I looked inside my black pouch, full of once used syringes and other tools of the trade. It was just as I expected. I was almost out of my shit.  Without the shit I can’t function. I can’t live. Without the shit I die.



I didn’t have many options, but going without wasn’t one of them. I called my buddy Paul, who goes through almost as much of the stuff as I do. Paul has a job that makes it easy for him to get it.



Paul understood the seriousness of my situation and eased my fears. He was holding and had enough to share. He always had extra, he said, and didn’t mind hooking me up. We made plans to do the deal later that night.



My wife and kid were in the car, but I didn’t mind. This was important, and besides, it would be fast. I put the Daewoo in park and saw Paul coming toward me, shivering from the wind and carrying a brown paper bag. I hopped out of the car and jogged toward him. It went down exactly how you’d expect.



“Here’s the stuff, man,” Paul said, glancing up and down the empty Tacoma street.



“Thanks, man. You’re saving my ass,” I replied.



“No sweat. Seriously. I know how it goes. I’m lucky. I’ve got insurance.”



I returned to the car and showed my wife the prize. Three milliliters of insulin. My faulty pancreas breathed a sigh of relief.



But seriously …



Five years ago I was diagnosed with Type 1 diabetes. It’s a bitch, but then again, so was losing weight, pissing every hour on the hour, sleeping 16 hours a day, and wondering if I was dying. Back then I didn’t go to the doctor because I was young and stupid, but I also didn’t have health insurance. I was a student at Evergreen, and the school has a small health clinic. By the time I finally made it in I had lost 60 pounds and done permanent nerve damage to my feet. I hadn’t been to a doctor in years, probably since high school. I was 22.



Long story short, I wasn’t just a really big fan of Squirt. My pancreas had gone tits up and was no longer producing insulin. From that point on I would need to shoot up once in the morning, once at night, and every time I ate carbohydrates in between. Every day. For the rest of my life. Just like the 20.8 million people in America with diabetes. Wherever I went, whatever I did, I’d need to have one little red and one little purple bottle of insulin with me.



The brown paper bag insulin deals are real. Like so many other people in Tacoma, Pierce County, and the United States, I don’t have health insurance (my employment insurance is still working its way through the system). When it comes to managing a chronic disease that requires constant and expensive medication, this presents a problem. When I was much poorer I was on Washington Basic Health, the state’s low-income health insurance program, and though I’d grade the medical care I received as average at best, it made getting the insulin I needed cheap and easy, and I saw a doctor every three months like I’m supposed to.

Now my wife and I make too much to qualify for Washington Basic Health — by $18 or something. Amazingly (and stop me if you’ve heard this one before), we’re unable to afford the $400 worth of prescriptions and diabetic supplies I go through each month — not to mention the cost of seeing a doctor. As it turns out, especially in an economy where filling up a Daewoo costs $50, we’re America’s uninsured “near poor.”



Pleased to meet you. We’re not the only ones in the boat.

The uninsured in Tacoma and Pierce County

Whether you believe me or not, I pitched this story as one about the medically uninsured in Tacoma and Pierce County. When I broached the subject with my editor, the Tacoma City Council had just passed a measure granting themselves access to the same health benefits as 0.9 full-time city employees, based on the hours they put in and the idea that offering health benefits was a way to make it feasible for a broader range of candidates to run for office. Who wants to work 32-plus hours a week on the City Council and not have health insurance they figured.



Who wants to live in Tacoma and not have health insurance I wonder. If Tacoma realizes the City Council needs health insurance to attract possible candidates, what’s Tacoma doing to make sure its poor and uninsured are taken care of? What does the picture of being uninsured in Tacoma look like?



The United Way of Pierce County has done a lot of research to help paint that picture. The organization compiles “Human Service Assessments” for the county, and currently one from 2006-07 is available at UWPC.org. These assessments are designed to monitor “the state of human services in our community,” according to the Web site. “These studies are as much about engaging the people as they are about having the right information to affect positive change.



“Perhaps the best service an assessment such as this can provide is to educate and inspire others to take action,” the Web site reads.



According to the UWPC’s Human Services Assessment for 2006-07, “About 200,000 Pierce County residents live on the economic edge of poverty.” Furthermore:

• Approximately 116,000 Pierce County residents, or about 15 percent of the population, lack health insurance. This figure includes more than 50,000 individuals with jobs and 19,000 children.


• Nearly all businesses (98 percent) in Pierce County employ 50 or fewer workers. Less than half of all small businesses provide health care coverage benefits, which means about 25 percent of our total work force is uninsured.


• One in three children (33 percent) in the county between 2 and 4 years old has never seen a dentist, and of the 85,000 Medicaid-eligible children (0-18 years old) in Pierce County, only 38 percent are receiving dental care. One in four children (27 percent) in Pierce County between 19 and 35 months old has not received standard immunizations.

