Another Look at Lawyer Suicide

Over a year ago, my first LCL blog of any substance dealt with the issue of lawyer suicide, at a time when 3 prominent lawyers had recently ended their lives, leaving many others not only saddened but also perplexed in a “Richard Cory” way. (For anyone unfamiliar with this reference, click here and also click here.)

Today, in the usually futile effort to reduce the pile on my desk, I came across Richard Schmitt’s article, “A Death in the Office” in the November 2009 issue of the ABA Journal that comes to the LCL office. Schmitt details the abruptly self-terminated life of Mark Levy, an ultra-capable, widely admired attorney with a seemingly perfect academic and professional background specializing in appellate practice.

This is a case that feels closer to me because, though I never knew him, I discovered that Mr. Levy was my classmate at Yale College (where, while I got by and spent most of my time on a cappella singing groups, he graduated summa cum laude). He went on to excel at Yale Law, then to clerk for the judge involved in both Watergate and the Pentagon Papers, and subsequently worked for a series of prestigious law firms as well as spending some years at the Justice Department.

Despite all of his accomplishments and a record of both successful cases and professional generosity, he was not adept at marketing or drumming up business. Like so many others in my generation, his values and grooming were oriented toward being a professional, valued for intellectual achievement and service to his society, not so much a businessman, valued for talent at making money or enhancing corporate growth. My own health-related field, too, has become a big business, with mega-hospital conglomerates competing for a piece of the insurance pie even as insurance companies vie to maximize shareholder profit -- and business sense tends to trump clinical savvy for those who flourish nowadays. This shift has come over our society as a whole, and there seems to be no way to turn it around (any more than to decide that the world was better off without Twitter and Blackberries), but it’s a shame.

One of my first clients at LCL, back around 1998, was a 50-ish man who had graduated Harvard Law. When he graduated, in the mid 1970’s, just doing a good job led to word-of-mouth referrals, and he made a fine living in a suburban solo practice. By the time he saw me, never having fancied himself a self-promoter and responding too late to the new realities, he was unable to keep up with the monthly obligations of supporting his family. And this was long before the economic meltdown.

At a much more elevated level, Mark Levy found that, distinguished career or not, he had become a commodity of decreasing value, having moved from one law firm to another in recent years. Taking his life in the very office from which he was being evicted (not even permitted, given his firm’s mentality, to remain there unpaid for a transitional period ) may have served partly to make a statement about today’s professionals –- disposable.

On an individual level, however, one wishes that no one would absorb that notion. So many lawyers have come into my office in a state of disappointment with their careers, alienated from their profession, unable to make enough of a living, etc., understandably exhibiting a depressed mood and perspective. Embedded in their reactions, to some extent, is an acceptance of the prevailing notion that financial success is the measure of personal and professional success. They are naturally hoping that someone will offer a straightforward solution, a way to switch career tracks and be redirected toward success (money, position). The reality for many of them is that they will need to cut back on lifestyle, make adjustments in their practices, maybe sell the house before it is foreclosed upon, and walk through a kind of grief process, mourning their former expectations, before turning the page to what can be a satisfying new chapter.

To psychologically survive such changes, it is important not to equate the vicissitudes of the professional market with any valid measure of one’s own worth. Rather, lawyers who face unanticipated setbacks must connect with the values and missions that originally inspired them to enter the profession, and continue to respect their own qualities and talents, even as they remain active in taking practical steps to readjust and reconfigure so as to make a living. Though there may be a reflexive or shame-based impulse to pull away from friends, family, and colleagues, these are the times when it matters most to connect with others, engage in new learning, find new ways to make an impact (even through endeavors that may produce no financial reward), and maintain hope for ultimately finding a new path that may even be more gratifying than what came before. In order to be at least partially immunized from the ever-changing environment, it helps if a healthy portion of the reward for one’s work comes from within.

When we, at LCL, seek to connect disheartened lawyers with therapists (especially those lawyers who are loathe to burden friends with the wounds to their self-esteem) or with career coaches or our comrades at the Law Office Management Assistance Program, or to our own recurrent Layoff Group series, it is because we see the potential for finding such a new path. Equally important is the recognition that to focus one’s sense of identity and value too much on career status (and too little on family, community, the arts, nature, reflection, charity, fun, etc.) is to accept the faulty notion that personal worth is a function of supply and demand.

