photos by Susan Adcock It is a gray, rain-soaked day in Giles County, the kind of wet gray that blends sky and hills in one indistinguishable muddle, foggy and formless. A man in a corduroy coat walks along two-lane Highway 31, which runs up and down these hills 60 miles south of Nashville, on his way toward Pulaski, a few miles down the road. My Honda Civic flashes past the man, with arm outstretched and thumb up, before I realize I have no excuse not to turn back and pick him up. I am headed toward nearby Lawrence County in search of Tennesseans who have lost their health insurance, and I’ll be passing right through downtown Pulaski. Besides, most hitchhikers don’t kill. His name is Howie. Round-faced and sunken-eyed, the tired, homeless 30-year-old gets in the car and we talk. He’s on his way to the county social services office in search of food stamps and advice. Howie was cut off TennCare a few months ago, leaving his bipolar disorder untreated. He’s been staying at a friend’s house outside of town for a while, but his friend has gotten in trouble with the law, and it’s time for Howie to leave, hopefully to find more permanent accommodations and a job. He’s not the stereotypical country drifter. As we’re first getting to know each other, Howie mentions that he had read Bernie Sheahan’s cover essay in the Scene earlier this year while living on the streets of Nashville (“A Beautiful Mind’s Uncertain Future,” May 5). Her description of life with bipolar disorder—and the threat of losing TennCare drug coverage—really resonated with him, he says. Bernie wrote that when mental health drugs are cut, the mentally ill will lose an important part of their safety net: professional lives will be destabilized, emergency rooms will be overcrowded, highway overpasses will shelter new occupants. “I’m middle-class, college-educated and mentally ill,” Howie says, “and here I am, walking in the rain without a dollar to my name.” Over coffee and a succession of Bronco Light cigarettes at the Sweet and Sassy café—he was too nervous to eat—Howie unfurls one of his few remaining possessions: a life story just three decades long. Born in Giles County to a family of educators and raised in the plush Nashville neighborhood of Green Hills, times were easy enough for him until age 14, when his father died. He became kind of an insolent teen, rebellious and fatherless, and began abusing drugs and alcohol. After two years at Father Ryan High School and less than two at the Webb School in Bell Buckle, Howie headed west to Colorado, where he studied history between runs on the ski slopes. Over coffee and a succession of Bronco Light cigarettes at the Sweet and Sassy café—he was too nervous to eat—Howie unfurls one of his few remaining possessions: a life story just three decades long. Born in Giles County to a family of educators and raised in the plush Nashville neighborhood of Green Hills, times were easy enough for him until age 14, when his father died. He became kind of an insolent teen, rebellious and fatherless, and began abusing drugs and alcohol. After two years at Father Ryan High School and less than two at the Webb School in Bell Buckle, Howie headed west to Colorado, where he studied history between runs on the ski slopes. He was 23 and living in Durango when he realized he was addicted to cocaine. Gradually, it took over his life as, time and time again, he sought out the intense high that coke provided him; then he’d crash and it would be time to start again. Later, Howie would be diagnosed bipolar. “I never really knew what was wrong with me,” he says. “I just thought it was the drugs.” Turns out, like many who suffer from manic depression, he was self-medicating, and in the process reinforcing his mood swings. “You can’t make the little things in life work,” he says of his drug addiction and mental illness. “Things are going good, and it’s party time. Things are going bad, and it’s out here in the rain. Party time gets you to the rain.” Around the time of his diagnosis, Howie moved back to Tennessee and started taking medicine for his bipolar disorder, paid for, he says, by TennCare since 2001. Eventually, life’s emotional poles began to moderate. He would see himself doing better, his manic moods contained, and think that he didn’t need those little pills anymore. He finally had his depression under control and could go on living without the meds, he told himself. And then, time and time again, he would crash and turn back to drugs. “The world seems lighter. It loses its shade. And then the fuckin’ shit hits the fan,” he says of his pattern. “It’s living, making mistakes, getting a little bit of help and falling down again. That’s the nature of mental illness.” There were lots of those little bits of help along the way, and Howie knows it. In June 2004—after getting clean while living on the streets of Nashville—he moved back to Giles County, where his mother and stepfather still live. They gave him a job cooking for their catering business. But the pattern kicked in again, and he had another angry, violent outburst, like so many that had alienated people before. Again, he left. There were lots of those little bits of help along the way, and Howie knows it. In June 2004—after getting clean while living