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Cost of Medicine Imperiling Lives Of Sick Survivors

For Melvin Tilles, the oft-recycled phrase “your money or your life” has had a more literal applicability than for most.

After two heart attacks and as many bypasses, Tilles, a Holocaust survivor living in Los Angeles, had one hope to continue living: a heart transplant. But his doctors did not want to perform the surgery. They argued that Tilles could not afford the anti-rejection medication that would run between $1,000 and $3,000 a month for the rest of his life. A survivor of the Theresienstadt ghetto in Czechoslovakia, Tilles was faced with the prospect of possibly losing his life over the cost of prescription drugs. Instead, Tilles and his wife fought a pitched battle to convince the doctors that they could cover the expenses.

Eight years after receiving an adolescent’s heart, Tilles, now 74, is indeed struggling with staggering medical bills. From a combined monthly income of $1,600, the Tilleses are left with just $300 once they pay for rent and medicine. Meanwhile, the price of the drugs is rising. The Tilleses have sold their baby-bedding company and moved from Los Angeles’s Fairfax district to more modest lodgings in the San Fernando Valley. The monthly pension Tilles receives for having worked as a dental technician at two different labs, and as a night watchman for a brief time, now barely makes a dent in the couple’s expenses. Although he benefits from Medicare, no supplemental insurance company will take on Tilles as a client. If not for the Jewish Family Service of Los Angeles, which kicks in about $500 a month for pharmaceutical costs, the Tilleses would have no discretionary income.

Tilles is but one of a growing number of Holocaust survivors living in America who have seen their living standard slashed by the double-edged sword of infirmity and rising health-care costs, which have jumped by between 10% and 15% per year for the past three years. The National Jewish Population Survey 2000-01 recently found that 23% of survivors are disabled and unable to work, compared to 5% of all Jewish seniors. Meanwhile, 27% of survivors described their health as “poor,” compared to only 8% of all Jewish seniors.

The living conditions of needy survivors in the United States and other countries have received renewed scrutiny as a federal judge in Brooklyn prepares to decide how to spend unclaimed funds totaling up to $600 million from a Holocaust restitution settlement. U.S. District Court Judge Edward Korman has called for public comments on how to dole out funds leftover from a $1.25 billion legal settlement between Holocaust survivors and Swiss banks. Heirs to holders of Swiss bank accounts so far have laid claim to less than $200 million of an available $800 million in looted account funds. Survivor groups from Israel, the United States and the former Soviet Union are all staking claim to the so-called heirless funds.

In the past, survivors from the former Soviet Union have received the lion’s share of unclaimed funds made available to survivors because they were deemed to be the neediest population. American survivor groups, however, say they have been shortchanged, pointing to needy survivors in this country as proof. Advocates of Jewish education are also fighting for a piece of the pie, to the consternation of survivor activists who insist that the restituted funds should go to the victims of Nazism, like Melvin Tilles.

Although the Tilleses must stretch their earnings by bargain hunting — a loaf of day-old bread can be had at the local bakery for only $1 — neither of them is complaining. “I owe a fortune for my heart,” Tilles said. “But I’m thankful for what I have.”

Several miles south in the heavily Jewish Pico-Robertson neighborhood, Sarah, a wheelchair-bound Holocaust survivor, has less to be thankful for. She scrapes by on $50 a month after paying her rent and medical expenses.

A child survivor rescued by the Kindertransport, Sarah, who asked that her real name not be used, suffered illnesses and abuses during and after the war that are often too painful for her to recount. It is difficult for her to keep a steady voice when speaking about her life. Polio and cancer have left her almost completely dependent on a home attendant who visits her during the week, the cost of which is covered by the state and funds from the Conference on Jewish Material Claims Against Germany. On the weekends, Sarah has no choice but to pay out-of-pocket for the attendant, usually with money the Jewish Family Service has given her to buy food.

A recipient of Medi-Cal, California’s version of Medicaid, Sarah is one of millions who may be affected by a proposed $900 million cut to the program proposed in Governor Arnold Schwarzenegger’s budget plan. Medi-Cal is a federal-state partnership that provides health insurance for the poor and disabled. California already ranks in the bottom tenth of states in Medicaid reimbursement to health care providers.

If the proposed budget cut passes, the Jewish Family Service of Los Angeles will lose 10% — about $4.5 million — of its state funding for its case management program and adult health-care centers, according to the executive director of the Jewish Family Service, Paul Castro.

As of January 1, at least two major California HMOs used by many Medicare beneficiaries — Kaiser-Permanente and Blue Shield — stopped covering brand-name prescription drugs, said Paula Fern, program manager for the Holocaust Survivor Program for the Jewish Family Service. Many survivors use drugs, including the cholesterol inhibitor Lipitor, for which there is no generic version. In the first week of January, Fern has already received calls from 20 clients, each requesting more than $300 in assistance because of the restrictions. In addition, she said, Kaiser is doing away with its one-time $500 hospital fee and is now charging $200 for every day spent in a hospital. Meanwhile, the caseload of survivors served by Jewish Family Service has been growing by 20% each year and mushroomed to roughly 550 in 2003 from 200 in 1997.

“It’s a huge amount of money,” Fern said of the rising costs. “I don’t know how people are going to pay these kinds of bills. So many of our clients don’t qualify for public benefits because they have a little more than the $2,000 in savings,” making them ineligible for Medi-Cal.

Sarah does not seem capable of absorbing any additional expenses. She receives $700 a month for disability, which is just enough to cover her rent. And a monthly check of $140 from a German reparation fund pays for local telephone access, food and drugs not covered by Medi-Cal. She receives seven frozen dinners a week from a “meals on wheels” program and lives on cheese sandwiches and tea for lunch. Rather than calling her daughter, she now waits for her daughter to call her, in order to avoid long-distance charges.

“If I have enough money,” she said, “I go and buy a salad once a week.”

An émigré from Israel who arrived in the United States in 1982, Sarah fits the profile laid out in a recent report from the National Jewish Population Survey, which found that 51% of Holocaust survivors who immigrated to the United States after 1965 are living in poverty.

The report shows that the median income of survivors who came after 1965 is just $8,600. Survivors who arrived here before 1965 have fared much better, with a median income of $41,000 and fewer than 1% living below the poverty line.

Despite her own predicament, Sarah has a more pressing concern. The fire and police departments in her city are being threatened with funding cuts, and she has taken it upon herself to help them.

She wrote a letter to Schwarzenegger beseeching him to do everything in his power to prevent the budget cut.Sarah is not driven by altruism alone. The uniformed officers have saved her life 17 times, she said, by rushing her to the hospital, or merely picking her up when she fell out of her wheelchair. In one instance, when the local disability transportation service was several hours late, the firefighters came to her rescue.

“They came with two big trucks from the fire department,” Sarah said. “They carried me to a small van, put my wheelchair on the big truck, and when they drove off with me they blew the siren all the way home.”

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