Foreword This impressive and moving document is the first published report on what the people for whom the Medicaid program was enacted have to say about this program. It is one thing to write and talk about the urban crisis-and to write and talk about the indignities of poor relief status as a condition for receiving tax-financed health care-but it is quite another matter to have the poor in our own neighborhoods share with us their excitement at being first class citizens when they open the door to the health service of their own choice. We have a long way to go before the Medicaid program is all that we hope for it. We have yet to begin the task of restructuring our health services so they will be more responsive to neighborhood decisions—and more comprehensive in response to neighborhood needs. But what this document does tell us is that the day has now come when health care must be a right, universally available to all people, on the same basis. Health need, and health need alone, must determine the right to health care. We can no longer segregate those who seek health services by the source of payment for the care they will receive. The meaning of what the Witnesses for Medicaid have to say is quite clear: the dignity and enhancement of self-respect essential for full participation in our democratic society mean abolishment forever of our twoclass system of health care. The very least we can do is to assure all people "private" status in the most personal of all services. It is against this social policy commitment that we must measure the effectiveness, and ineffectiveness, of today's Medicaid program. The gaps and deficiencies are many. Some of these deficits will be corrected only by legislation-others require better administration of existing laws. Most important of all, perhaps, is that the people for whom the programs are designed must share in the decision-making process. Medicaid is the beginning of a series of changes which must be revolutionary. They must remove the welfare stigma too often associated with all of the tax-supported services--a welfare stigma too long characterized by our health care system. Eligibility criteria and application procedures are unsatisfactory and unrealistic in today's democracy. Weaknesses in administrative and fiscal procedures, many of which are revealed in this testimony, can and must be corrected without further delay. We must get on with the job of bringing to all people in all neighborhoods the comprehensive health center concept of services. This first effort of "Witness for Medicaid" must be repeated throughout New York City-repeated throughout all our urban communities. It must be repeated often. These voices are one way of preserving the small gains that have been made and of building on these gains. It is these voices which will bring the public participation needed to strengthen the laws and to make public officials aware of their responsibility to improve the quality of both the administrative procedures and the health services provided. United Neighborhood Houses has once again demonstrated that the strength of democracy rests with the people ---and where health is concerned it is at the point where program meets people that the final test of program and social effectiveness must be made. Harry Becker Executive Secretary Committee on Special Studies What Is Medicaid? Medicaid is a New York State health care program for the medically indigent of all ages which currently covers all medical bills for hospitals, doctors, dentists, nurses, druggists and others who provide needed medical care and services. This includes preventive care as well as treatment of an illness. Participants in Medicaid are free to choose where they want to go for medical care—to any hospital (public, voluntary or private), or any doctor, dentist or other practitioner who participates in the program. The practitioner, instead of charging the patient, bills the city. The program is financed under Title XIX of the federal Social Security Act and State enabling legislation. Why a "Witness for Medicaid" Hearing? "Witness for Medicaid," an informal hearing held by United Neighborhood Houses on April 14, 1967, was conceived as a means of dramatically informing New York City's Congressmen and the City and State administrators of Medicaid on what Medicaid means to those who use it. UNH's frank hope was that the testimony would help persuade Congress not to reduce the scope of Medicaid and suggest to Medicaid's administrators ways of improving the operations of the program. United Neighborhood Houses views Medicaid as an enormous forward step in freeing low and moderate income persons from the economic hazards of illness, while providing them with high quality medical care. UNH strongly supported the enactment of the Medicaid program in New York State and has fought against subsequent efforts to dilute it. Two threats to Medicaid prompted the April 14th hearing: First, Congress was reported considering limiting federal reimbursements. Second, Administrative roadblocks were discouraging medical practitioners. as well as persons eligible for the benefits, from participating in Medicaid. The hearing was chaired by Congressman Jacob H. Gilbert (22nd C.D.) and by Mr. Theodore Pearson of the UNH board. Two other Congressmen attended William Fitts Ryan (20th C.D.) and Leonard Farbstein (19th C.D.). Two others sent aides-Stephen Berger, representing Jonathan B. Bingham (23rd C.D.), and Ira Rubin, representing Edna F. Kelly (12th C.D.). The City and State agencies responsible for administering Medicaid were represented by Joseph H. Louchheim, Deputy Commissioner, New York State Department of Social Welfare; John Mullaney, Medical Assistance Administrator, New York City Department of Welfare and Dr. Howard Brown, Administrator of Health Services, New York City. The witnesses were, for the most part, ordinary people enrolled in Medicaid who were known to UNH's member settlement houses. Some were Welfare recipients; others were not. Among the witnesses