Stuck to the Streets for Healthcare
Monday, January 31, 2011 at 04:38PM 
By Tim Covi
Here’s a story. I recently sat down with a man who is homeless, expecting to talk a bit about life—how he landed on the street and what his hopes, goals and plans were.
The reasons people are homeless are as myriad as their personalities. I’ve heard stories of complete crap luck, stories of personal triumph, stories of one bad decision after the next. I’ve heard stories of people becoming homeless because of healthcare problems, because the costs drove someone out of house and home. But what I had never heard was someone remaining homeless because of health insurance—being held hostage in this state of homelessness for fear that, if they find a fulltime job, they might not be able to afford health procedures that are covered by indigent care, and that their health situation could worsen, causing them to be unable to work and to become homeless again. This was a disturbing new twist that left this already-cynical editor slack-jawed.
Then after a minute I realized there was nothing to really be surprised about—just disappointed in the way we provide care in our country. And I’d like to share that disappointment with you in hopes that when healthcare policy is discussed, you’ll think about this gentleman and the crazy trap he’s ensnared in. Stay homeless and get surgery, or find a job and gamble on the cost of surgery. There’s a lot more to look into; it’s never that black and white, and down the road I hope to make this the subject of a more complex article than can be written here.
Here’s the story. For the most part it’s a lot like thousands of other stories from the past few years. Guss (not his real name) became homeless after he lost his job.
He looked for work and lived off of savings for several months, but eventually couldn’t afford his house any longer and had to short sell it.
He relocated to Colorado hoping to find a slightly better situation. “The homeless system in Las Vegas was violent,” he said. “No sense of civility at all. It was just, literally people snaggin’ food from each other. I decided that I liked Denver, so I got some bus money together and came here.”
He was in an accident two years ago. He received a settlement at the time, but within the past year other injuries started to surface that were related to the initial trauma. He needs knee replacement surgery, a piece of bone removed from his neck and minor wrist surgeries. He said he’s up to five small surgeries and one major one.
Having worked as an office manager and lived a middle class life, the jobs he would like to get, the jobs he’s been applying for, are middle class jobs making a decent income, but not so large that he would be able to afford $250,000 in surgeries—the estimate he gave for all his needed procedures—without stellar health coverage.
In his current condition, if he gets one of these jobs he might not be able to work long before needing surgery, and at that point he wouldn’t be guaranteed affordable healthcare. So his options sound like: suffer through homelessness and hope to get surgery within a year through indigent care or a similar program (bad), get a good paying job and hope to afford healthcare (risky), get a mediocre job and hope the bills don’t put you back on the street (risky and bad). Is there a right course of action here? How have we created a system where working people can fall into medical bankruptcy, and where someone who is homeless can’t make a good choice about their future?
Tim Covi, catch-22, healthcare, homeless in Editor's Note
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