Election 2012

I read two articles in the newspapers today, one about Governor Romney’s 2011 tax returns and the other about a welfare mother. (Remaining cognizant of the fact that this is the NYT, a newspaper with a liberal bent.)

It made me think about my role in this society. I am a legal alien. I came to this country as a student and went through specialized psychiatric training. I invested a huge amount of my own money to start the process and was then paid a salary by my training programs, in return for the patient care I provided as a trainee. By general consensus, medical trainees provide a lot more skilled labor than they are paid for. While training as a specialist, I worked 80 hours a week, took overnight calls taking care of extremely sick patients, and made anywhere between 30,000-50,000 dollars a year throughout my 5 year training.

At the end of this training period, my agreement with both US and Indian governments was to return to my country. But like most skilled immigrants, I wanted to stay. The US government allows me to do that if I promise to serve in an under-served area with a health professional shortage, for a minimum of three years. Before hiring me, a health organization has to prove that they advertized for an American citizen to take the job for at least 6 months, and no one did. I took one such job.

I now work for a Federally Qualified Health Center in an inner city area. All my patients are poor, most of them have Medicaid, with a small proportion being on Medicare and private insurances. I also see patients who do not qualify for Medicaid yet can’t afford private insurance- the center puts them on a sliding fee scale, and they are able to see me and their other doctors at about $20/visit. This adds up when you add the cost of paying for medication out of pocket, but thankfully, the 4 dollar drug programs from companies like WalMart allows me to make sure they have the bare bones medications they need.

What does this mean for me? Most days, my practice feels like trying to plug a hole in a dam with my finger. A vast majority of my patients have been too sick to work for years. This includes those with schizophrenia, those with severe bipolar, crippling depression, dementia, traumatic brain injuries, moderate-severe mental retardation.

Some people who come to see me have milder symptoms. Often, they bring in disability papers for me to sign. Sometimes, I have to tell them that, in my opinion, their mental health diagnosis is not enough to keep them from working. A lot of these people drop out of treatment when I tell them that. Some don’t.

Most of my patients live in a continual state of crisis. They don’t have transportation, or housing, or food, or money for their children’s school supplies, money to take their family to doctors who don’t accept Medicaid. I try to see them often, because every month brings a new crisis. “I lost my visiting nurse because the insurance said I no longer qualify.” “I can’t afford physical therapy.””I went to interviews, but no one will hire me because I’m old/have a prison record/have visible tremors/am overqualified.”

I work as hard as I can. The clinicians I work with often double as social workers for these patients, helping them finding crisis housing when they lose their apartment, filling out paperwork for them to be brought to the doctor’s office when their clunker dies, finding vocational opportunities that allow them to find work, even if a few hours a week.

For this work that I do, the government pays me a salary that puts me squarely in the top 10 percentile of the income distribution. This salary is considerably lower than what other specialists make, and considerably lower than what I would make if I were in private practice, or employed by a for profit hospital or university. It is more than enough for what I consider a very comfortable life.

And I’m grateful for this. I’m grateful for the opportunity to remain in this diverse, open country, grateful for the opportunity to do what I do best, grateful that my 30-35% taxes pay for this health center, the roads, the traffic lights, the police, the EMS, urgent care centers, housing shelters, and yes, various forms of government assistance.

Because I come from a country where there is no government assistance. Every day, I’m aware of the fact that most of my patients, had they been in India, would either die, or resort to begging on the street in order to survive. This nation allows them not to do that. And for that, I’m grateful.

*Disclosure- I am neither a Democrat or a Republican. Being on a visa, I cannot vote. Like most Americans, I try to see beyond the smoke screens both parties put out. I don’t completely support either side, but have a clear bias towards one.

About purplesque

Psychiatrist, cook, bookworm, photographer. Not necessarily in that order.
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10 Responses to Election 2012

  1. mizunogirl says:

    Nice post! Interesting. I thought you were back in India? How is it that I miss so much? At any rate, I think that continual state of crisis really impacts anyone’s ability to really cope and live a life that feels worth living. It is something that many many people have never had to deal with. And while I had my own years of a continual fight or flight life, it was relatively secure…I can not even imagine what it must feel like to try to focus your children when everyone knows that in a few weeks they might have to move again. Good on you, I have a feeling the US is darn lucky to have you where you are.

