Sunday Commentary: One Year Since ‘the Other Davis’… What’s Changed?

Gonzales-building-WoodlandIt was a year ago, that I wrote “The Other Davis” from, ironically enough, a hotel room near the LA Airport as I was on vacation.  For a few moments it seemed like it might get people’s attention, but the moment was fleeting.

I have spent several years explaining to county supervisors and their staffs how the social services system in this county is broken, but no one really seems to care.  They will pay it lip service, but no one has taken the initiative to change it.

I understand money is tight, but much of what ails the system is not money but simple respect, common decency, and a little bit of competence.

The amazing thing is that the more people I talk to about these sorts of problems, the more it just confirms that our experience is a common one and it reinforces the accuracy of my perception about the difficulty that people have in the system.

I do not intend to start a debate on Obamacare, but let me just say that moving my kids from the community clinic to Kaiser has been an eye opener.  No more are we treated as second-class citizens.  No longer is our time treated as inconsequential.

What was the final straw was trying to get copies of the medical records of my two-year-old nephew, of whom we are guardians, so that he could attend nursery school this fall.

The community clinic almost cost him a spot in his preschool because they cancelled no less than four appointments and refused for a time to sign a medical record form without seeing him, and once they did sign the record, they failed to sign it in the correct spot.  It was a small deal, but at the same time a massive headache, that cost us at least five hours in total, perhaps more.

But this understates the hassle.

The Davis Community Clinic, on the first occasion, actually called up less than ten minutes before an appointment to cancel.  Remember, we have a number of small kids and getting anywhere is a hassle – gathering the kids, loading up the car, making sure they have gone to the bathroom or their diapers are changed.

The next time, my wife was a running a few minutes late having to get one of the kids from school, and something came up and they cancelled the appointment on her.

The third time, they made my wife and kids wait for hours and they never saw a doctor.

The fourth time, my nephew was finally vaccinated but they refused to fill out the form, requiring a separate appointment.

That saga was fresh in our mind when we signed up with Covered California this fall.  That too was an ordeal, but calling them on the phone proved effective and we were able to get the whole family covered under Kaiser.  No more early morning phone calls, no more waiting hours for a walk-in appointment because the only scheduled appointment was a week out – and someone was sick or in a good deal of pain, only to be told that they are full and can’t see us.

No more being treated rudely as though we are second-class citizens because our kids, all of whom are adopted or we are guardians for, do not have their own health insurance.

This was the year we had the debate over fluoridation.  The public health community came out in favor of fluoridation as a way to help the poor.  I believe that the proponents of the initiative were sincere in trying to help poor kids.

But many of them have been rather indifferent when it comes to the plight of people attempting to access county services.

Every year in June, Assemblymember Mariko Yamada takes what she calls the “Hunger Challenge.”  According to a press release from back in June, “Hunger Challenge participants pledge to live for one week on the nation’s average weekly food stamp benefit of $4.46 per day, or just $1.49 per meal.”

“The challenge is a reminder to me that for millions of Americans, hunger is a daily reality,” said Assemblymember Yamada.  “While I struggle for only a week, far too many who cannot make ends meet face going hungry every day.  Those living in ‘food deserts’ – often students, the disabled, and seniors – are particularly affected.”

While I respect the Assemblymember’s efforts, in my opinion and from my experience the worst part is not the limited budget you get on food stamps – but rather the horrible treatment that poor people get across the board.

If Assemblymember Yamada wants the true picture – she needs to hold her job and attempt to get food stamps and Medi-Cal, and take her children to CommuniCare.

I have often told the story of our nephew who moved in with us in September of 2010, severely malnourished and with grave emotional issues.

It took us from September of 2010 until April of 2011 before he finally saw a counselor.  How did it finally happen?  Did Social Services in Woodland point us in the right direction?  No.

We walked into Supervisor Jim Provenza’s office, his staffer Gina Daleiden walked us across the hall, and Katie Villegas made a few calls and several days later finally got us counseling.  I want to stress this was a kid that most people would have considered in SERIOUS need of medical services.