Counterpoint to Myself (re plight of new lawyers)

Inasmuch as my previous post (“Is the Legal Profession Neglecting its Young?”) could be considered a bit inflammatory (though it is meant solely to support the needs of the profession’s newcomers), allow me to convey some additional information provided to me by lawyers within the walls of our suite.

With regard to the sorely missing training element of apprenticeship:

• Some states do offer some kind of apprenticeship. Delaware and Vermont require at least a few months (Delaware, 5; Vermont, 3) of full-time clerkship in a licensed lawyer’s office in order to be eligible for admission to the bar.
• Some other states, including New York, permit law students to behave as lawyers in certain settings, offering but not requiring the opportunity for this kind of real-life experience prior to independent practice. Here in Massachusetts, Northeastern University School of Law’s co-op program provides each student with four distinct 11-week work experiences in real-life settings as a standard feature of legal training. Some other law schools provide a “clinical” component that also offers some exposure to real legal work under the supervision of a licensed attorney with a Supreme Judicial Court Rule 3:03 certification. (This is more analogous to the practicum components of other kinds of graduate schools than to the post-graduation internship and supervised work experience.)
• A limited number of students each year who attend University of New Hampshire School of Law are permitted to bypass the bar exam by participating in a program of supervised practice.
• In Vermont, Virginia, California, and Washington, one may actually be admitted to the bar without having attended law school, but having instead spent an extended apprenticeship under the aegis of a judge or licensed lawyer.
• Many countries do require (and thus offer) an apprenticeship after achieving a law degree. These include: China, Israel, Japan, Belgium, Denmark, Finland, Germany, Ireland, Italy, Netherlands, Sweden, Switzerland, United Kingdom, and Canada. [This list of countries comes from Wikipedia, so we cannot fully attest to its accuracy. Other information provided above was confirmed via review of official state or university web sites.]

With regard to deficiencies in availability of post-law school education and guidance:

• For help with practice management (as opposed to the how-to of handling cases), Massachusetts attorneys are fortunate to be able to get guidance from the LOMAP program, in areas including marketing, technology, proper handling of client funds accounts, etc. Also useful in this regard is are the articles posted on the Board of Bar Overseers/Office of Bar Counsel web site, covering a wide array of topics.
• Although Massachusetts does not require continuing education, according to the ABA (http://www.abanet.org/cle/mcleview.html), all but 6 states do.
• While available mentoring programs are limited in their scope and intensity, they are available in one form or another through various bar associations. Our widely knowledgeable colleagues at the LOMAP program have offered two very useful blog posts on locating mentors, which you may access by clicking these links: http://masslomap.blogspot.com/2009/02/finding-mentor-tool-for-success.html, http://masslomap.blogspot.com/2010/05/mentor-de-perseverance-mountain-legs.html .
• Despite the paucity of guidance offered in any routine fashion to new lawyers, a lawyer who puts enough energy into the legwork can, I am told, develop his or her own cluster of mentors by continuing to approach candidates and not being deterred by those who decline.
• More so than in the clinical professions, sufficient reading/research (accompanied these days by all kinds of listserv options), can elicit much of the guidance a lawyer needs to address novel challenges. Resources include West Law’s Mass Practice, LexisNexis, Social Law Library, ABA’s SoloSez listserv, and more.

So, although the legal profession generally offers much less than other professions in structured, routine guidance and grooming, it’s out there for those who go after it. Those newly admitted to the bar must recognize that, even without formal requirements or supervised experience, their professional education is by no means finished upon obtaining the degree.

Is the Legal Profession Neglecting its Young?

Physicians follow their academic training with years in hospitals, through internship and residency, partly as cheap labor, but under the watchful/critical eye of more experienced physicians. Psychologists follow their years of classes with a year’s internship and two years’ supervised experience (generally in a clinic or hospital) before they can be licensed for independent practice. Social workers must also garner two years’ of closely supervised clinical experience before seeking independent licensure. Nurses, teachers, barbers, etc. all have mandated mechanisms for apprenticeship before allowing novices to go out and practice on their own.

Not so for most lawyers. After a mere three years in law school, and usually very little exposure to the real-life practice of law, new attorneys leave the nest on their own and, to mix metaphors, dive right into the deep end. Those who obtain employment in agencies or large firms at least have some kind of structure in place to undo their mistakes and provide some kind of quality control, though many find that they are highly stressed, given little guidance and many demands. But the many, many new lawyers who jump right into solo or small firm practice are often forced to learn on the job, making their inevitable mistakes at the expense of real clients. Those who care deeply about doing the best job often develop anxiety symptoms. Those who are less troubled by such worries may find themselves doing things that could come back to haunt them by way of undesired input from the Office of Bar Counsel.

