DIE-ALYSIS: Alabama Governor Dr. Bentley and the Legislature’s Plan for Kidney Patients

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Guest Column
by David Underhill

MOBILE, Ala. — I didn’t like counting out the coins from the fruit jar and adding up how far they would go toward a family’s unpaid bill at the medical group practice where I worked. They fell short. Policy said no patients owing money could get service. Practice allowed exceptions. Both the mother who’d brought the jar and her baby were visibly, audibly sick, and the top doc relented. King Solomon with an MD degree said the clinic would treat one of them. The mother selected the baby, of course.

That was an especially jolting episode, but the routine handling of insurance, billing and medical records was an education. It revealed a system that turns health care into a tool of extortion. Pay and you will receive treatment that eases your pain, perhaps saves your life. Don’t and you will get nothing, or get slow and shoddy service, and perhaps die early.

Some refuse to submit. A human speed bump catches the eye. This was in the driveway of a fast food joint. I tried to get him up and out of the way but he was barely conscious. Somebody called 911. Teetering near a coma, he noticed the approaching siren and began to mumble. I leaned an ear toward his mouth and he was saying: “Please, don’t let them take me to the hospital…I can’t afford to go to the hospital…don’t let them take me there…I’d rather die.”

Add to these dramas the many drab instances of skimping. You ought to get a regular check up but don’t because of fretting about the cost. A persistent pain needs medical inspection, but the bill worries you even more, so you just hope the pain will go away before you do. If a doctor wrote you a prescription, this is probably something you need, but you never fill it at the drug store because of the price.

Such experiences might make anybody wonder whether the system for delivering medical care is sane and humane. They could prompt thoughts about how to structure a better way of promoting health.


But nothing rivets the attention like discovering somebody is tinkering with the system in ways liable to kill you. That turns airy notions of proper public policy into idle speculations and forces the realization that you must act, with speed and skill, or your time may be short.

This abrupt juncture arrived when recent news items from the state capitol in Montgomery began inserting the word dialysis in stories about looming budget slashes. The effect was like being in the jungle at night and hearing a rustling in the bushes, and glancing toward that edge of the clearing, and seeing a pair of big cat eyes glinting at you in the moonlight.

I Do Solemnly Swear — No Taxes

When Dr. Robert Bentley of Tuscaloosa dropped his medical practice and took up politics full time as governor, he took The Grover Norquist Pledge too. Swearing never to raise no taxes on nobody for nothing has become an initiation rite for Republicans. Their fierce loyalty to this oath suggests the mystic grip of ceremonies inducting priests and mafiosos into their calling.

But Bentley and the Republican majorities in both houses of the legislature also took the stimulus funds offered by the Democratic administration in DC. This was a IV lifeline directly into the state budget that had turned acutely anemic during the economic swoon that ended the Bush era.

The Republicans accepted this immense welfare dole without shame or apology and also without any provision for when it ran out — just as they accuse the poor of doing with assistance from the government. Now it is gone, and the economy has not perked up enough to pump up tax receipts enough to replace the drained stimulus.

So the legislature stages hearings about what to do. These are a sham because The Pledge chokes off consideration of anything except chopping. Although accounting maneuvers and juggling tricks might deflect the pain from one part of the budget to another, no new revenue will appear without raising somebody’s taxes. And that is forbidden.

The looming cuts are large and nobody pretends that the usual suspects — waste, fraud, inefficiency, etc. — can be rounded up and squeezed enough to prevent the carnage. In this setting fear is the friend of those who have always preferred having government concentrate on enforcing order and protecting property, while leaving fairness, justice and the general welfare largely to charity and chance.

Without cops, courts and prisons the criminals will take control! These agencies might get dinged but not crunched. The biggest, politically tempting and safest targets are education and health.

At budget hearings in the house of representatives witnesses told devotees of The Pledge what to expect if they made the contemplated cuts. The head of the state’s public health agency warned that, among other blights, kidney patients could lose access to dialysis.

“I know exactly what happens if you don’t dialysize people,” he said. “They’re dead in two weeks.”

So Long: It’s Not Been Good To Know You

My kidneys are faltering, probably headed toward failure. Tests revealed the problem last year during treatment for something else.

And, no, I haven’t lived such a loose and riotous life that I deserve this, including the bills. I’m not claiming sainthood, but my habits have generally been drab and sober enough that I could have passed as a Mormon. The doctors don’t know why the kidneys are shutting down ahead of other parts. Maybe this was built into my genes.

Whatever the cause, the condition is chronic and irreversible. For anybody reluctant to participate in the tainted transplant organ trade, the remaining choices are dialysis and death.

I’ve already had a talk and tour at the nearest dialysis facility here in Mobile. I left with a handful of literature and a head full of the varied methods and equipment. Soon I may have to decide which type of dialysis to use to stay alive — if the politicians let me.

By luck more than design, my insurance and I could finance this treatment for a while. The budget snaking through the state capitol aims at those patients reliant on government help, not me. But when my resources run out, then I too am in the bull’s eye.