on the streets of Nashville—he moved back to Giles County, where his mother and stepfather still live. They gave him a job cooking for their catering business. But the pattern kicked in again, and he had another angry, violent outburst, like so many that had alienated people before. Again, he left. As of this dreary November Monday, Howie has been clean for three months, he tells me. Yesterday, he visited his mother, who told him she won’t help him anymore. He has burned all his bridges, and besides, even if his mom let him move back in, where would he get $500 a month to pay for his medication? Despairing, Howie sighs. For now, he needs to find enough money to get shelter where he can rest, clean himself up and find work. Worry about the bipolar meds later. “If I could just get myself stable, I could get the drugs. Or is it if I get the drugs, I could get myself stable?” he asks. “It’s a chicken-and-egg thing.” He is a man who feels trapped by problems he both did and did not create. They are his actions, yes, but they are the actions of a sick man. “It’s the duality,” he says. “You don’t look the part, but here I am. You don’t look like a raging mental health case, but here I am.” In the span of one hour, Howie’s emotions range from self-pity to self-loathing, optimistic predictions of happier times ahead to a fatalistic acceptance of his own death on the streets. Too scared to be hungry, sitting across from me at the Sweet and Sassy café, Howie tells his story for two reasons—other than the fact that he has time to kill while the social services office takes a lunch break. First, he wants people to know how important mental health drugs are to his literal survival—and to the survival of thousands of other Tennesseans. “You want to scream it to people,” he tells me. “It was just like Bernie said in her story: don’t be pissed off when we’re filling up your streets, your hospitals—people like me—because that’s the health care situation in this country.” “If it’s not completely out of hand right now, it definitely will be in the next year,” he says of the TennCare cuts. “There’s a lot of people out there like me.” But also, Howie seeks redemption through helping others—telling them his cautionary tale—even as he fails to help himself. “I don’t come from a trailer back here where my father beat my mother. My parents are college-educated. My grandparents are college-educated,” he says. “I never thought in a million years that this is where I’d be today.” For the first time in years, Howie said a prayer this morning. He is not particularly religious. He does not know where he will sleep. For the first time in years, Howie said a prayer this morning. He is not particularly religious. He does not know where he will sleep. Marcella Richardson is crashing. The pale body of a 64-year-old woman sits slouched in a chair in Exam Room 1 of a medical clinic in Lawrenceburg. The ambulance is on its way. Marcella’s eyes roll back in her head as nurses, secretaries and a daughter-in-law shout at her to “Breathe, baby, breathe!” and “Look at me! I need you to breathe!” They are holding an 8-inch tube in her mouth with some sort of medicated steam coming from it. She is barely able to inhale. Someone tries to check her blood pressure but cannot find a pulse. “She’s crashing fast,” a concerned nurse mutters. Marcella’s daughter-in-law, Laurie Richardson, cries, paces, helps where she can. Angrily, helplessly, she laments the situation unfolding before her eyes. “She didn’t even want to come in today because she couldn’t afford the bill. She’s worked all her life, and what does she have to show for it? “I wish Phil Bredesen were here to see this,” she hisses through petrified tears. Laurie isn’t the only one crying. A tearful Pat Burks, the advanced practice nurse who runs North Terrace Medical Clinic, holds a comforting arm around Laurie’s shoulders one moment. The next, she confidently kneels to help her ailing patient. “When you’re in a small town, people aren’t just your patients, they’re your friends.” That’s what Pat had said 10 minutes earlier in her office, mere seconds before an assistant interrupted to say that Marcella Richardson was in bad shape. I’d shown up unannounced around 2 p.m., introduced myself and told her I was working on a story about people dealing with the effects of TennCare reform. Pat went to check on Marcella, then came to get me. “Come see a face of TennCare,” she said. Laurie isn’t the only one crying. A tearful Pat Burks, the advanced practice nurse who runs North Terrace Medical Clinic, holds a comforting arm around Laurie’s shoulders one moment. The next, she confidently kneels to help her ailing patient. “When you’re in a small town, people aren’t just your patients, they’re your friends.” That’s what Pat had said 10 minutes earlier in her office, mere seconds before an assistant interrupted to say that Marcella Richardson was in bad shape. I’d shown up unannounced around 2 p.m., introduced myself and told her I was working on a story about people dealing with the effects of TennCare reform. Pat went to check on Marcella, then came to get me. “Come see a face of TennCare,” she said. Marcella was suffering an acute asthma attack, known as status asthmaticus. Bundled into an