As troubling as all that is, it’s nothing new. Surprise, surprise. Health care in this country needs reforming — and that includes Tacoma and Pierce County. Everywhere you turn families, friends, and people you know are being forced to make sacrifices and go without because of it. Diabetic hacks like me are tracking down insulin through friends and parking lot hookups. Canadians are laughing at us. None of this is new.

The poorer the better?

The silver lining of the situation is there are a number of places for the poor and uninsured in Tacoma and Pierce County to turn to, and not all of them are last resort ERs. The poorer you are the better. Many qualify for state or government social service programs whether they realize it or not, and even if they don’t, there are organizations designed to help. Both the Sea Mar Community Health Clinic, which has an office at 11th and Cushman, and Community Health Care, which operates several medical and dental clinics in our area serving primarily the poor and uninsured, charge patients on a sliding scale based on their income — or lack thereof. Both agencies also place a heavy emphasis on helping qualified people get lined up with state or federal assistance, such as Basic Health, Medicaid, Medicare, and the State Children’s Health Insurance Program (aka SCHIP).



“Hopefully we only have to see them uninsured once,” says Robert Kinch, marketing and development director for Community Health Care.



“The primary population we serve are low income, low education and without social skills,” Kinch continues, adding that many people “don’t know how to access the resources” they qualify for. “The process can be somewhat overwhelming.”



The process may be overwhelming, but at least it’s out there. Washington is better than most at offering health insurance to its poor and especially its poor children. Basic Health may have flaws, but compare the state health insurance program to those in other places and it doesn’t take long to realize we’ve managed better than most to make sure the poorest and most vulnerable are covered. But for the estimated 200,000 workers in Pierce County living on the “edge” of poverty, a population coming to be known as the “near poor,” this system isn’t always as helpful.



Yearly, $35,200 and some change is the cutoff for Washington Basic Health eligibility for a family of three. Say a mom and a dad are working their asses off to provide for the family. Neither of their jobs offers health insurance. They’re part of the 25 percent of the workforce without health benefits. Gas prices keep rising; the price of food keeps going up, and the mom and dad work as hard as they can to have enough. It’s not pretty, but they’re doing all right.

What if one of them gets really sick? What if one of them develops a chronic disease like diabetes or cancer, or some other damn thing that’s going to require stockpiles of prescriptions and hours of doctor visits? What then? They work hard to earn their, say, $36,000 a year — but because they do they’re not eligible for Basic Health or Medicaid. Luckily the kid is covered, thanks to SCHIP, but the parents are S.O.L. They want to keep working, but there’s no way to afford the doctor visits and medications without insurance. Does one of them quit working and become truly poor so they can get the insurance they need? Or do they keep working and ignore their health?



Decisions like this are made every day in our state. Kinch estimates that 50 percent of the patients seen at Community Health Care suffer from chronic disease, and he estimates the organization serves 10,000 people a year. If the silver lining is that Washington does a better job than most at insuring children and the really poor, then the sour, foul-smelling film on that silver lining is the frightening number of near-poor families left out to dry.



With all of the help places such as Sea Mar and Community Health Care provide, the problem is bigger than any solution they can offer. Remember the 116,000 estimated uninsured in Pierce County? The clinics could slide the scales all they wanted and still reach only a fraction of that population. And the same fickle economy that has you worrying about your job has agencies like Sea Mar, Community Health Care, the United Way, and others wondering how they’re going to adjust.



“Everything that everyone in the economy is feeling, so are we,” says Kinch. “We’re preparing to lay off 11 people in June. It’s a matter of ever-increasing expenses and reduced income.”



However you look at it, and whatever silver lining you try to paint, it’s clear to see the system isn’t working. Something needs to happen, and the only real answer is some form of universal health care. In a nation as wealthy as the United States there’s no reason people should be suffering this way.



“Last year we provided $11.3 million in uncompensated care,” says Gale Robinette, media relations director for the Franciscan Health System, which operates the St. Joseph Medical Center in Tacoma, the St. Clare Hospital in Lakewood, and several others in King and Pierce counties.



“A lot of the people who come into our ERs are really poor, just struggling with daily existence. People may not know where to look. They assume, incorrectly sometimes, that they don’t qualify (for Medicaid or Basic Health). There are 48 million uninsured Americans. There is no reason to feel ashamed or embarrassed. People just need to feel comfortable asking for help. People need to remember there’s no need to be alone.”



“Frankly, it’s inhumane,” Robinette says of the estimated 116,000 uninsured people in Pierce County. “(We need) universal health care — or at least basic coverage. That’s where this issue is at. Sure there are pros and cons of universal health care, but I can’t think of one pro of people not having insurance.



“Until something is done, the only thing certain is the problem will continue to get worse.”

“The number of uninsured people we serve is continually increasing. And a significant number are working poor,” says Kinch. “It’s an economic problem.”



And it’s everyone’s problem — the poor, the near poor and even the rich. It’s time we finally stepped up as a nation and did something about it. There are about 116,000 reasons in Pierce County alone.