And I know that The Pledge takers who would put me there are just the local agents of a national effort. It yearns not only to end state support of medical care but also to euthanize Obamacare, as they say with a sneer, then privatize Social Security and Medicare, en route to repealing the New Deal, to arrive back at the real America of unbridled, stampeding capital owned by gilded robber barons, and all the rest of us are left to scuffle with each other.

I might imagine that I could ride this out paying my own way — while others, the poorest first, fall in batches — until, finances depleted, my turn comes. Then the allies I could have had will be gone, and those better cushioned than I will stand back as I go down alone, and they will watch, thinking they might somehow remain exempt.

To recycle a line from somebody with his own national holiday: a threat to dialysis anywhere is a threat to dialysis everywhere. This makes it wiser to say now that, not I, but we in dialysis or facing it have our lives at stake in the state’s budget decisions. The same applies to those with other grave ailments and needs.

But the takers of The Pledge don’t care. Ideology means more to them than life.

Deadly Right To Lifers

One name has appeared often in reports on the legislative torture of the state’s budget: Jim Barton, a Republican businessman from suburban Mobile. He chairs the committee that gets the first whack before sending the flayed document to the full House of Representatives.

Several months ago at a public meeting in the city he accurately forecast the budget’s fate. Some in the audience suggested various ways of raising revenues to avoid this. To every such idea he had one identical answer: No.

His reason was equally simple and blunt. Except for a miraculous economic revival, which would boost revenues, nothing but tax increases can accomplish this. And that cannot be done, he said. Period. The voters wouldn’t stand for it — and neither would he.

Barton is a captive of The Pledge, and he showed no signs of struggling to escape. Regardless of how warped the existing tax structure may be, it is sacred and cannot be changed.

It doesn’t matter that property taxes for mega-landowners are shockingly low and sales taxes on food and medicines shockingly high. It doesn’t matter that the poor regularly pay a larger percent of their income in state and local taxes than the wealthy do. Any alteration of these highly regressive arrangements to increase total revenues would involve raising somebody’s taxes. And that is forbidden — particularly if the alterations would require those with more to pay more.

This is the attitude written into the budget, which has now passed the House and been sent to the Senate in an ambulance. The senators will pass it along, barely alive, for the governor’s signature. He has announced that if tax increases of any sort (about as likely as a blizzard in Mobile) accompany it, he will veto them.

Officials responsible for carrying out the slashes in health services have not completely specified how they would do it. They have said they will try to avoid quickly fatal cuts, like terminating or crimping dialysis. But they won’t guarantee this.

The result could be that kidney patients are dying in agony at home or hospice while the dialysis equipment and personnel who could save them are sitting idle at a nearby clinic. If that scene is too gruesome for Alabama to tolerate and funding is scrounged to prevent it, the budget cuts in less dramatic aspects of health will have lingering effects that also lead to funerals.

These deadly things are being done by Right to Lifers. Most of the politicians mangling the state’s budget, and the voters giving them that role, fervently oppose abortion and trumpet the sanctity of life. Yet they align with the crowds at Republican presidential debates cheering for executions and for the death of the ill who took a chance on staying uninsured and can’t pay cash for medical services to save themselves. They generally adore war too, or have few hesitations about it, at least.

This embrace of death is so persistent and intense among Right to Lifers that they can’t truly believe in the right and sanctity of life. Instead, their stridently professed devotion to life — in the womb — serves as a bloated moral camouflage for neglect or hostility to life in other stages.

Only a conscience numbed in this manner could endure the contradiction of proclaiming the Right to Life while adhering to The Pledge that no taxes shall be raised, regardless of the consequences. This means some citizens denied health services will die, so that others may retain more money to play with in their investment portfolios and real estate speculations.

The majority in the legislature is at ease with this outcome, in mind and soul. So is the governor.

Standing Your Ground To Stay Above It

One benefit has come from the Florida neighborhood watchman shooting the strolling teen. It has alerted everybody to the existence of stand-your-ground laws.

Alabama has a similar one.

The authors intended these laws to shield wanna be Dirty Harrys and Rambos from prosecution for dispensing amateur justice too readily in the streets. But laws designed for one use often turn out to have additional possibilities.

What if the menace isn’t somebody with the wrong clothes and wrong complexion on the wrong street? What if it’s somebody in a capitol office with a fine suit and an imposing title? But he’s scheming legislation that feels threatening to us who must rely on public health agencies to stay alive.

Merely feeling that way is sufficient under stand-your-ground laws to whip out your pistol and prepare to fire. But we really are under threat of bodily harm. When the pending state budget takes effect, if the cuts stop dialysis for some citizens they will be dead a couple weeks later.

In such circumstances, what steps does the stand-your-ground law authorize us to take? The question hasn’t arisen before and the answer isn’t obvious. But we need an answer so we can proceed accordingly.

We could ask the state Supreme Court for an advisory opinion. But the justices are probably all Right to Lifers and devoted to The Pledge.

Perhaps we should seek guidance from a Higher Authority.

© 2012, Glynn Wilson. All rights reserved.

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