ambulance and sent to the hospital, she would spend the night in the intensive care unit on a ventilator, her life in the balance. Twenty-four hours later, her condition would still be dire. She had been deprived of oxygen for precious minutes. That afternoon, after calling the hospital to let them know Marcella was en route (“Hi Mary, it’s Pat at North Terrace,” begins the familiar call), Pat explains the situation. Months ago, like 191,000 other Tennesseans, Marcella had been dropped from TennCare, as were her ailing son and daughter-in-law. With little money to pay for medical care, she was being kept alive mostly through free samples of asthma medication procured and distributed by the staff at North Terrace. Pat says that today’s scene is becoming increasingly common at her clinic, which overwhelmingly sees TennCare patients and, now, former TennCare patients. “This is a daily thing. It’s like losing a member of the family,” she says, crying and needlessly apologizing. “I’m sorry. It’s just that I’m really passionate about this.” What really upsets her is that Marcella didn’t want to come in because she couldn’t afford to pay for a visit. Pat sees that as her own personal failure. “You think you get the message across: when you gotta come, you just come on,” she says. Again, there are tears and embarrassed laughter. Someone who has spent so much time around sick people who can’t afford health care is predictably upset that Tennesseans would allow people like Marcella to lose their health insurance. “Some folks have bad habits, but most of them are good people who have the terrible misfortune of bad health. Marcella Richardson hasn’t smoked a day in her life,” Pat says. “I just want people to think, ‘This could be me.’ ” It was Ernie. And it was Junior. They are two of Pat’s three patients who died while she was on vacation. Ernie was Cuban and full of life; he died of a cardiac arrythmia three days after a visit from a trio of state officials that included Jim Shulman, assistant to the finance commissioner and a Metro Council member. They had visited the clinic, presumably because Pat’s been such a squeaky wheel about the TennCare cuts. She remembers Shulman telling Ernie to “hang in there—in a few more days, we’re going to have this all worked out,” referring to a medication program he needed. Ernie didn’t make it. Neither did Junior. He had stents in his heart, but while Pat was gone they became clogged, she says, because her patient couldn’t get necessary blood-thinning medication under TennCare’s new five-drug limit. While I sat in her office, she took a call from Junior’s grieving daughter. Together, they cried. “You just don’t expect it,” the daughter said, explaining that both she and her mother have been having nightmares since Junior’s death. Pat tried to reassure her, telling her that the last time she saw him, Junior expressed contentment in the face of death. “He said he had a good life, he had a good family; he talked about going to the mountains one more time,” she told her friend. “Honey, y’all made his life wonderful. There are not better kids anywhere…. Honey, we’ll do whatever we can do for you.” That is Pat Burks—nurse, friend, grief counselor, mourner, advocate. She regularly works until two, three or four in the morning filling out the paperwork that will allow her patients access to free prescription drugs from drug companies and non-profit supply programs. Each prescription requires a stack of paperwork; multiply that by several prescriptions per patient—and there are hundreds—and you get a sense of her workload. Health care is not a job to her; it’s a mission. Not a luxury, as she puts it, but a right. She is a friend to anyone who will supply her patients with the expensive medications they need. More often than not these days, that means drug companies. They have been far more generous than state officials have. “I grew up dirt poor. I remember seeing my parents cry over a $5 medical bill,” she says. Again, Pat gets teary. “My obligation is to these patients. It’s not to those people with the silver spoon in their mouths.” She and her husband Richard have just returned from a three-week vacation to Europe that she planned for a year-and-a-half. It was, she says, her dream trip. But while she was gone, three patients died. She wonders whether she could have kept them going a little while longer. She feels guilty that she didn’t do enough. She also feels betrayed by a governor she worked to get elected in 2002. “I have no use for him right now,” she says of Bredesen. (That’s one of the nicer things folks in Lawrenceburg have to say about the governor.) In her office is a photo of her and the governor. Someone—not her, she swears—has painted horns, a moustache and goatee on him and put a pitchfork in his hand. A hand-written thought bubble above Pat’s head reads, “Man with no heart!” With comments like he made during a visit to the Scene’s offices several months ago—something to the effect of, “I wish the media would quit telling individual stories of people who have lost TennCare. Can’t you see it’s a management problem?”