Posted:So I was having a talk with my senior resident.
Ok here's the setting: We work at a city hospital that serves Medicaid patients. These are poor, underserved patients who can't afford their own medical insurance and so have government insurance.
The thing is that most of these patients live on welfare, too. And when I say "on welfare," I mean that mom doesn't work because she has three kids and three kids pay enough welfare for mom to be able to support the family without working.
Here's the general life cycle in the Bronx. 1) 15-year-old girl gets pregnant, has baby. 2) 15-year-old girl, of course, cannot support baby and collects welfare. 3) Now 16-year-old girl drops out of school (or perhaps graduates high school) and in the process, manages to repeat the mistake and have another baby. 4) Now 19-year-old girl is working a minimum-wage job while grandma (aged 35 or so) is raising the two kids...and...manages to get pregnant AGAIN... 5) Now, with three kids, the welfare check is sufficient that she can maintain her three kids in a 2-bedroom apartment, and she stops working so she can raise her kids, because Grandma is at wit's end. 6) Now 25-26-year-old woman either fails to talk to her daughter about the birds and the bees or simply forbids her daughter to have sex. Which eventually results in... 7) 15-year-old girl gets pregnant, has a baby.
So here is my resident's plan. Quite simply, you are limited to three kids that you cannot support. Once you have that third kid, if you apply for government assistance, you are forced to undergo a tubal ligation/vasectomy. Both of these are reversible procedures so that if you do manage to pull your life back together, you can have (at government cost) the procedure reversed. Her reasoning is simple: "If you can't make a responsible choice and continue to spend my tax dollars on raising your kids, then I have to make the choice for you."
As horrible as it sounds, I honestly believe that these children are poorly raised by immature parents who were poorly raised themselves. As long as this cycle is allowed to continue unchecked, it will continue unchecked.
Here are my additions: 1) Sex ed is MANDATORY for all kids at age 10. Seem young? Most of my patients had coitarche (coit-ark-ee, meaning the onset of sexual activity) at age 12-13. No religious opt-outs, no exceptions, nothing. EVERYONE gets sex ed. Reading, writing, 'rithmetic, and reproductive planning. And condoms are provided FREE in schools. Birth control may be prescribed without parental consent and is available FREE to teenagers.
2) If you get pregnant and you are under 18, you have two choices: you may a) abort or b) give the baby up for ANONYMOUS adoption. Children may not raise children. If it's 11:58 PM on the evening of your 18th birthday and you have a kid...tough. Adoption. If you want a kid that badly, you can have another later.
Yes, it sounds harsh, but you have to look at it from the point of view of someone who has to take care of these children. I find them to be almost uniformly medically neglected. I have *NEVER* seen a parent actually fill a prescription for antibiotics that I have given, in spite of careful instruction and pep-talks into the importance of these. Parents expect us to GIVE them (because we do) over-the-counter drugs such as ibuprofen and acetaminophen (paracetamol, as they call it in the UK). They also expect the hospital to GIVE them passes on public transportation. And they call the EMS for their kid's coughs and colds because they know that EMS has to accept all pediatric patients, regardless of whether the complaint warrants EMS transport. And they have to pay ZERO copay for ED visits. I have seen so many children come in having asthma attacks and needing high-dose steroids (with cumulative toxicity) because their parents couldn't be arsed to fill and administer their preventative meds. I have seen obesity because more than 90% of a kid's diet is fast food because the parents can't be arsed to cook.
I beleive in government health care and I believe in the need for a social safety net, but there has to be some personal accountability in the system. The system as it is (at least in New York City) seems to reward people for abusing it. It's time that some pop-off valves were installed.
After all, I'm a working physician. I pay for my health insurance. If I go to the ED, I have a $50 copay and office visits have a $20 copay. Prescriptions have a copay from $10 to $30. I don't get over-the-counter drugs covered. And my insurance would LAUGH at me if I asked them for a MTA Metrocard. Why do unemployed people get better health insurance than I do?
At least I know where that third of my paycheck is going.
-Doc "The Conservatives aren't wrong about *everything*" Lightning
-Mike )'( Certified Mad Doctor and HoP High Priest of Nutella