A month after that, we finally got services for him through the school district as part of AB 3632 – something that entitles a student with an IEP (Individualized Education Program) to academic-related counseling, something that was a vital lifeblood that has been threatened with being cut due to state budget problems.

Food stamps were a nightmare.  Because the kids – our daughter was a foster child up until last October and we were the boys’ guardians – were considered sole incomes, we were entitled at least to food stamps.  But that required hours of paperwork and multiple trips back and forth to social services.

Even when you have an appointment at social services, it takes hours to be called forward and hours more to process paperwork.  Can you imagine a working single mother having to take off a half to full day of work to get the paperwork processed?

The sad thing is that not only have elected officials and their staffers been aware of these problems, they have often assisted us with these issues – and done a good job, by the way.  My complaint is that none of these problems have seemed to lead to change.  The system remains the same.

Thousands of families in our community face these same issues, but without the resources, connections, and wherewithal to push to get the services that they are entitled to as a matter of law.

That is the story of thousands of people in this community who live in the other Davis.

—David M. Greenwald reporting

About The Author

David Greenwald is the founder, editor, and executive director of the Davis Vanguard. He founded the Vanguard in 2006. David Greenwald moved to Davis in 1996 to attend Graduate School at UC Davis in Political Science. He lives in South Davis with his wife Cecilia Escamilla Greenwald and three children.

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49 thoughts on “Sunday Commentary: One Year Since ‘the Other Davis’… What’s Changed?”

  1. growth issue

    Kaiser has been great for us, the local clinic is very accessible. Just curious, what’s is Kaiser costing your family monthly under Cover California? What are your deductibles, copays, and yearly out of pocket maximums.
    Ours rates went up almost 10%, we now pay $25 copay instead of $20 for primary doctor visits, 90% of hospital stays are covered where before it was 100%, my plan has no deductible but our yearly out of pocket was raised from $3000 to $6000. So in essence our rates went up much more than 10% with all the extra hidden costs.

    1. Mr.Toad

      My brother is saving $600 a month through Covered CA. and his coverage actually improved. Not only that he no longer lives in fear that he will not be able to get insurance or will get kicked off when he needs it on some pretext about pre-existing medical conditions. I guess he is a winner under Obamacare.

    2. DavisBurns

      I have a self employed friend with a medical condition that puts her in a high cost category who was paying $700 a month for kaiser. She is single and in her 50’s. Her kaiser bill is now under $200. Don’t want to digress about ACA but that may satisfy your curiosity. It seems to help self employed who make too much for med-iCal the most and these are the folks who have suffered with very high rates for decades.

  2. B. Nice

    My good friend had a similarly frustrating experience trying to get her child an appointment at the dental clinic. She was told in November to call back in January and try to schedule an appointment then.

  3. Mr.Toad

    Perhaps some economic development might help some of the people in this county, 17% of whom live in poverty, get a job that pays enough to escape the social welfare system.

    1. Frankly

      It is well said. The frustrating thing is that it needs to be said at all.

      I wonder how it must feel to be an able-bodied person and wake up in the morning knowing that someone else is going to supply me with free services and free money so I can survive? I honestly don’t have that experience… ever… even having been dirt poor growing up.

      I think it must make a person feel pretty bad.

      But then since people don’t like to feel bad, I assume that eventually a person can get used to us. And of course there are all those left-leaning crusaders for social justice making sure society is as accepting as possible for all these people perpetually down on their luck.

      In my personal life experience, I have not experienced a single happy ending to the situation where a family member or friend got on public assistance. In 100% of the cases, the life of these people never got better or else it got significantly worse. Now, in some cases the public assistance was just a symptom of deeper problems like substance abuse. But not a single person was lifted up by the hand-outs.

      And I think this is the common story played out. Few move forward. Most stagnate or move back.

      I employ recent college graduates. They all tell me that school did very little to prepare them for working. They all tell me that so many things about their life and their opinions about life changed after working for 6-12 months at a challenging job.

      Most young soldiers I meet tell me the same thing. They tell me that all it takes is a month in service and the light bulb comes on.