—Bredesen makes a pretty convincing man with no heart. Bob, age 48, may or may not have been cut from TennCare. It doesn’t really matter. He was a patient of Pat’s who suffered from bipolar disorder, and amid all the public hoopla and politicking of TennCare reform, he thought he was going to lose his health coverage. Pat had treated him and his family for years, she says. Not long ago, Bob wrote a note to his family and a poem for his sister. I know what a burden I’m going to be, and I don’t want to put you all through it, he wrote. He went to the local cemetery, called 911 and told the dispatcher that they could find him on his mother’s tombstone. Then, he pulled out a gun and shot himself. Linda Beeles wasn’t cut from TennCare. Like 320,000 people, she’s had the number of prescriptions the state’s insurance plan will cover capped at five. “It’s pick and choose every month, and I can’t afford it,” says the 56-year-old Lawrenceburg resident. Like her diabetic heart-patient aunt and sister, Linda is having a hard time making ends meet. “All I can say is, thank God for Pat Burks, because we’re all on fixed incomes,” she says. Pat gives her free samples and helps her locate free drug programs. Linda, meanwhile, says she brings in $711 a month and would have to spend over $600 a month on medication. Bob, age 48, may or may not have been cut from TennCare. It doesn’t really matter. He was a patient of Pat’s who suffered from bipolar disorder, and amid all the public hoopla and politicking of TennCare reform, he thought he was going to lose his health coverage. Pat had treated him and his family for years, she says. Not long ago, Bob wrote a note to his family and a poem for his sister. I know what a burden I’m going to be, and I don’t want to put you all through it, he wrote. He went to the local cemetery, called 911 and told the dispatcher that they could find him on his mother’s tombstone. Then, he pulled out a gun and shot himself. One of the most frustrating problems for her are the confusing lists of drugs that TennCare will cover, and under what circumstances. There’s the ever-changing formulary that tells what meds can be prescribed and when, and there’s the “short list,” five pages of drugs that don’t count against the five-script limit. While Linda appreciates any attempt to get her prescription drugs, the lists have been fluctuating and confuse her. That’s doubly hard for people on medications that must be kept in the proper balance, she says. “What good are these damn lists doing if they’re changing every month?” Linda Beeles wasn’t cut from TennCare. Like 320,000 people, she’s had the number of prescriptions the state’s insurance plan will cover capped at five. “It’s pick and choose every month, and I can’t afford it,” says the 56-year-old Lawrenceburg resident. Like her diabetic heart-patient aunt and sister, Linda is having a hard time making ends meet. “All I can say is, thank God for Pat Burks, because we’re all on fixed incomes,” she says. Pat gives her free samples and helps her locate free drug programs. Linda, meanwhile, says she brings in $711 a month and would have to spend over $600 a month on medication. “Bredesen should be made to take this kind of income for a year and live in these kind of houses where we have to put plastic over the windows because there’s no insulation,” she says. (The governor lives in his own Nashville mansion while his wife Andrea is raising millions in private dollars to restore the official governor’s residence.) “Every decision this man is making is taking away from the needy and the elderly,” says Linda, noting that she supported Bredesen during the campaign. “Little did a lot of us know how he would backstab us when he got up there.” One of the most frustrating problems for her are the confusing lists of drugs that TennCare will cover, and under what circumstances. There’s the ever-changing formulary that tells what meds can be prescribed and when, and there’s the “short list,” five pages of drugs that don’t count against the five-script limit. While Linda appreciates any attempt to get her prescription drugs, the lists have been fluctuating and confuse her. That’s doubly hard for people on medications that must be kept in the proper balance, she says. “What good are these damn lists doing if they’re changing every month?” The day after Marcella went to the hospital, I met a tiny, 68-year-old woman in Exam Room 1 named Barbara Pyrdum. Seated in the same chair Marcella was lifted out of by two EMTs, Barbara was shaking all over but trying to play down her pain. She had been taking seven medications, among them mental health drugs and breathing drugs, but had been cut from TennCare. Like many seniors, she is trying to figure out the new Medicare drug plan; so far, she says, it doesn’t look very helpful. Patricia Davis, 56, is uninsurable. She has cancer. Or, according to her official diagnosis: kidney and liver carcinoma, COPD (lung disease), elevated blood pressure, hormone deficiency, chest pains related to coronary artery disease, peripheral vascular disease and Raynaud’s disease (a blood vessel disorder) with gangrenous changes to upper extremities. For the past three years, she’s paid a few hundred dollars a month for her TennCare coverage because no one else would cover her. After having part of her kidney removed in January, she was dropped from TennCare. In a letter to her primary