CallMeJim

A lot of the discourse about poverty reminds me of this:

> I do occasional work for my hospital’s Addiction Medicine service, and a lot of our conversations go the same way.

> My attending tells a patient trying to quit that she must take a certain pill that will decrease her drug cravings. He says it is mostly covered by insurance, but that there will be a copay of about one hundred dollars a week.

> The patient freaks out. “A hundred dollars a week? There’s no way I can get that much money!”

> My attending asks the patient how much she spends on heroin.

> The patient gives a number like thirty or forty dollars a day, every day.

> My attending notes that this comes out to $210 to $280 dollars a week, and suggests that she quit heroin, take the anti-addiction pill, and make a “profit” of $110.

> At this point the patient always shoots my attending an incredibly dirty look. Like he’s cheating somehow. Just because she has $210 a week to spend on heroin doesn’t mean that after getting rid of that she’d have $210 to spend on medication. Sure, these fancy doctors think they’re so smart, what with their “mathematics” and their “subtracting numbers from other numbers”, but they’re not going to fool her.

> At this point I accept this as a fact of life. Whatever my patients do to get money for drugs – and I don’t want to know – it’s not something they can do to get money to pay for medication, or rehab programs, or whatever else. I don’t even think it’s consciously about them caring less about medication than about drugs, I think that they would be literally unable to summon the motivation necessary to get that kind of cash if it were for anything less desperate than feeding an addiction.