      I remain completely convinced that the human soul and spirit is nourished through work, and it is corrupted without work. I am talking about work that provides the opportunity to grow prosperity.

      I frankly think that without work a human cannot easily achieve self-actualization. That is the light bulb. It is that first taste of what it feels like to tackle a challenging job, succeed, get recognized, get a raise, get a promotion. This is what cause the epiphany of forward progress in prosperity and fulfillment of higher-level needs that previously seemed completely out of reach.

      Government policies that destroy job opportunities destroys lives.

      Government should get out of the business of trying to provide so many people with basic needs other than the basic need of a job.

      Our lack of economic development is just mean, selfish and indicative of a level of greed that Gordon Geeko would be happy to recognize.

      Obamacare is costing many jobs.

      It was/is the completely wrong way to go about getting better healthcare to more people. It just increases that downward spiral away from many of the things that have made this country so great and so successful.

      1. DavisBurns

        May you never be too ill to work and have to live on SSDI. May you never suffer a blow to the head rendering you executive functioning to level of a first grader. May you never suffer heart failure and spend your unemployed time wondering when you ICD will fail and when you will need that heart transplant. May you not have to learn how to self-actualize without work while living on less than $800 a month. Many people do not work because they cannot work. Not because they are lazy or don’t want to work. Government assistance allows these people to live independently in a tiny subsidized apartment and eat po’ folk food and dress from the SPCA and that’s about it. So revel in your food health and your sense of euphoria when a job is well done. Just cause you are blessed doesn’t mean you should take a dump on those less fortunate.

  4. David Greenwald Post author

    I’m sorry that I mentioned the ACA, because it’s small point in the much larger point which is the treatment of people receiving county services.

    1. growth issue

      LOL, I know you don’t want any discussion about Obamacare because you know what a complete disaster it already is and is going to be. But David, you know as well as I do that if it was going good you would be writing many articles about it. I guess the best you can do for now is try and squash any blog comments.

      1. Don Shor

        I am going to ask you again please not to try and discuss national political issues on threads that are about local issues. It is off topic, and derails the thread.

        1. growth issue

          Don, okay, but at least in this thread David discussed Obamacare in his column. Almost every thread has off topic posts, for instance someone was talking about trolls on another thread (not the Internet type either), but you always seem to be right on top of mine. I guess I should take that as a compliment.

          1. B. Nice

            If troll talk started an off- topic debate on how they would be effected by Obamacare then I’d see your point. For now it seems to just add some comic relief, and friendly banter between otherwise sworn blogging enemies.

          2. B. Nice

            You have to asked to respond to comment on this blog? Man someone should have told me that. Who I am kidding that probably wouldn’t have stopped me.

          3. David Greenwald Post author

            What I discussed here was that what we are getting under Obamacare is better than what we had under the county, but the purpose of it was to illustrate how bad the county services are.

      2. David Greenwald Post author

        I’ve written almost nothing this year on national subjects and the few I have, had direct bearing on issues that are of local import or the the local work we’ve done.

  5. growth issue

    There are some good things about Obamacare, latest CNN poll: “The new survey, conducted in mid-December, indicates Republicans with a 49%-44% edge over the Democrats.”

  6. Ryan Kelly

    I agree that efficiency is severely lacking in social services in Yolo County. Your stories about long waits and irrational rules are widespread, not only in this County. I once confirmed an appointment over the phone before I left home with a foster child, only to be told that there was no appointment in the book when we arrived not ten minutes later. I too have had the experience of waiting 7 hours in an uncomfortable waiting room, while my sick child was in an ICU at the hospital, to submit an application for medi-cal and then waiting over 6 months to receive an answer. I sometimes wonder why or how people were hired and why they are retained when they make repeated mistakes and treat people so poorly.

    If attention was paid to vastly increasing efficiency, using technology for appointments and applications, terminating employees who are incompetent or rude, and examining policies that waste time, increase the number of visits or are designed to discourage people from accessing services, we could all be proud of our local social services agencies.