physician, Patricia’s oncologist wrote that taking away health insurance for her follow-up exams—the ones that ensure cancer won’t recur—made “a mockery of comprehensive cancer care.” She’s a lifelong resident of Lawrence County who’s owned her own restaurant for 19 years. She can’t provide health insurance for her employees, she says, because her own conditions make group health coverage too expensive. (The cheapest she’s found for herself alone, Blue Cross, would cost $1,700 a month.) Express Scripts—a discount pharmaceutical company—provides some of her medications, but not nearly enough. Her husband, a truck driver, can’t secure health coverage for her either. “I think the governor ought to look and see what he is doing,” she says, outraged that so many elderly people have lost their health insurance—or seen it severely limited. “That’s awful. They’ve worked their whole life just to sit down and die.” Like many residents of Lawrenceburg, she knows that plenty of people abuse TennCare to procure and sell pain medication. “They’ve got to monitor this drug usage better.” Joseph’s is a story of pain and overmedication. He’s had doctors who, unable to diagnose some of his physical ailments, would prescribe him excessive doses of morphine, oxycodone and other pain-relieving drugs. He has had severe dental problems, was raised in an abusive, alcoholic family and had a girlfriend who abused prescription pain-relievers, all to the point that he became suicidal. Joseph is unemployable, due to physical and mental health limitations and a lack of other skills. His family helps him wherever possible, but they have a slew of their own problems. His, indeed, is a tough case. The day after Marcella went to the hospital, I met a tiny, 68-year-old woman in Exam Room 1 named Barbara Pyrdum. Seated in the same chair Marcella was lifted out of by two EMTs, Barbara was shaking all over but trying to play down her pain. She had been taking seven medications, among them mental health drugs and breathing drugs, but had been cut from TennCare. Like many seniors, she is trying to figure out the new Medicare drug plan; so far, she says, it doesn’t look very helpful. For most of her professional life, Barbara worked in retail—specifically produce. After years of lifting 60-pound boxes of celery, she has grown frail, and for whatever reasons, osteoporosis has set in. She is divorced, and a couple of years ago, her daughter died of cancer. Barbara needs help, a medical procedure, but doesn’t want to bother her extended family across the state to care for her. Today she is alone with her emphysema and depression, dependent on whatever free or cheap drugs Pat Burks and the staff of North Terrace can procure for her. She is almost constantly in pain. She cries frequently. “But,” she says, “a lot of people have it worse.” “I appreciate what TennCare has done,” he says, remembering the endless circles of doctors and caseworkers it put him through, “but I don’t know—it’s drove me nuts.” Pat’s dog died recently, and he would like to give her one of his own but wonders if it’s too soon to replace her beloved pooch. Joseph Casteel is a quiet man with free-flowing hair and a long, unkempt beard. At first glance, you might mistake him for Forrest Gump after many months of running. These days, the 33-year-old lives in a trailer on his parents’ property with “a couple three dogs” and no running water. He uses a five-gallon bucket to get water to his home. Born on a farm and working since sixth grade, Joseph also spent time as a sandblaster, structural steel man, bricklayer’s apprentice and scrap-hauler before getting a job as a union painter. In the early 1990s, he was a passenger in two major car crashes that affect his life to this day. He has suffered a collapsed lung, broken arm, broken jaw, ruptured spleen, bulging disks—you get the picture. In his second wreck, the man says, he was pronounced dead on arrival. Then there are the mental health problems. Joseph’s is a story of pain and overmedication. He’s had doctors who, unable to diagnose some of his physical ailments, would prescribe him excessive doses of morphine, oxycodone and other pain-relieving drugs. He has had severe dental problems, was raised in an abusive, alcoholic family and had a girlfriend who abused prescription pain-relievers, all to the point that he became suicidal. Joseph is unemployable, due to physical and mental health limitations and a lack of other skills. His family helps him wherever possible, but they have a slew of their own problems. His, indeed, is a tough case. Like many TennCare recipients (and former TennCare recipients), Joseph hasn’t understood all the letters the state has sent him. They’re filled with bureaucratic jargon. Some of the doctors he’s seen, not knowing what to do with him, have prescribed handfuls of pills and shots. State caseworkers have written him off, a hopeless casualty of ignorance and political circumstance. Amid it all, Pat Burks and the staff at North Terrace have provided him a dose of humanity and compassion. At times, she has been his unofficial therapist, talking with him and finding him the antidepressant he needs for free. More than anything, she has helped him secure pain relief that works: Duragesic patches that