Musings on Medicare

Stan wears a navy cap and military badge, though the closest he came to the army was attempting to draft himself to Vietnam, before his history of mental illness caught up with him.

He smokes a cigarette in the garden of Opal House, the residential care home in Oakland where he now lives. He fled his last home because the subsidised housing facility assigned him a room mate who kept snakes; For a while everyone co-existed, but one morning Stan was putting on his socks when an escapee snake broke the harmony and bit him on the ankle. He is pleased to tell me there are no snakes at Opal House.

it is a twee suburban kind of a place; Outside there is a plastic butterfly stuck into the lawn of the garden and a dirty US flag. Inside, the television mumbles soap operas at two other residents sit in the half darkness of the living room. Their chins are lodged on their chests seemingly oblivious to the drama that unfolds across the screen and the sound of bird song and a lawnmower just beyond the lacy curtains. Two shriveled figures, unmoving and clamped in place on two identical brown sofas. A carer gives them a cursory introduction and then takes me through to the office.

We are talking about health care, but a discussion of Medicare - the government health care plan for the over 65's - cannot be removed from the darker details of life as a low-income senior: lack of affordable housing, a fifty dollar cut-back in monthly social security payments and isolation. Making things worse is the fact that the state of California is bankrupt and for the 16,500 low income seniors in Oakland there is no longer money to cover their dental care, speech therapy or a host of other medical services they used to receive for free. Medicare may entitle low income seniors to free medical care in principal, but the reality is that many are unable to access such services; often this is due to a lack of knowledge as to what they are entitled to, a fear that going to the doctor is too costly and an inability to afford transportation. This is compounded by the ethnic and linguistic diversity of Oakland and the frailty and forgetfulness of low-income seniors, who are more likely to wait until they are so sick that they require emergency treatment than pursue preventative care.

Stan has just turned 65. Unlike other 65 year olds instead of being about to retire, he is about to enter the workplace. He is looking to become a dishwasher. He tells me he must take a shower Monday, Wednesday, Thursday and Saturday so that he can be clean for the restaurant. He will work an hour at a time. He needs the money, he says, because his entire social security cheque goes to his landlord at Opal to pay for his food and board. He has no money left over for himself, he tells me. He saves dollar notes to collect for the bus fair to the doctor.

He is only brushing his teeth once a day now, so that he can save on toothpaste.