  7. Tia Will

    I thoroughly agree that efficiency, competence, respect and an ethic of doing as much as possible for each individual at each visit, aided by efficient staff and up to date electronic records are all hallmarks of an optimal social service or medical delivery system. What I find missing from this conversation is any discussion of how very much these systems cost. I would not have the vaguest idea if I had not seen these systems evolve over time within the Kaiser system. I wonder how many of those who berate the efforts of those now providing care are willing to pay the cost in taxes or otherwise financially support those agencies to improve training, electronic records, and integration of systems necessary for the top rate system we would all like to see.

    1. B. Nice

      Tia the thing I found disturbing about my friends incident is that she was given bad information from the person she initially talked to. She was telling me her story about trying to get an appointment at the dental clinic in passing one day, and when I heard that she was told that no appointments were available and that she needed to call back in two months (according to my friend the person she spoke to was abrupt and not particularly friendly), I encouraged her to call the clinic again thinking she might get a different answer if she spoke to a different person. She took my advice, and was indeed able to book an appointment within the next week or so (I can’t remember the exact time frame). I wonder how many people were told the same thing initially, took it as truth, and put off dental procedures for their kids. It sounds from David’s article that these type of experience is not an isolated one.

      1. wdf1

        For those who live on more modest means and may not have available dental insurance, I suggest checking out the Dental Health Clinic at Sacramento City College for basic teeth cleaning: link. It is the teaching clinic for the dental hygiene school there. You have to be ready for longer than normal appointments (2-3 hours), but the price is probably the least expensive that you could find in the area. Yes, dental hygiene students are the ones who do the cleaning, but there is a certified dentist on site.

        I used to go there as a grad student when I didn’t have dental insurance. They did good work.

      1. Jim Frame

        Kaiser subs out to Delta Dental, at least in Northern California. It’s an add-on to their regular policies, and like most dental insurance, it provides only limited coverage. I’ve often considered dropping it, but inertia keeps me hanging in there.

        1. B. Nice

          We have Kaiser through my husbands work, but no dental insurance, it think I looked into Delta Dental at one point but it didn’t seem worth it, sounds like you feel the same?

          1. Jim Frame

            The monthly cost is for dental is about $27 per person, but the problem is that the “usual and customary” amounts it pays for services are only a fraction — and not a very big fraction — of what local dentists charge. For my family of three, the $950 per year would buy all our normal dental services, with lots left over to bank for the occasional expensive stuff (e.g. crowns). But I’ve never actually run the longitudinal numbers to determine how it really comes out. For the nonce, inertia rules!

          2. SouthofDavis

            We pay cash for our dental care and have a great local dentist that gives us a great cash discount because he knows we don’t have dental coverage (and we pay in real green cash before we walk out the door). We have a cash cushion (so we won’t have to sell a car if I need a crown) but dropping dental coverage has been a great deal for us and we get to pick our dentist (vs. getting stuck with the slim pickings that most insurance companies let you go to).

          3. growth issue

            SOD, I don’t have dental coverage either. Can you give me the name of that dentist as I wouldn’t mind paying cash either if I could get discounts.

  8. SouthofDavis

    Tia wrote:

    > I thoroughly agree that efficiency, competence, respect and an ethic of doing as
    > much as possible for each individual at each visit, aided by efficient staff and up
    > to date electronic records are all hallmarks of an optimal social service or medical
    > delivery system. What I find missing from this conversation is any discussion of how
    > very much these systems cost.

    It does not “cost” that much to build and maintain a paitent database. I keep track of 20,000+ clients and contacts using two PC (worth less then $200 each running older copies of Outlook) and an iPhone and iPad and Microsoft Exchange to synch and back everything up on all four devices for $48/user/year.

    I don’t want to go off on the ACA but many respected software developers (off all political parties) have said that if we were smart we could have had a better running ACA website (a year earlier) for about a HUNDRED times less than the close to one BILLION in taxpayer money spent on the site so far.

