Romney and Government Handouts

     Mitt Romney is all over the news today for comments not intended for the news media but overheard and recorded surreptitiously, and published in Mother Jones.  This is what happens when a big election is just seven weeks away.
     Romney said that 47% of Americans were being carried by the government--not paying taxes, not creating jobs, and therefore likely to vote for Obama, because they would want to perpetuate the government entitlements they receive.  Romney despaired of being able to win these voters to his side because, he said, they have no desire to take charge of their own lives.  He remarked that they don't contribute to the American economy. 
     Democrats are using these comments to accuse Romney of being rich, privileged, and failing to understand the lives of "ordinary Americans."  Their retaliation is that this group of Americans does, in fact, pay sales tax.
     I have been a longstanding Democrat, a bleeding heart, a tree-hugger, an advocate for the disenfranchised, a believer in government programs to help people, when they are in a bad way, get back on their feet.
     There are abusers of every charitable enterprise.  America is a charitable country, but we are not good at distributing charity fairly.  When someone is awarded disability, it's supposed to be for a permanent condition, and it's rare to see the label reversed.  In twenty years of work as a physician I have seen only two individuals come off disability--and they were not identified or encouraged in this by the government, but insisted on getting jobs and removing themselves from the disability rolls.  They did this because they were languishing under disability and wanted their lives to expand with greater opportunity.
     Even the Democrats agree that 46% of voting-age Americans are not paying income taxes. amd instead are receiving government handouts.  So Romney's number wasn't an exaggeration. 
     Who should be getting disability, I ask myself every day?  Not a day goes by in my office when I don't wonder, "Why is this patient on disability?"  I have started asking patients, directly, why they get disability, and I hear some pretty strange answers.  Here are two from the past week.
     "I was molested when I was nine," explained one woman in her early twenties.
     "OK," I said.  "But one-third of American women were molested as children.  Did the experience cause you lifetime disability?"
     "No," she replied.  "I feel fine."
     "Why are you on disability?"
     "I guess they thought the experience upset my mental state," she said.
     "Are you unable to work?"
     "I can work.  But I can't find a job. Besides, then they'd take away my payments."
     "Can you go to school?"
     "Yeah, I'm thinking about it."
     "Why don't you get off disability, and get some training for a career?  You seem pretty smart."
     The patient laughed at the part about getting off disability. Why would she give up free money?  But she said she was looking into an online course at Santa Fe, so she could stay home with her daughter.
     "I'm thinking about having some more children," she added. " Could you refer me to a fertility specialist?"   She had one child at home, but her new boyfriend wanted her to have more children for him.  Her Medicare and Medicaid would cover the cost of bearing children.
     Another patient, age 42, has been on disability for twenty years. He's lithe and muscular, moves about with ease, and says he makes money "on the side" by doing small construction jobs.  By "on the side" I understood him to mean "under the table."  He told me he was put on disability for a back problem.
     "Your back looks fine to me," I commented, after examining him.
     "Yeah, it doesn't give me any trouble."
     "Can you lift heavy things?"
     "Oh, sure," he said.  His powerful shoulder, arm, leg and abdominal muscles were proof of this.
     "Why do you keep getting disability?" 
     "They said my back was twisted or something," he said, with a baffled look.
     "But your spine is straight," I said.
     "Well, maybe it wasn't back then," he explained.  He had had a motorcycle accident, after which he went to the Social Security office to apply for disability.  His mother and brother were "getting checks" and he thought he'd be eligible too.  He was right.   He also gets Medicaid, food stamps, and subsidized housing.
He uses cocaine ("not regular, just every few days"), smokes two packs a day, and admitted to drinking twenty-four beers a day.  For food, he eats a baloney sandwich or two.  He likes to hang out with his friends down the road, and he watches a lot of TV. 
     My work will be to get this man to think about himself and his life differently, and to stop using substances that will cost the healthcare system mightily in the next decade or two.  But Medicaid doesn't pay family doctors for substance abuse counseling, and it forbids the patient to have more than two medical visits a month.  Whereas that might be plenty of medical care for an average person, most such patients don't have average health problems.  This man's labs were extremely abnormal, his liver was enlarged, his teeth were missing or decayed, and his EKG showed signs of stress. 
     I haven't been a big fan of Mitt Romney.  But I'm not sure what was so bad about his comments.  In a country with so much to offer, where people have access to clean air, food, water, housing and education, why are 46% of adults on government assistance?  It's a good question, and I think it's one Republicans want to ask, without being accused of insensitivity.  We need to rethink how our charity and our healthcare dollars are being distributed.