also were neighborhood workers who had been engaged in enrolling people in Medicaid and in helping them make use of its services, two hospital spokesmen, a dentist and a sprinkling of other interested parties. The testimony which follows is verbatim. The only editing consisted of arranging it by topic and eliminating excessive repetition. To those who want to know directly from those who are experiencing it, what Medicaid is all about, here is the living testimony. What's Right "Out of the clear blue sky you have to figure $10 for a penicillin injection..." MRS. BERTHA JACKSON: (Parent, Church of All Nations Neighborhood I'm happy to be here to be a witness for Medicaid. Because Just before we were able to get our Medicaid cards, which was September, my husband had an operation which was $125 and then I had to go to the dentist and he told us that it would cost us $250 for some work that I had to have done on my teeth. And that was just...well that was just the end, because that was the end of the bank account that we had and, well, we just were at the end of the road, the bottom of the barrel. We started looking around trying to figure out, "What are we going to do now?" We just were really finished--flat out. So we got our Medicaid card and right after that, I had to go to the hospital for three weeks and it took care of a three week stay in the hospital. Since that time, I've had other medical attention which involved an IBT x-ray, which would have run us $65, and my little boy had to have some extensive dental work done on his teeth which is going to be taken care of. Also, the work that will be done on my teeth will be taken care of, too. So I want to say that this is a wonderful program and it's just marvelous to think that people even exist today that are really interested in the average poor person, or someone that is below middle class. "I think it's the best thing we ever had." MRS. ADA CABEZUDO: (Head Start Parent, James Weldon Johnson When I got my Medicaid card I didn't even know what it was all about. I was two months sick and almost paralyzed. I was going to a City hospital and it took me a long time to get my medicines. When I got my Medicaid card I had to call my (Welfare) investigator and find out what it was about and he told me that I could go to my private doctors, or any private hospital. So I went to one of the better hospitals that we have in New York and, thanks to Medicaid, I am walking. I have my braces that without Medicaid I wouldn't be able to pay for. I think it's the best thing we ever had. With Medicaid MRS. NANCY DELAUROT: (Parent, Child Development Program, Colony House) When I first heard about Medicaid, I said to myself this is too good to be true. The most wonderful thing for me was to be able to go to a dentist for the first time in years. "For the first time... a family doctor." MRS. MARILYN FARMER: (Community Aide, Forest Neighborhood House) For the first time, many of these patients have had what we generally call, a family doctor... They've had one doctor. Previously, when they called the Department of Welfare for a doctor, they got one this week, one the next week. And treatment was not always the best that it could be because the doctor wasn't aware of their problems. "It has lifted our out-patient department out of the nineteenth century.' RICHARD LORRANCE: (Manager, Out-Patient Services, Long Island While there are some difficulties with Medicaid applications-they are very complicated and the processing takes a good deal of time--the more positive aspects of Medicaid in terms of their effect on the hospitals are very gratifying. For example, at our hospital, it has lifted our out-patient department out of the nineteenth century into a twentieth century type of clinic. We have developed an appointment system. We've done away with the three and four hour waits that people had to suffer through. We have developed a preventive medicine program, so that the doctors are concerned with the whole patient and not with the patient who comes with one specific illness in one specific part of his body. More important, however, to me is the fact that the hospital has moved out of its removal from the community and become part of the total community life. 83-481 68 pt. 2 12 This is a magnificent thing to watch--that a person is able to choose whether he wants to go to a group service, a medical service, or a comprehensive program in a hospital, or a private doctor. This is a tremendous thing to say for any country. MRS. EVELYN CUMMINGS: (Parent, Child Development Program, Lenox Hill Neighborhood Assn.) After I got my Medicaid card we joined HIP and it's very nice. I have my own family doctor; my kids have their own pediatrician and I've started going to the dentist. It's very easy to do. It's sort of one center; you have everything done there. specialists also. They have MRS. BRUNILDA VASQUEZ: (Community Worker, Action-for-Progress, Before Medicaid, I went to the Department of Welfare dentists for dentures and had to wait about five months. Three times I kept my appointment which required two hours of travelling time and was told that my dentist didn't come that day. Finally, when I did get them, my dentures didn't fit and, you can see, I don't have any teeth. I went back to the dentist a couple of times and he told me not to come anymore, that it was all in my mind. Now, under Medicaid, I go to a private dentist who has promised to let me come back all the times I want to, until my dentures fit. MRS. IDA VADAN: (Parent, Head Start, Grand Street Settlement) Before I was in Medicaid I used to go to the City clinic. You get there about 9 o'clock in the morning. You stay there 'til twelve-two o'clock in the afternoon. They give you the run around for this and that. They have you coming back every day of the week for something...Since I've used Medicaid, I haven't had the problem to go running back to the clinic when you can use a private doctor of your own at any time. I think it's very important that we keep it just like it is. |