on which they gave it to her.

It is hard to summarize how many ways this is stupid. The most glaring, though, is that past tense thing. Coverage is now off. There is no coverage. She has to navigate all of this stuff and sort through paperwork without the benefits of any kind of health care. So, for instance. If she’s on antidepressants? Better hope there’s enough left to cover her until such time as the slow and overworked bureaucrats review the letter and come up with another excuse to say no.

It is frankly insane for any dispute to start with coverage already retroactively cancelled. The first you hear of an issue should never be that you are already off the support network; it should be a warning that you will be if the problem isn’t resolved. Seriously. People who do not get their health care die.

Furthermore, it’s especially stupid given that there is no possible way this dispute indicates a sincere belief that the patient’s circumstances would in some way not reach the level of qualification for care. No one is saying that the smallish amount of money her parents gave her disqualifies her from care. No one is suggesting that she lied. All they want is some form of verification. (I can’t even guess why; is there a big problem with people claiming their parents gave them money when they didn’t?)

And to add insult to injury, this is a change from the previous six-month thing, where they denied coverage because she hadn’t explained where the money came from; that time, saying “my parents gave me money” was sufficient. This time, apparently, we need proof. Apparently it is very unusual for parents to give their kids money more than once?

This whole system is insane, and the very fundamental problem is that the people who really need help are pretty much the least qualified to navigate all these hoops and barriers. And the fact is, the cost to society of all these heroic efforts to prevent fraud is huge; not just in the insane cost of processing all this paperwork, but in the large number of people who fall off the grid, who end up either dead or doing illegal things to survive.

One of my friends has gotten as far as getting disability coverage. She now lives on the princely sum of, if I recall correctly, $900/month. Plus foodstamps, to the tune of $15/month. There was some concern about the loss of the foodstamps, which was a fairly major crisis.

Lemme tell you something. A lifestyle where the loss of $15/month in foodstamps could mean not eating? That is not a lifestyle people are willing to perform elaborate frauds to get into if they have other options. Seriously. I think we need a sort of Catch-23 here; if you are badly enough off that you would try to defraud the government out of a fraction of minimum wage, you are presumptively declared to be badly enough off to need help.

And the really, really, frustrating part? Having known a few of the crazy people who are struggling with the system, and watching what they can do on the occasions when things aren’t so bad? Honestly, if we took the barriers and hoops away, I think a lot of them would be able to become productive, contributing, members of society. As is, all that effort is going into valliant efforts to get around the random hurdles and challenges placed in the system, presumably all to “prevent fraud”.

What’s really funny is, we call the people who can’t successfully navigate the system crazy, but not the people who set it up that way. The people who can’t navigate the system often have major brain disorders; what excuses can we make for their tormentors?

Peter Seebach




  1. That’s why there is a whole sub-industry of the law profession – all they do is deal with gov’t benefits for handicapped/disabled. They make a fortune.
    The only people who get nothing out of the gov’t benefits for handicapped/disabled are the handicapped/disabled.

    Lissa · 2012-03-14 07:36 · #