Overwhelmed young lawyers may also find it harder to justify taking the time for continuing education courses – these, too, are mandated for health professionals, teachers, etc., but not for Massachusetts attorneys.

I am not pointing any fingers – this is the way the profession has evolved, and systems that are firmly in place are notoriously difficult to change, even if there were a consensus. Given this perilous state of affairs, it is impressive to recognize that, in the vast majority of cases, it seems that no great harm comes to clients or to lawyers’ careers (aside from stress-induced effects on health, family life, etc.). Is this because new lawyers get case-specific help from their more seasoned colleagues? Not so much.

Some bar associations have mentoring programs, generally offered in a group format, that provide a helpful kind of overarching support, but not specific advice on what to do at the moment when a lawyer, trying to appear knowledgeable, is suddenly confronted by an unforeseen development in the evolution of a case. When I was a new psychologist, as anxious as I felt when a patient seemed potentially suicidal or otherwise unsafe, it was immensely helpful to know that I could contact my clinical supervisor for guidance. In the analogous legal situation, some new attorneys are fortunate enough to have personal relationships with voices of experience, or are assertive enough to track down those they don’t know but who are often kind enough to offer their perspectives. (At least one other setting reportedly provides close supervision to newer attorneys: agencies that operate under the Committee for Public Counsel Services.)

When new and anxious practitioners come to LCL for consultation, we try to help them identify and pursue sources of helpful input. In some of our discussion groups, like the Solo Practitioners Forum, they get support. But let’s hope that, over time, the profession itself will find additional ways to guide its progeny into the jungle of real life practice.

[Coming very soon: Counterpoint to the above.]

BEHAVIORAL HEALTH COVERAGE -- COMING BACK TO THE PARITY

One of our main activities at LCL is referring lawyers, law students, etc to see behavioral health professionals. In my blog of August 2010, I briefly described the history of efforts to achieve insurance coverage for mental health and addictions treatment that was roughly equivalent to coverage for physical conditions. Laws with this purpose have been known as “mental health parity” laws. [None of this pertains to the more recent health care reform package.]

A major improvement of the Massachusetts parity law of 2000 came in 2009, when alcohol/drug abuse/dependence, as well as eating disorders, PTSD, and autism, were added to the list of diagnoses for which coverage was mandated. These illnesses, like those already included (e.g., major depression, bipolar disorder, schizophrenia, panic disorder), were no longer subject to arbitrary maximums of treatments, and even less severe conditions had to be covered up to 24 outpatient visits a year.

Then, the new federal parity law was to take effect in 2010, apparently bringing all psychiatric diagnoses under the parity umbrella, and applying even to most self-insured plans (which had been excluded from the state law, along with MassHealth and Medicare).

But things have become murkier with the advent of 2010. Some or all of the federal law seemed to be on hold and awaiting feedback until July. And I have not found any finalized word in my own Googling efforts. However, I notice that at least some Massachusetts insurers who post benefit information on line are no longer providing information about treatment maximums (which may suggest that the maximums no longer apply).

The upshot is that the chances that your behavioral health treatment will be covered are probably enhanced with the convergence of the federal and Massachusetts parity laws. But certainly you should be prepared for exceptions, which include plans through employers with 50 or fewer employees, and insurers may still find a way to exclude some conditions. And don’t forget that, if you have an HMO (and even the rare PPO, such as the Harvard Pilgrim plan now available through the state’s GIC program), no services will be covered without pre-authorization. Through the process of pre-authorization, the managed care company will determine how much treatment is “medically necessary.” Even without maximum numbers of visits, the mere fact that you and your treatment provider believe that therapy/counseling is indicated does not mean that the insurer will agree that they should be paying for it.

Although coverage remains as uncertain and ambiguous as ever, the overall trend is toward improvement. And though I wanted you to be an informed consumer, aware of the pitfalls, I certainly do not want you to use these complexities as an excuse to avoid getting the help you need.

Unsolicited Advice to Lawyers with Associates

Since I joined the LCL staff in 1998, I have personally seen 2 or 3 lawyers a year who come in distressed, and often depressed, with regard to their role as associate in a law firm. In some cases, they function as sole underling to a seasoned veteran who has taken them into an otherwise solo or small practice. In other cases, they are making a big income with a giant and prestigious firm. In either situation, the associates that I see (who are, of course, self-selecting to come to LCL) are struggling to keep their heads above water.

