by Elissa Ely

You might think that what homeless men and women need above all else are homes. An expert I know, though, says that there is something they need even more. He says the answer to homelessness is nationalized health insurance.

He is not an economist or an academician. Where he works, there are no endowed chairs. In order to sit in his office, you usually have to move a few garbage bags full of belongings that are waiting, like their owners, for someplace permanent to settle. His limited view overlooks a turnpike. When the office gets hot and he wants to open the window, he reaches above him without turning around, pulls down a pole handle until it cracks a slit overhead, and traffic sounds flow in. Pretty soon the office gets cold and he reaches above him to push the handle up. Then there is silence until it gets hot again.

He is an expert at tidying the chaos that comes from leaving one place for another. People leave for all kinds of reasons. But it is his professional observation that they too frequently leave because they have bad healthcare coverage and believe, or have heard, that there is better coverage somewhere else.

I saw this once in a ridiculous form. I was evaluating someone in the shelter who had moved from the other side of the country. He kept insisting, in a deep voice, that he needed our services in order to complete his treatment. I thought his treatment was for depression. It turned out that his treatment was for gender reassignment; someone had assured him Massachusetts insurance would cover the sex change operation inconsiderately uncovered where he had come from.

My expert has seen this in less ridiculous, more poignant forms; mothers dragging children, children dragging parents, looking for medical opportunity, taking buses across the country with healthcare hopes. Recently he told me of someone he had met. She was an elderly woman who had picked cotton down South since childhood. She lived and raised her own children in huts on various farms, squatting and relocating to follow her profession. But in the places where she squatted, there was family, church, and close community.

With age came medical diminishment. The many decades of stooping caused painful spinal problems. Where she lived, she had no insurance and the quality of public healthcare was poor. Her family encouraged her to come North to Boston, where doctors were famous, hospitals were first-rate, and insurance was easy to get. So she took a bus to South Station.

That was some time ago. She is living in the wet shelter (though she is a sober woman), still in great pain, and without insurance yet.

There is a devout network of health care practitioners for the homeless in the shelter itself, and she has been led to it.

But she is without her family, church, and community. Who brings her around? Who helps her get the pain medications? Who protects her when her back is turned? Who waits with her to feel better? Who knows that she exists? In the South, she was surrounded. She was stooped, but upheld. Here there are clinics and specialists, but she is utterly alone.

My expert shakes his head and reaches above him to shut the window he cracked open a few minutes earlier. He has seen this story many times. He could tell anyone, if they were listening, that there is more to homelessness than needing a home.