relieve some of the pain in his ailing back. Finally, a night’s sleep—but ordinarily, it would cost him $530 a month. Now, without TennCare, he gets this medicine for free directly from the drug company. Big pharma’s supposed beneficence, whatever the motive, has proved more humane for one gentle, troubled man, than what the state can—or can’t, actually—provide. “I appreciate what TennCare has done,” he says, remembering the endless circles of doctors and caseworkers it put him through, “but I don’t know—it’s drove me nuts.” Pat’s dog died recently, and he would like to give her one of his own but wonders if it’s too soon to replace her beloved pooch. Kindness. Compassion. They flow mutually in Lawrenceburg’s impoverished health circles. “All I’m trying to do is get a little help,” says Joseph, who now has a fear of riding in a car he’s not driving. Unemployable and gentle, he needs whatever help he can get. Last week, he gave Pat a puppy. There are other stories from Lawrenceburg in my notes, phone numbers left on my voicemail. They represent one small town—hundreds of people in a state of millions, hundreds of thousands of whom are seeing their health care coverage reduced or eliminated. They are the working poor, the middle class, the disabled, the elderly, the sick, the forgotten. By all accounts, Ann Barber should be dead in three months. The 38-year-old’s Hepatitis C has developed into cirrhosis of the liver. Her bottom teeth have rotted out. She is anemic. Her gums bleed profusely. She suffers from osteoporosis. She has circulation problems. Currently, she’s under the care of hospice and her daughter Ashley, a senior in high school. Several months ago, while Ann was in the intensive care unit, she was cut from TennCare, she says, without explanation. Her income? Sixty-three dollars a week in child support from an ex-husband who abused her. Ann’s spectacled eyes, big and fish-like, can convey a sense of urgency, of innocence, of impishness. (She brags about the frames she fashioned for her glasses out of multicolored yarn.) Above all, she has not lost her sense of humor. She is crafty and loves to bake. She makes bread and candy for neighbors in her public housing project, her sense of compassion well intact. Ann boasts 33 credits from the University of Pennsylvania, an Ivy League school, and 55 credits from two other colleges. She studied elementary education with a concentration in art. Daughter Ashley, a stellar student, hopes to be a doctor but, her mom says, sings like an angel and has a real talent for drawing. She also cleans up the blood that spills from many parts of Ann’s body, no questions asked. Last year, for Christmas, Ashley made Ann a sock-doll; mother made daughter a purse out of an old shirt from American Eagle Outfitters. Though Ann is slow on her walker, the family shops at Goodwill on Mondays, when you can get 10 items for $5. When she talks about Pat Burks and Pat’s husband, Richard, Ann cries. So do I. (So does Pat.) Once, Richard gave Ashley money to buy name-brand shoes, a gesture that will never be forgotten in their family. This year, Pat and Richard will help cover high school graduation expenses for Ashley—photos, announcements, cap and gown and whatnot. Ann’s mother died before Ann could graduate high school, and all she wants to do is live to see her daughter walk across the stage to get her diploma. She wants to do other things, too—take Ashley to a beach in Florida, give her a car to drive around town—but surviving until graduation is goal enough. Losing her health coverage was hard, an indignity, but at this point, Ann is determined in the short term and resigned to fate in the long term. “We’ve done it,” Ann says of the family’s survival against long odds. “By the grace of God, we’ve done it. But we don’t eat a lot of meat.” “I’m going to die,” Ann says. She knows that. For now, she just wants a little more time. Could better health care buy her a few precious months? There are other stories from Lawrenceburg in my notes, phone numbers left on my voicemail. They represent one small town—hundreds of people in a state of millions, hundreds of thousands of whom are seeing their health care coverage reduced or eliminated. They are the working poor, the middle class, the disabled, the elderly, the sick, the forgotten. To a person, they are angry. Betrayed by an American health care system that will leave them with few options, with virtually nowhere to turn. Left behind by an HMO-executive-turned-governor many of them supported, a man who pledged to fix a broken system and did so by jettisoning them, by making their lives less livable. Who is to say whether Bredesen’s TennCare reforms are the tough medicine this state must swallow—whether, as he said last week, “we’re getting the results we need”? Perhaps this is, as he insists, the best of some bad options. Who knows? But right now, this week, this Thanksgiving, it’s worth pausing to remember that these are not mere lines on a chart or numbers on a page. These are the stories of human beings who live, who die and—as a result of some very specific decisions, drastic changes to an impersonal, bureaucratic system—who suffer, today more than ever. These are the faces of TennCare. There are fewer of them every day.
