Access Part I: The Dentist Problem
The tiny barriers that keep the poor, poor and the rich, rich
I’m taking the morning off work today to go to the dentist. That, in itself, is frightening enough, but the implications of this situation are far more insidious.
I’m a teacher. This morning represents my last hours of paid time off I have for the rest of the school year. No more PTO until May 23. But, no problem, I have a whole summer of PTO, not to mention a week off coming soon for Spring Break. I can go to the dentist then. Except that I have a tooth that desperately needs a crown. And my dentist takes the same days off as I do. Same holidays, spring break, and even a large vacation time in the summer. He, and his staff, face the same problem as I.
At my last dental appointment (during my Winter Break), I talked to the dental hygienist about this problem. She is a single mother of two teenage daughters. She works the same days and hours as the medical professionals she and her daughters need to see. She uses the majority of her own PTO with getting appointments filled for all three of them. Her ex-husband, the girls’ father, lives out of town, so she can only get those appointments scheduled on the days when her daughters are with her, she has the PTO available, and the providers have open appointments.
Meanwhile, I took my second-to-last PTO hours last week to take my own daughter to the doctor. My sick time renews every school year, so that means that between August 4, 2022 and today (February 6, 2023) I have used up all of my time until it refreshes again next August. Where did that time go? Sick kids, appointments for me, for them, emergencies with daycare providers, etc. And, ironically, none of those days were taken when I was actually sick. What will happen if I do get sick and have to take more time off? I’ll take a dock in pay. What happens if my kids get sick, or the daycare provider’s kids get sick and she closes, or my kids need an emergency visit to the dentist or doctor or a million other things that happen in the course of living?
I’m not saying all of this for you to feel sorry for me. Actually, please don’t feel sorry for me because that’s not my point. Thankfully for me, I have a stable salaried job. If I have to take some unpaid time off, then so be it. I’ll still have a job. I also have a wonderful husband who can, and will, take time off from his job if the kids get sick or need a trip to the eye doctor. Also, it’s not about feeling sorry for my dental hygienist. She has supports, as she shared with me, and her oldest daughter can now drive and take herself to certain appointments.
My point is this: If it’s difficult for her and I, in good-paying jobs with benefits and actual paid time off, with support and means, to navigate basic medical care for ourselves and our kids, how much more difficult is it for people without those luxuries?
I think of the single mother with two kids. Her kids have different fathers. She is earning minimum wage on the night shift at a 24-hour pharmacy. She sleeps during the day while her kids are at school. After school, she picks them up, feeds them, then drops them off at their respective father’s homes for the night. Sometimes their dads are there, sometimes it’s grandma, or aunt, or sometimes a neighbor comes by and sleeps in the house with the kids when dads’ homes are not available. If mom takes time off work, she loses income. She doesn’t have benefits at this job, so even if she could get the time off work to take her eleven-year-old son to get an annual check-up, how would she pay for it? What if her seven-year-old daughter needs a tooth crowned? Too bad, so sad - that’s money out of pocket for the appointment AND for the time missed from work.
And what about the other end of the spectrum? The stay-at-home parent, or the couple with well-paying jobs, plenty of time off, and access to the best benefits and providers?
Imagine to yourself hundreds, thousands, millions of scenarios along the spectrum from stay-at-home parent to minimum wage single household. Not with any pity or jealousy, just with a cool analysis of the difference in one thing: access.
Let’s add to this mix the elderly. Those trying to care for themselves, or family members, who are retired and maybe don’t have the benefits, mobility, and capability of getting to those essential visits. I, myself, am in this position. While juggling a crown for my own tooth, check-ups for my daughter, and sick days for my son, I am caring for my 77-year-old mother. Please don’t misunderstand me. I am in no way complaining. It is an absolutely wonderful privilege to care for someone who cared for me. In fact, she’s my biological aunt, but treated me like her daughter while I was growing up. I am more than happy to be in this “sandwich generation,” as they call it.
And yet, it highlights more of this issue of access. She can’t drive herself around. She lives in independent senior living. She has so many appointments I can barely keep them straight. Thankfully, her living situation provides transportation. Thankfully, she is still in relatively good health. Once again, I am back to my original point: I have the supports and the luxuries that others lack in order to handle this situation.
In all of this situations, aging parents, kids, dentists, doctors, illnesses, from the stay-at-home to the single parents and everyone in between, we face the same insidious issue of medical professionals only being available when the rest of us are unavailable.
Who made this system? It’s asinine and backward!
I’ve talked to many people, and they all say the same thing. Why do we ALL have to work the exact same Monday-Friday, 9-5 hours as all the other professionals we’re trying to see? And why does it have to be so difficult to get the baseline care that our bodies need? Because, at the end of the day, what happens when our bodies are denied that care? A family lacks access, so the issues that are addressed quickly in other families fester, grow, and get worse. That is when you see people at the urgent care and the emergency room with conditions that could have been simple and preventable. Insurance companies, hospitals, medical providers, parents, employers - they’re all charged with more time and more money than it would have cost to grant easy access in the first place.
What about getting to the bank during working hours? Or, heaven forbid, you have to meet with an attorney, or an accountant, or a million other sorts-and-sundry professionals who keep business hours.
Let’s get one thing clear, though. The problem of access is not limited to doctors and dentists and bank deposits. Allow me, if you will, to return to my own life.
My husband and I have stable, moderately-paid jobs. Working hard, and with some outside help, we managed our finances to build up our savings, pay off our cars, reduce our debt, buy a nice house, and put down a large amount of equity to get the loan (and the mortgage payments) to a manageable amount. We were doing well, providing for our kids without having to pinch. Then, property taxes went up, raising our monthly mortgage out of that “comfortable” range. Energy prices went up, leaving us no choice but to pay double our previous budget in gas for our vehicles and heat for our home. Groceries went up, day care costs went up, and on, and on. Suddenly, we’re having to put groceries on the credit card because we’ve come to the end of the month without any wiggle room and milk costs $5 a gallon. Comparably, we live a life of luxury. If things really got too bad to maintain, we could sell our house, pay off our debt with the equity and move to a smaller house within our previous budget. Both my husband and I have potential raises coming soon, and our youngest son will be in kindergarten next year which eliminates the highway-robbery-level costs of pre-kindergarten care.
And yet, for people like us, who live in relative comfort, to struggle like we are, how much more are people struggling who have previously been just scraping by?
We fit into that neat little income bracket of making “too much” money to receive the supports that are available to struggling families, but “not enough” money to really pay for things that others take for granted. There are millions upon millions of households in this same, and worse, predicament. We can make it work, but how many families can’t?
We can make it work, but how many families can’t?
Access doesn’t have to do with those who “have” and those who “have not.” Access is about those with the potentials and opportunities and those who are barred from those same potentials and opportunities.
In this series of posts, I would like to take a microscopic view of the realities in access provided or denied families and individuals in the world. Stay tuned for a closer look at how access to education, energy, housing, child care, and even food perpetuates and entrenches the socioeconomic divides in our society.