They complain that they feel swamped with work demands, but ill-equipped to do a good job. The more senior attorneys to whom they answer are quick to point out the associates’ errors, but mostly unavailable to provide guidance. (In some cases, their “door is always open,” but on most given occasions they are too busy.) In a small practice, the associate is sometimes in the predicament of having to try to juggle many different kinds of cases at once, all of them with little previous experience, further reducing their chances of attaining mastery. They have little or no say about how they are to spend their time or how a case is to be addressed (i.e., the senior attorney expects that it will be handled just as s/he would have done). Many of these individuals were highly successful in law school and now feel much less competent, humbled if not humiliated.

Some of these associates blame the seemingly uncaring boss to whom they answer. Others blame themselves. Either way, as their mood declines, so does their productivity. They respond by working more hours. As their home lives or social lives deteriorate, their lives become less balanced and they are less able to function in a healthy way. Eventually, they either make it through this “rite of passage,” gradually master the needed skills, and re-achieve personal equilibrium, or they leave the firm. In some firms, large and small, the turnover rate is high.

From a psychologist’s point of view (and these thoughts are influenced by the writings of Dr. Martin Seligman, father of “positive psychology,” who has addressed himself to depression-promoting aspects of the lives of lawyers), if someone running a law firm wanted to keep the firm’s associate(s) happier and more productive, and to retain more of these newer lawyers for a longer period once they have learned the ropes, one might do some of the following:

• Provide actual mentoring, not just oversight. Take some time, even one uninterrupted hour a week, focused entirely on the associate’s questions, concerns, and ideas. The time you invest will likely pay for itself in the associate’s increased productivity, flowing not only from the concrete information and advice that you can provide, but also from his or her increased effort in response to sensing your support and interest.

• People are generally more productive (and happier) according to Seligman and others, not to mention common sense, when empowered to have a say in what they do (what he calls “decision latitude). That suggests that your associate will do better if there is some discussion about what s/he will do and how, and if the associate has a voice and choice in determining how their time will be spent. That is likely to include a chance to master certain kinds of tasks before plunging into others.

• Different associates are likely to have different strengths, based not only on past experience/learning but even more on personality and native talents. You can utilize a win-win strategy by noticing and capitalizing on their particular strengths, increasing their sense of efficacy and optimizing their contribution to the firm.

My sense is that such efforts will pay off in productivity, retention, interpersonal atmosphere, decreased conflict, etc. Meantime, LCL remains a consultative resource for those (at any level of the hierarchy) who find their work environments a source of stress and dysfunction.

Integrity Among Lawyers (and Others)

[The following thoughts arose out of discussions of some of the struggles endured by members of the LCL Solo Practitioners Forum that I facilitate.]

There is no greater delight than to be conscious of sincerity on self-examination. (Mencius)

• A legal task took less time than you expected. Although ample funds are sitting in the client funds account, you bill only for time actually spent.
• A practice that is profitable but ultimately irresponsible has gained momentum in the law firm that employs you. To the extent that it is improper, responsibility for it is spread across the whole firm, including those in positions of greater power than yours. Despite that, and the fact that raising the issue may have a negative impact on how the partners view you, you speak up.
• You find yourself burning the midnight oil, putting an inordinate amount of effort and diligence into a family law case on behalf of a client who you know will probably never pay you; but you do it anyhow, even though you wish you’d never met this client.
• You find that you can board a Green Line train to work from a rear door by merely waving any card, and you watch others do so and take their seats. You bother to walk to the front of the train and pay the $2, by which time no seats are left.
• A fellow lawyer, you observe clearly by her behavior in his office and in court, is in rough shape, not firing on all cylinders. Though you hate to intrude into someone else’s business, you can see that she is on a path toward harming clients and her own career. You express your concern and offer to go with her to LCL for a confidential assessment, knowing full well that the suggestion may well elicit an angry, defensive reactio
  

Nothing is at last sacred but the integrity of your own mind. (Ralph Waldo Emerson)

Issues of integrity arise (whether or not consciously acknowledged) in all our lives every day – perhaps even more so in the lives of lawyers, who on the one hand sometimes find themselves representing the interests of the dishonest and vile, and on the other hand operate within an intricate foundation of laws that would seem to require an honorable respect in order to remain standing.

