We’ll just call him by his first name. He won’t mind if we used his full name. He won’t even mind if we published his SSN in this blog post. He doesn’t think he has anything to lose. Why should he? He is a Medicaid beneficiary. In fact, from his story, it seems like he belongs to one of the four living generations of his family that rely on Medicaid for health insurance, the city of Seattle for housing, DSHS for income, and Meals on Wheels for food.
John's Story
We met John on a bright, sunny Friday at Genesee Park in Columbia City. He was sitting alone on a bench. We sat next to him and talked about the weather a bit, then we asked him how he was doing—at this point, he opened up. He talked at length about his family. He talked about how his mom (now 87) raised seven children—including John—how she is hard of hearing and relies on Meals on Wheels for food. He talked about his brother that recently moved into public housing in Seattle. He talked about how he doesn’t get along with his son but is proud that his daughter works at the Sound Transit Authority and gets her health insurance through her employer. He also talked about his 2 grandchildren and how he has other grandchildren that he has never met.
Then, he talked about himself. He is 53, four years younger than the Space Needle, and distinctly remembers riding the monorail as a kid. He has never held a steady job. He has always relied on public assistance for income. He makes $300 per week for showing up at a place in Tukwila where he may or may not get assigned some work, work that may or may not have any purpose. In the past, he has flipped burgers at McDonald’s, helped that Philly cheesesteak stand in downtown Seattle—but he has never held a job for long. He also complained that nowadays one needs to have basic computer skills to be employed at McDonald’s.
He currently lives in an apartment and pays $1000 per month rent (leaving him with $200 per month for everything else). His goal is to move to public housing (like his brother). We asked him why he wouldn't share his apartment with a roommate, but he avoided that question (we would later find out why). He showed to us the housing application (he calls it “app”) that he had filled a month ago but had not submitted to the Seattle Housing Authority. We again asked him why not and he said because he couldn’t pay for transportation.
A System Gone Wrong
We offered to drive him to the housing authority and get his paperwork submitted. He agreed and sat in the front passenger seat as the navigator. He knew the way to the housing authority building on Queen Anne Avenue like the back of his hand. As we entered the housing authority building, we were surprised to see that there were no long lines. We helped him with his paperwork and submission at the counter, where we were surprised to learn that the city needed a mailing address in the application. Once the paperwork was accepted, he was given a receipt and a list of properties with wait times for each. None of the properties had a wait time of shorter than 1-2 years.
Most had wait times of 3-4 years or longer. John was going to have to wait a long time before he could move into his state aid assigned apartment. On top of that, while waiting, he would need to check-in monthly with the housing authority via the internet, phone or in person. If he failed to check-in, his application would be canceled. John has a government supplied phone that is only good for making phone calls and sending/receiving text messages. He doesn’t have the internet on his phone - not that it would have mattered. He has never used a computer or internet in his life and doesn't know what Google is (he knows about Amazon because he has seen commercials on TV). We couldn’t offer to check-in on his behalf as the system requires his SSN to be keyed in, and we didn’t want to have his SSN.
Moreover, it didn’t seem like John kept track of time. Would he remember to check-in with the housing authority every month? Most likely not. John will most likely lose his spot on the wait list and will be back at the end of the line in a month or two. Then, the cycle would need to repeat itself with a new application (if he cared to submit one). The housing authority probably needs that monthly check-in to know that the person is still looking for housing - and they are probably proud to have provided 3 ways to check-in: in-person, by phone or via the internet. The irony is that these won't work for John. He doesn’t have the money for transportation to check-in in-person and there is no one to remind him to check-in via phone. The internet is out of the question.
Not a One Dimensional Problem
It was almost 2 p.m. We were done with the paperwork at the housing authority. We invited John to have lunch with us. We got a table in a mostly deserted Mexican restaurant near the housing authority building. John ordered the least expensive enchiladas on the menu. We ordered sopapillas for dessert - John first refused to have any dessert because he thought it was unhealthy but had a couple of sopapillas at our insistence. We asked him what he generally had for meals - and his answer was Wendy's 4 for 4.
But for all the cheeseburgers he ate, he weighed only about 140 pounds. (Our guess is because he ate only once per day, or maybe even less frequently.) We asked him if he had ever needed to visit the emergency room, and he said no, even though he has been diagnosed with hypertension during one of his periodic visits to Harborview Medical Center (he saw the same doctor every time - kudos to the doctor for John’s good health).
As we were having lunch, John opened up even more. He had lived on the streets for 6 years. He had spent close to 2 years in jail. He had recently moved into a downtown apartment in Seattle with a roommate (his share of the rent is $500). This didn’t match his account from when we met him first in the park, but at this point, it didn’t seem like a big deal. After we ate our lunch, we offered him a ride to his apartment. Instead, he wanted us to drop him back at the park where we first met him. As we drove back to the park, we asked him if he would be willing to learn how to operate a computer at a nearby library. We told him that it is easy to learn to operate a computer and that it is nothing to be intimidated of—not only that: it will open up job prospects for him and he will be able to check-in with the housing authority easily. He promised us that he will learn computers later, but we knew what that meant.
As we turned from Rainer Avenue to South Genesee Street, he pointed at the job agency building on the right and told us how they wanted him to be in that office at 5:30 AM for a job. He wasn’t going to be able to do that, possibly because of lack of transportation or possibly due to lack of will. We may never know for sure which one it is.
As we said goodbye, John was thankful to us for helping him submit his paperwork and buying him lunch. We didn’t offer him any money, nor did he indicate at any point that he wanted any. He was too proud to tell us that he was sharing an apartment with a roommate, and he was too proud to order anything but the cheapest item at the restaurant. We thanked him for spending the time with us.
Proper housing, transportation, and food will continue to be the biggest priorities for John for the foreseeable future. John is healthy now, but at some point, he will need care for his hypertension and associated conditions. Like millions of individuals like him, he will most likely end up in the emergency room when he needs care for one of his ailments. The fact that he sees his doctor periodically (whatever that means) isn’t going to help when he ages with hypertension and continued consumption of unhealthy food. His healthcare costs will soar, so will the Medicaid budget. His problems of health will follow his problems of housing, transportation, and nutritious food. The problems of housing, food, and transportation (the social determinants of health) that will be left unaddressed today will create more expensive problems for his community tomorrow.
Authors (based on personal experience): Vijay Bhuttar, Dr. Parag Patel and Krish S
Edited by: Kaarin Slotte