My patient S______ was one of my best friends. We shared the same birthday and much more. S______ lived alone in a local residential care facility for seniors. I was not aware of any other visitors other than myself. She felt I was like a son to her. Often, she patiently listened to my personal struggles, giving me motherly advice and understanding. I enjoyed hearing about her memories of youthful exuberance and experiences, like watching the Enola Gay take off on its fateful doomsday mission from a base in the Utah desert.
S_____ ’s last days were not too much fun for her. Her family chose to ignore my recommendation to let her live out her last few months in peace. As a former Hospice Director I am familiar with relative’s struggles at this critical time in their loved ones lives. Their decision to drag S______ all over Salt Lake City (it was painful for her to get around) to see a handful of expensive specialists for a second opinion was understandable, especially when they seldom came to visit her. But, was it necessary, or wise?
S_____ suffered from multiple organ failure. Her heart, kidneys and lungs were barely keeping her alive. I had been treating her conservatively with a high dose water pill, narcotics and oxygen. She was comfortable and even looked forward to joining her beloved husband, whose smoking was the principal reason for her health troubles. After approximately $20,000 worth of testing and doctors’ fees, the recommendations for aggressive dialysis and more drugs thankfully fell by the wayside, yielding to common sense. S_______ was able to enjoy a few weeks of peace before she finally passed away.
I am afraid that S_______’s story is all too common… and too expensive. Roughly 40% of our health care expenses are wasted on misguided and often guilt-driven trips like S______ ‘s that cannot avoid the inevitable. Yet, it seems like an attempt to stop this madness is viewed by some as “death panels.”
While not spending enough to comfort our loved ones’ suffering at the end of life is just as reprehensible, cooler and more mature minds must prevail to strike a happy medium. After all, soon, it will be you and me in S______ ‘s slippers.
In my opinion, there are many other outright lies being thrown around in the health care debate raging in our country.
Please, keep you eye on the ball: we need to help alleviate the suffering of millions of Americans, some of whom get very little health care, if any (compared to S_____ getting too much.) We must not be blinded by the ideology and self-interests of the “man behind the curtain.” Insurance companies and Big Pharma have a nasty habit of planting misinformation designed to confuse Americans. These institutions, which originally set out to do good now are focused on doing well. Remember the controversy over Canadian drugs? Well, it was fueled by Big Pharma: Canadian drugs are safe and cheaper and will continue to be so, unless we wise up and put people first, ahead of corporate interests.
The British are upset that the debate in our country vilifies their beloved health care system. So are the French and Canadians, who view our scare tactics to brand change as “communist” as a moral outrage. I agree.
Lest you think I am spewing partisan politics, let me say that I find President’s Obama’s secret meetings with the Insurance companies and Big Pharma reprehensible, albeit predictable. By now you may have heard that deals have been struck with the big boys to assure them that their profitability will be maintained. While I understand Free Enterprise and profits (I love Adam Smith) I feel they must never be at the expense of our community’s health.
Mr. Obama’s pragmatism is understood and even necessary. No doubt the final draft of health care reform will include provisions to keep big business happy. But, let us not lose tract of some simple facts:
- A Public Plan Option will not discourage competition. How could it? Have you not seen the massive negative response from those who feel any government-run program is of the devil? Surely most of those Americans will choose not to join such a plan, just like many of them never use the US Post Office (which continues to hemorrhage money, unaided by the Feds,) preferring Fed Ex. Surely most of them also don’t use public schools or public parks, preferring private schools and open spaces within their gated communities. Excuse me if some of that opposition does not enjoy those affluent perks; I often wonder why people oppose any program that would expand their choices and services. Many seem to defend the interests of those who already have it made in the shade. I will continue to wonder, even though I know the answer: “keep the government out of my life.”
- The government is already involved in Health Care. The “single-payer” systems called Medicare and Medicaid have overhead expenses estimated to be less than 5%, while the “better run” private insurance companies’ overhead is anywhere from 15-30%.Very few doctors choose to participate in those programs. Doctors will not go for any system that threatens to “employ” them; a Public Option Plan would not. The government is already deeply involved in private insurance, too. This is the only reason such a dysfunctional system works at all. If left to their own devices, the big boys would do even more antisocial things, beyond their cherry picking healthy patients and denying payments. The present employer-based coverage is possible because of government intervention: tax breaks make it workable. By the way, I feel this is a mistake; it hinders competition and burdens a vital sector of our society with the moral obligation we should all be shouldering.
- Health Care rationing will always be part of any system we choose. It would be naive to think otherwise. Right now we choose to ration health care by leaving out in the cold 47 million Americans. Other countries choose rationing by covering the most essential of services for every citizen, and leaving “boutique care” uncovered or delayed by a “waiting list.” Such care is still available to those who can afford it, and/or are able to wait for it Those “communist” systems spend half of what we spend on health care, yet, they lead the world in health care parameter like longevity. Their citizens are more satisfied with their imperfect systems than we are with ours.
- “Follow the money.” We must recognize that our national preference for a capitalistic system will always result in “shadow governments” by wealthy, amoral elitists who cannot fathom extending a helping hand to those who suffer. While I agree we need to avoid a “welfare state,” we cannot morally or economically afford to deny essential necessities to the less privileged segments of our society. Let us not be so naïve to think that only one political party is in the elitists’ pockets: they both are. For instance, “blue dog” democrats who oppose a Public Plan option have been documented to get significant financing from Big Pharma.
- There will always be dissatisfaction. When we choose “guns over butter” we must live with our choices (see “rationing” above.) The only reason most Americans seem to be satisfied with the present system is because of government intervention in regulating the insurance companies. “If you currently have decent health care insurance, thank the government.”
- No health care reform will work, unless we shift our focus away from expensive, inefficient and ineffective treatments. We must focus on preventive services (like nutrition) that work on the root issues, not the symptoms. Read my previous blog.
- We should have never abandoned the “not for profit” model of health care. Health is not a business; it is the moral obligation of healthy, mature societies who are able to balance profits, business with healthy governments that are not in the pocket of special interests. In my home state of Utah, health care used to be in the hands of churches; what a sad day when their mercy, compassion and “communist” thinking gave way to business-run health care…
- We face a moral issue, not a business issue. Please, keep this in mind as the debate rages.
 PBS.com, August 14th 2009
 J. Business Week August 11th 2009, cover issue & Salt Lake Tribune, August 13th 2009.
 New York Times, August 2nd 2009
 Paul Krugman, New York Times.
 “Promoting More Conservative Practices,” JAMA 2009;301:865