    The companies with connections have learned to game the system so they make as much as possible. Companies that work with Democrats to help the poor will make sure that nothing “off the shelf” will be allowed so they make millions just like companies that work with Republicans to supply our troops will make sure that nothing “off the shelf” will be allowed so they make millions.

    I have no idea why we got such a crappy Obamacare site for the hundreds of millions spent, but a friend in the Army said that the Army has special ‘specs’ for everything so they can’t buy a Craftsman 18 oz. hammer for $5 or 8’x10′ tarp from Wal Mart since only one company (that gives big bucks to politicians) makes the 18.7 oz. “Army spec” hammer and the 8.7’x10.4′ “Army spec.” tarp (I am making up the exact numbers but he did say that the Army really do have “special” hammers and tarps and can’t buy them from Sears or Wal Mart)…

    1. Jim Frame

      “I have no idea why we got such a crappy Obamacare site for the hundreds of millions spent”

      A friend who owns a web design firm (as distinct from “a guy who builds web pages”) tells me that federal contracting requirements are so onerous that only very large, very stodgy companies compete for jobs like the ACA site. The innovative and nimble outfits aren’t able — and don’t really want — to play in that part of the sandbox. So the ACA website outcome was predictable even without the politics layered on top.

      I’ve only had one federal contract in 20+ years of business. It was a sole-source arrangement that was actively pushed by the agency’s PM, but even with that advantage I had to jump through a lot of hoops to get it in place.

      1. growth issue

        “First Lady Michelle Obama’s Princeton classmate is a top executive at the company that earned the contract to build the failed Obamacare website.

        Toni Townes-Whitley, Princeton class of ’85, is senior vice president at CGI Federal, which earned the no-bid contract to build the $678 million Obamacare enrollment website at Healthcare.gov. CGI Federal is the U.S. arm of a Canadian company.

        Townes-Whitley and her Princeton classmate Michelle Obama are both members of the Association of Black Princeton Alumni.”

        1. SouthofDavis

          Thanks for the update, this probably comes as a shock to the half of America that watch CNBC and reads HuffPo. My goal in life is to get more people to step away from the “our team is great the other side is bad” news feeds and realize that “both” sides are doing what they can to get as much of our money to their friends and classmates. I bet most people that watch Fox and read Drudge have any idea that William Henry Draper, III Yale class of ’50 was tapped in to the Yale Skull & Bones group by former President George H.W. Bush (they are also both in the same Bohemian Club camp). Bush later set him up to run the US Import Export Bank where he gave tons of money to “friends” of the GOP…

      2. Jim Frame

        Oops, make that two federal contracts. Same agency (USBR), same PM, but two years apart. One sole-source, the other I may have had to compete (can’t remember).

  9. WesC

    Kaiser took 10 years and spent $6 BILLION to get it’s electronic health record up and running which covers approx 9 million members in 9 regions. Kaiser spent $400 MILLION on it’s initial attempt at creating a electronic health record before writing it off and starting over from scratch.
    The health care reform act states that meaningful use of technology by providers nationally would cost $11 billion. Kaiser’s CIO says that this will be a nice down payment and it will actually cost tens of billions of dollars to implement this.

  10. WesC

    Medical practices with electronic medical records in selected countries as of 2009: Netherlands 99%, New Zealand 97%, Norway 97%, UK 96%, Australia 95%, Italy 94%, Sweden 94%, Germany 72%, USA 46%. An article in Bloomberg Businessweek of June 21, 2012 stated that part of the problem is “The difference between the state-run approach and the market-driven one is stark. There are 551 certified medical information software companies in the U.S. selling 1,137 software programs. Some are big, such as GE HealthCare (GE) and Epic. Some are tiny niche players catering to sub-specialties. Their products have one thing in common: They don’t communicate with one another. And this is by design. EHR vendors, which charge as much as $25,000 per doctor for a system and a monthly subscription fee on top of that, want to lock out competitors while locking in customers for life.”

    1. DavisBurns

      Why medicine for profit should be illegal. We need a one payer system and I want something better than Medicare because it is still a tangled mess even if it’s better than ACA. I want what France has–one card and only one card that covers everything for everyone. No middlemen, no insurance agents, companies, no billing departments, no collection agencies and no middlemen. We could do better if we took out the profit.