  2. I read the article written by the former “welfare mother” earlier today and wept. Being a single mother who’s struggling to pay bills and deal with bureaucratic paperwork in order to survive isn’t the cushy lifestyle Romney and his cohort seem to believe. Also, like mizunogirl said, living in constant crisis makes it extremely hard to focus on getting a job or raising one’s own children. I’m glad someone as compassionate and as insightful as you is working with the most vulnerable in our system. But I’d argue you should have the right to vote as much as anyone in this country. Your service is as valuable if not more so than the people who have chosen to serve in the armed forces and who receive automatic citizenship as a result.

    • purplesque says:

      It made me tear up as well- she writes so well.

      I would certainly like to vote- but the path to citizenship is a very long one, and I’m not completely sure we’re ready to start down that road yet. In the mean time, there are other ways of supporting the candidates I like. 🙂

  3. jaklumen says:

    I just can’t keep my comments short… as usual. I wiped what I was typing and hope this is more acceptable in length, although it probably isn’t.

    Mitt Romney is family. Here’s a quick and dirty: http://en.wikipedia.org/wiki/Pratt_family#Relationships_table Yes, it’s Wikipedia, but my parents probably did the hard, reliable research. I don’t think they read Wikipedia whatsoever. If they tell me he’s related, he most probably is. Rey there is my great-grandfather. One of his daughters is the mother of Don Bluth, the animator, who is much more fun to say I am related to. You’ll notice Jon Huntsman is on that family tree as well. I will let you imagine how that all discomfits me.

    You know I am living a life much like some of your patients. Maybe you remember me mentioning my trauma issues: basically I have a fear that everyone (yes EVERYONE) is going to proverbially stab me in the back eventually. Any time there is a subject that mixes Politics, Religion, Sex/Sexuality, and Money/Finances I feel this terror that I am going to lose it and no one is going to understand why I feel hurt. (The more of the above that gets mixed in, the worse it gets. And I often do lose it.) I would describe myself as slightly left of center and very, very loathe to bite the hand that feeds me… and I’ve taken up too much length already.

    • purplesque says:

      Jak, I apologize if the politics/money stuff in the post set off the terror. These are complicated things, and in my effort to be honest there are times I say too much.

      (That Wikipedia tree is so interesting! I remember hearing somewhere that Mr. Romney and Mr. Huntsman were distantly related. It must feel strange to have not just one, but two presidential nominees in your family tree.)

      • jaklumen says:

        It’s not you personally, really. Things have been difficult lately.

        The relations are what they are; Mormons did a fair bit of colonization. I’m sure that you understand how that tends to keep members of a group related to each other; I’m a 5th generation member on my father’s side, so, yeah.

        It’s strange just having personal beliefs in a national spotlight, but most of my immediate extended family is estranged. He’s distant enough (not that distant though) this shouldn’t be much of a consideration at all but I have much closer relations basically acting like the others don’t exist. Thankfully that mess is NOT actually in the spotlight.

  4. phantomxii says:

    It’s been distressing to hear Mr. Romney caught on record as a de facto wealthy elitist who thinks 47% of his fellow citizens are freeloaders, then to have him expect to wipe away the indiscretion by merely saying it was completely wrong, and then for quite a few voters to apparently buy the reversal. While it might not be the hot soundbite of the moment, I still believe that no matter what else Romney might be for or against, such explicit disregard for regular folks—followed by an apparent belief that those same folks will forget it overnight—is a horrible attitude for a presidential candidate. Perhaps he doesn’t really want to gut programs that help poor people, but he’s sort of trashed his own credibility on that point.

    • jaklumen says:

      If he was a closer family member– I’d actually ask for an apology (as a family member), because I *know* I am part of that 47%. (Friend of mine said it was like a slap in the face– she’s a homeless vet right now– she’s struggling harder than me and I think she’s got a right.) Now, I’ve got in-laws and blood kin that are pretty staunchly conservative, but I know they aren’t giving me a hard time, too much. They quickly point out I’m not one of the ones they’re worrying about– I mean the folks that abuse the system, or really are lazy, etc. I still would like them to consider all the other circumstances that lead people to do such things, but then I get annoyed when I see that, too. I don’t particularly want others to make it harder for me and mine– it’s pretty tough already.

  5. amelie says:

    Great points, I don’t think people realize the downward spiral that poverty sets off. As for Romney, it’s laughable that he and his cronies make themselves out to be businessmen who came from nothiing just because some distant relative of theirs may have been poor. Let’s see them live on minimum wage and no health insurance for ten years and see how they do. I think every politician should be required to work for those wages for at least a year before taking office. One report I heard stated the average person would need to earn $22/hr to make the most basic payments these days.

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