Fear of discovery, punishment, humiliation, etc. is, of course, a major help in making responsible choices in the face of all the short-term rewards of cheating. That’s a major raison d’être for institutions such as the auditing wing of the IRS, or the Office of Bar Counsel. But it has not stopped the Bernie Madoffs or Bernie Keriks of the world (no offense to people named Bernie), or those who ignored construction standards in the Big Dig, or those scientists and pharmaceutical companies who publish only studies supporting their (profitable) propositions and ignore contradictory evidence, or … well, you know all of this. And the fact that so many people, so much of the time, ignore social values and go for quick profit (even your personal trainer who demands to be paid in cash) makes it all too easy to rationalize doing the same.

But there is an upside to behaving ethically, responsibly, and maintaining personal integrity. You go about your life without fear of being “caught.” You do not carry the burden of guilt, or go to great lengths to escape awareness of that guilt. To the extent that “what goes around comes around,” you are ready for what comes around. Your friends and associates come to trust you, and with reason. Your knees don’t shake if you get a letter from the BBO (at least not as much as some other lawyers’ knees). If you believe that the purpose of life is to amass the most money or fame in the shortest time, you may be disappointed. But, as they say, you can look at yourself in the mirror. Your clients, coworkers, bosses, and friends may never notice, may never thank you. But inside, where it counts, integrity must be its own reward.

This above all; to thine own self be true. (William Shakespeare)

The Many Demands of Solo Practice

The other day I was telling a colleague about the lives of the lawyers who attend our monthly Solo Practitioners Forum. In the process, he and I both realized that running a solo practice requires a surprisingly long list of skills. Some of them are:

· Legal/Intellectual – this goes without saying, and calls upon much of what you learned in law school and in subsequent reading and continuing education, but no one can know it all. A major problem arises when lawyers, not recognizing their limits, fail to ask for guidance from someone who knows more about a particular subject.

· Accounting – unless you have paid staff, you have to log your time spent, bill your clients, and keep track of where your accounts stand. I can’t tell you how many lawyers I have met who are months behind in billing. For some of them, it’s because they are uncomfortable asking for money, especially from clients they know are far from well off. (Naturally, this is easier when someone else asks on your behalf.) They may feel a degree of shame for billing for services that were, perhaps, not delivered in a timely fashion. Or they may just have a brain that is allergic to columns, rows, and figures.

· Marketing – there may have been a time when just being a competent lawyer would eventually create enough word-of-mouth referrals, but that is no longer enough. Aside from CPCS as a ready source of (low-paying) referrals, the solo practitioner must figure out ways to get business. For most, it’s uncomfortable and oh-so-avoidable to contact people asking them to send business your way, or, for example, to do public speaking or spend a bunch of money on ads.

· Interpersonal – a slew of interpersonal skills are required to know how to deal with a variety of clients with different personalities, not to mention legal adversaries, judges, clerks, etc. – each of whom calls for a different approach. It helps to be able to read body language, discern unspoken agendas or expectations, etc., and to consciously manage your own reactions to individuals who “press your buttons.” Some practices call for evolved skills in negotiation or persuasion. And some clients behave in ways that require diplomacy in the form of clear limit-setting so as to avoid burning out or losing your temper.

· Organizational – in order to make a living, any lawyer has to be relatively efficient and productive. Most clients would not care to pay for your hours spent in reverie, even if you are finding parallels between their case and your readings of Proust, never mind Facebook. So you need to schedule yourself, keep yourself motivated, keep on top of deadlines, and prioritize tasks by importance, urgency, etc. Those who work at law firms have others around, and to whom they answer, to notice if their noses veer from the grindstone, or if they are putting undue work into matters that don’t demand it, or if they are taking too long to get back to clients, but those in solo practice must be their own overseers.

I’m sure that there is much more, but it becomes obvious how many skills and tasks must be juggled in order to carry on a solo practice. In order to thrive, and stay out of trouble, it is important to be aware of how you are doing on each dimension – few people could be adept at all of these functions. Identifying real deficits in any of these areas calls for action, such as delegating some tasks or getting further training or coaching for yourself. Those who attend our Solo Practitioners Forum use the opportunity to clarify, vent, brainstorm, and seek solutions. But that group is not always the right option for the lawyers who come to us for assessment; sometimes the thing that helps most is a referral to, for example, an organizational coach, mentor, or counselor. We also frequently refer to the Law Office Management Assistance Program (LOMAP), which is funded by LCL. It makes sense for practitioners to make use of such resources when you realize just how demanding and multifaceted a job they face.

