Letters of March 14

Medi-Cal A Quagmire that Makes You Sicker

You have to be poor to qualify for Medi-Cal, which is California’s version of Medicaid. But poverty is only the beginning of your troubles. 

For example, following an injury requiring hip surgery, Maria needed physical therapy (PT). A physical therapist came to her house once — then she was on her own. Several months later, Maria still had severely reduced range of motion in her hip, making her unable to walk. 

Between Maria’s surgery and when I first saw her, Medi-Cal changed a regulation to reduce cost of treatment. The new regulation requires everyone in 30 California counties who has Medi-Cal to enroll in a managed-care plan (HMO).

 For 3 million of the 4.4 million Medi-Cal recipients in 14 counties, only two plans are offered. Most plans contract out and require endless authorizations for each medical service. Before this regulation, patients had few choices, because most physicians would not accept Medi-Cal’s meager payments. Now, patients have only two.

Maria could not return to her orthopedic surgeon, who had stopped working with Medi-Cal. Her primary-care physician in her HMO referred her to a different orthopedic surgeon. That orthopod gave her a prescription for a PT 15 miles from her home. After many phone calls (partly because the original referral to PT had expired), I was able to get her a referral to PT within traveling distance. After Maria had three sessions, that PT group closed its contract with the HMO.

I arranged for a medical transportation company to take Maria to PT.  They couldn’t transport her because her leg was stuck straight out. I made other arrangements for transport, after going back to the primary MD and getting yet another order for PT. That doctor also ordered another ortho consult and additional diagnostic tests. 

His orders never reached the middle level of the insurance company. I kept making phone calls to try to straighten this out, but could never get a live person on the phone. When we finally got Maria to PT, they took one look and said “her case was too complex” for them.

It took more phone calls and threats of filing a grievance to get Maria another orthopedic appointment. The orthopod wouldn’t see her without a new X-ray, which required going back to the primary care physician. The primary doc had to write new orders for the diagnostic tests, because the first ones never showed up at the insurance company. 

These months of delays in getting Maria the physical therapy she needed resulted in irreparable damage to her hip and knee, and we still don’t know what harm may have been caused by the delayed diagnostic tests, which have yet to happen.

Many Medi-Cal patients try to deal with their HMOs and insurance companies on their own, and eventually give up. The politicians have no qualms about cutting services to those at the bottom. You never hear them talk about cutting interest payments to California state bondholders.

The state has also been slashing funds for In-Home Supported Services (IHSS) and for group homes that serve the disabled population. They keep tightening the criteria for IHSS and cutting the number of hours of care patients get. 

The cuts in the group homes force providers to cut corners in food quality and hiring standards. When the upcoming additional 10% cut is initiated, some providers say they will have no choice but to shut down.  These cuts result in further destroying people’s health and in shortening their lives. Seeing this is one reason why I participate in a CHALLENGE readers group.

Public Health Worker

Knowing a PL’er and CHALLENGE Changes Workers’ Ideas about Communism

Since being laid off from my job at a school, the distribution of CHALLENGE at my former workplace — combined with concerted efforts to build strong relationships with our friends and co-workers, in a conscious effort to broaden our base — is helping build the Party. 

When workers and friends saw an article about the circumstances at our job, their responses were positive. Comments were made like, “That is just what is happening here,” and “I hope people will see that we are really living under fascism”. 

Recently, we got together for some pizza, wine and political conversation. This event was the second in a series of meetings comrades from different workplaces are hosting. Our mission is to strengthen our relationships with workers and “cross-pollinate” our bases. We started by discussing the CHALLENGE article as previously mentioned. We reviewed how racism divides the working class and is used to depress the working conditions and wages of all. 

One worker, who is white, said that black workers on the job had told her, “You are out here in the fields with us”, when they were describing the disrespect suffered at the hands of black bosses on the job. She also said that PL’s analysis of racism made it clearer that bosses of the same ethnic group as the workers will still be racist. 

We concluded that even if our school was closed in the coming months, we could and should fight against what the capitalist class is doing to workers through the dismantling of public education. Some workers talked about their sharing CHALLENGE with their family and telling them, “Hey there is this guy at my job who is a communist”. 

We have encouraged every CHALLENGE reader to take two — “One for you and one for a friend.” These workers shared stories of hearing about the “evils of the communist enemy” as they were growing up. But knowing a communist on the job and having the opportunity to read CHALLENGE was changing their ideas about communists and communism. PL’ers pointed out that the fights posed by the old socialist movements led to many of the benefits workers won, and are now losing. 

We also strategized about how to fight for PL’s politics in the current labor movement, how to avoid the anti--communist ideas that capitalism can be made better for workers or that masses of workers can’t be won to fight for an immediate transformation to communism. Together, we read parts of the PLP document “Road to Revolution IV” and the “What We Fight For” section in CHALLENGE. 

We decided we should get together more often. Word of another gathering reached the workplace and workers who did not attend said they wanted to come the next time. Our base-building efforts require us to be flexible. 

The Party will grow through personal and political struggle. We should build strong relationships and win them to fight for the Party and its ideas in their personal and political lives. Pepperoni and Pinot Grigio do not make a revolution, but building personal ties and political honesty with our friends should definitely be put on our plates.

Red