In the Great Recession, Even Death Is Too Expensive for the Poor
Rita is only in her 30s, but she knows all about death. What she
didn’t know until recently is how expensive it is, especially now in
the Great Recession, for the poor to die.
Rita’s parents, her only relatives in the U.S., died in a car crash
during her sophomore year in community college. Rita dropped out of
school to earn a living as a shipping coordinator at a Bay Area package
company. A few years later, she found herself coughing and coughing.
She was always short of breath. Tests revealed that Rita had a rare and
fatal disease of unknown origin–one that leads to the slow closure of
the blood vessels feeding the lungs. She will suffocate to death before
the age of 40.
“I know the end is coming,” she tells her doctor and nurses; after
many meetings with her chaplain, she is, she says, “at peace.” At the
medical clinic in San Francisco’s General Hospital, Rita tells anyone
who will listen that she has two goals. She wants to continue living
with her cat in her one bedroom apartment in the Mission District of
San Francisco. And she hopes to continue receiving the few medications
that mitigate her symptoms.
There are currently more than 1.2 million Americans like Rita who
are facing a terminal illness. The health care providers who treat them
routinely have to ask: How do you wish to die? Some of the
dying–wanting to keep death at bay–repeatedly ask to participate in the
latest pharmaceutical trials. Others have drawn up a “bucket list” of
adventures for their final days. But more people have two simpler
requests: to die at home instead of in a hospital, and to eat a decent
In this recession, even these simplest last wishes have become nearly impossible for many to fulfill.
Two years ago, Rita fainted on the job. Her boss had noticed her
diminishing level of performance; he said that Rita was just too winded
to work. Unemployed, she initially received disability coverage. But
like the other eight million Americans unable to work because of
illness, she was required to apply for a continuation of benefits after
Rita’s problem–the clinic’s social worker explained–is that like
most young people who are ill, Rita is dying too young to have paid
significantly into Social Security. This meant Rita would receive
“Supplemental Security Income” (SSI): $830 a month and California’s
Initially, Rita thought she could stretch these funds. She would
have to give away her cat and move into a studio apartment–something
smaller and cheaper than the average studio in San Francisco. She would
also buy food in bulk, saving at least $200 a month for her
But the politics of budget cuts stifled her plans. Over 65 percent
of SSI claims have been denied during the recession, a record high
number. A series of the governments reviewers of her case interrogated
Rita, and one without any medical training misinterpreted her medical
chart. Despite the fact that Rita had “pulmonary arterial
hypertension”–severely increased pressure in her lungs–he wrote that
Rita suffered from run-of-the-mill high blood pressure. Rita was
The clinic’s social workers tried to intervene. They were told that
Rita would now have to wait for an “appeals hearing” after 90
days–possibly longer that she had left to live. She would be without
income for her last months of life.
Due to new state budget cuts, Rita’s Medi-Cal coverage was also
limited to six medications. Her doctors had to decide which pills they
could take away without suffocating her immediately–a deadly guessing
game since there is not enough research to guide doctors in forecasting
When clinic workers discussed the dilemma, Rita joked: “I should
have been a banker instead of an ordinary taxpayer. Then I could have
been bailed out.”
Rita lost her apartment. She slept for a few weeks on an
ex-boyfriend’s couch, until he threw her out, suspecting her cough was
from an infectious disease. She had signed up for welfare, at the usual
rate of $422 per month plus food stamps. But without an address, the
only way to get a roof over her head was the City’s “care not cash”
program for the homeless–$59 a month, and a shelter bed.
Rita’s inhalers were stolen on her first night in the shelter. Her
shoes were stolen on the second night. So she began to sleep in the
parks, her symptoms worsening. Finally her doctors convinced her to
check in to the hospital.
In the hospital, Rita was stoic. Her face had assumed the tough sheen of ceramic.
When a social worker asker her whether she would be willing to
modify her plans, let the clinic find her a hospice bed, Rita said she
had written it all down. She couldn’t discuss her thoughts with any
more clarity. And besides, going over her problems would only make her
cry. And crying made it difficult to breathe.
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