  11. Robin Affrime

    Dear Mr. Greenwald,

    I am so sorry to hear that you feel you did not receive excellent service at CommuniCare Health Centers, Davis Community Clinic. It is our mission to provide high quality health care to those in need, regardless of their ability to pay, and I am sad that your experience here was not first-rate. I can only imagine how frustrating those experiences must have been for you and your family members.

    I appreciate you voicing your concerns, as we can only improve when we are aware of the issues. In particular, I am looking into the issue you highlighted about cancelled appointments – which is unacceptable. Of course, I would encourage you (or any other unsatisfied patient) to contact us directly so that we can address specific concerns or challenges, as we are committed to continual improvement. We regularly conduct surveys and implement initiatives to make things better and better for our patients.

    At CommuniCare’s health centers in Yolo County, we saw more than 22,000 patients and provided more than 94,000 visits in 2013. We see more than ten percent of the Yolo County population at our clinics, and we strive to achieve the highest quality care for all of our patients. We hope every one of those visits is a positive experience – and we recognize there is always room for improvement. CommuniCare is committed to the successful implementation of health care reform in our state and in our county; and I am happy for all of us – because we now have more choice about where we receive care.

    Again, I am sorry your experience was not a positive one and I’m glad you spoke up so we can work toward making improvements, as we are committed to providing the best care possible for our patients. I wish you and your family the very best in this New Year.

    Sincerely,

    Robin Affrime
    Chief Executive Officer
    CommuniCare Health Centers

    1. Frankly

      Wow. Very nice letter. David, I doubt would get the same response from Kaiser for service complaints.

      And you will have service complaints.

      Your comparisons are transactional. Give it some time and you will have some bad transactions at Kaiser too.

      And with Obamacare causing doctor and service shortages, you will start having more and more service problems.

      Frankly I am a bit unhappy about this article because it appears that David is just pushing propaganda about Obamacare. I wonder, did he take the time to contact anyone at the clinic to complain?

      There is no question that low-income healthcare options are less satisfying than those that cost more. Just wait until the healthcare market is completely transformed into two markets: private concierge arrangements and government-run. The concierge services will be more satisfying for those that can afford them and so we will be back to this same complaint.

      1. Tia Will

        Frankly,

        Wrong again. While it is true that the letter of apology from “Kaiser” would not have been written by Robbie Pearl, it would quite likely have been written by a local senior administrator.
        I know because for the past 5 years, I have been reviewing complaints about care provided within the Davis clinic and addressing the issues directly when appropriate, and escalating to a senior administrator when beyond my scope. Speculation adds very little to the conversation whether on the local or national level.

  12. DavisBurns

    Reliable sources tell me Yolo county mental health routinely schedules appointments they cancel, sometimes the day of the appointment but that’s not the frustrating part. They cancel appointments, you don’t show up then they record you as a no show. It happens a lot. After they do this three times they throw out your records. you cannot make an appointment until you go through the application process again including an orientation. This takes months. Then you get to make an appointment which will take another three months. By then your prescriptions are expired and your life has fallen apart and of course it’s all your fault. Yes they need to weed out the no shows but maybe the real no shows need extra support not less and for the conscientious people who are anal about keeping appointments and showing up on time? How do they prove the office called them at 9 am to tell the doctor canceled their 10 am? Do they have any option other than take the abuse? Maybe they are lucky enough to have an advocate who will “walk across the hall and fix it” but mostly they have no one to help them. Yes, David, being poor means being at the mercy of people in authority who can pretty much treat you as they please. It means taking what you are given and not expecting a break. It means every user fee the rest of us grumble about takes a real chunk out of you $25 a month disposable income. It mean a ticket meant to deter the rest of us wipes out a meager saving account. Barbara Eherenreich’s Nickeled and Dimed is a good read if you’re one of the fortunate non-poor. I think being poor means never having a choice. Or very limited choices.

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