Universal Coverage? Not Exactly

On occasion, the “universal” health coverage system initiated in Massachusetts during the Romney administration and sustained in the Patrick years has been pointed to as a model of what might be accomplished on a national scale. As the various kinds of “public options” seem to be fading away, it looks even more similar – adding a requirement for all citizens to arrange coverage, without any substantial renovation in the system (e.g., there is clearly no appetite for adopting the kinds of systems found in most other countries, even though many of them reportedly offer better care at much lower expense). It is quite understandable that the idea of losing our familiar forms of medical coverage triggers anxiety in most of us. The Massachusetts plan does have a kind of “public option,” but it has not made coverage truly universal. The problem, and I am not claiming to have the answer on its solution, is that many citizens, having no way to pay for the mandated coverage, continue to go without it. [Let me be clear that I am taking no political side here, since there are clearly drawbacks in any approach that has been proposed – my concern is strictly for those who need care that they cannot get.]

Personally, I was very pleased when the Massachusetts plan came along, because I had been able to present few treatment options to lawyers who came to LCL (or others who consulted with me elsewhere) in need of therapy or medication but with no means to pay for it. Publically subsidized clinics and mental health centers had long since become unable to offer truly low-cost services (probably since the end of the Dukakis administration), so the main option remaining was to refer people to community-oriented hospitals drawing upon a statewide “free care pool.”

Little did I suspect that I would be faced with a significantly larger number of uninsured lawyers after the advent of “universal” coverage here in the Bay State – and virtually nowhere to send them (since the free care pool subsequently diminished or disappeared).

I don’t think that the advent of expanded coverage itself could have caused an increase in numbers of uninsured middle class citizens – that must be a reflection of the economy – and I’m sure it has reduced the number of uninsured citizens in dire poverty. [I don’t have evidence that the trend toward more uninsured even extends beyond lawyers who come to LCL, but there was no mistaking it among those I saw there.] Aside from imposing state income tax penalties on those without coverage, the new Massachusetts plan brought about two main changes in coverage options: (1) private insurers began making some more affordable plans directly available to consumers and (2) the state began offering its Medicaid plan, MassHealth, to a significantly expanded group of residents, under the name of Commonwealth Care.

But consider the case of an LCL client (or other citizen) with a spouse, 2 kids, and a combined family income of $70,000. The private insurers have developed stripped down plans, with less extensive coverage resulting in lower premiums for young adults -but not much lower for those who have reached middle age. So, what about the public option, Commonwealth Care? In order to qualify for Commonwealth Care (the application is somewhat cumbersome and processing takes well over a month), your income must be less than 300% of Federal Poverty Guidelines. For our hypothetical lawyer/consumer with a household of 4, that means under $66,168 – and he will still have to pay about $1200 a year in premiums. In order to get the least comprehensive plan and not pay premiums, the annual family (of 4) income would have to be under $33,084. An individual (family of one) would have to make less than $16,260 to receive fully subsidized coverage. (That individual can get Commonwealth Care with an income of under $33,084, but would be paying premiums.) Of course, just like private insurance, the plan also requires co-pays for office visits and prescription drugs (with an annual cap on out-of-pocket expenses).

Thus, more than one lawyer seeing me at LCL has demonstrated that, since s/he makes too much money to qualify for Commonwealth Care, there is no way to afford health insurance without giving up, say, food, the house, or the car. They can better afford the tax penalty. Certainly, hospitals will not throw them out on the street if they require emergency care. But for less urgent services, and certainly for most LCL referrals, consumers are on their own – “free care” is apparently difficult or impossible to come by. As the state’s coffers empty, the capacity to subsidize coverage may further erode. At LCL, we do what we can to help, but too often it is simply not possible to arrange the kind of treatment to which we would refer any of our insured clients. This may be the best that can be realistically expected in this place and time, but it is not “universal” care.

If you live in Massachusetts and currently lack health insurance, here is how to find out what you’re eligible for: Get on the internet (at the library if you don’t have it at home), and go to www.mahealthconnector.org. Click “Individuals and Families” or “Young Adults,” whichever applies, fill in the requested information (e.g., family size, income), and you will be led to either the opportunity to apply for Commonwealth Care or to a selection of private health plans, with information on their costs and benefits. If you are still left in the cold…. Well, let’s see what happens on a nationwide level…….