Writing is an ego thing. I have very few friends who aren't either aspiring writers or who wish they were. I don't know if it is a cohort thing; it could be age related or the result of those things that bind us together in the first place. Many of my friends were, or are, in the health care industry and/or have an interest in human psychology, which would lend one to making observations. And to being in your head much of the time. Which I think can easily lead to writing; getting things out of one's head yet keeping them accessible. I make brilliant observations in the middle of the night or when working in the yard but find that if I don't write them down they are lost; until the next time I make that observation, which may be days or even years later.
So here I am in the place of not having written for over a week with so many passed up opportunities to make brilliant observations that I feel rusty and out of tune again. Nonetheless here I go.
Like many people in this country I am disgusted by our congress; their inability or unwillingness to govern. It is as if they are playing a football game with all that matters is who wins and who loses. If not for referees football would be a brutal game; where in politics are the referees? The rules? This game is about power; who has it, who lost it and how to keep it or get it back. For the last five years our governing body has had little interest in anything except the power. Using their power for the good of the country, for what the majority of the people desire, want or need, has not been in their scope of work.
At issue right now is healthcare. All of us need it but only some of us can afford it. In reading about healthcare reform I was overwhelmed with the history of attempts to develop some system of health care in this country. As early as 1845 citizens organized to pressure the government to develop some system of health care for the indigent and insane. As other countries bowed to the pressure to provide care for its citizens, notably the United Kingdom in 1911, the United States fought against that kind of "socialism".
In The Nation I came across an article titled "This Week in 'Nation' History: Eighty Years of Opposition to Universal and Affordable Healthcare" dated October 5th this year. Here the author, Katrina vander Heugel states that "corporate and conservative opposition to universal coverage has existed since the 1930s, when many supported including national health care insurance in the Social Security Act and Senator Robert F Wagner of New York proposed what we would now call Medicare-for-all. Campaigns to defeat what Nation contributor Leonard Robins called the last great piece of legislation since Roosevelt's New Deal have always involved race baiting and scare tactics."
The history of the fight over some form of national healthcare in this country is mind boggling. If one thinks the push for universal coverage is the sole creation of this 'demon president', Barack Obama, one need only read this article to be disabused of that fact. Or google the history of healthcare reform, or the debate over healthcare reform. It is enough to turn ones stomach.
My journey with healthcare is personal and has informed my politics. My earliest memories of doctors and hospitals are from the age of six as a military dependent. I was frequently sick as a child necessitating numerous trips to the hospital over the course of a decade when, after having my tonsils removed at the age of eleven, I became the model of health. However by that time I was hooked; I loved hospitals and the care I received and those feelings would lead me to become a healthcare professional.
As I look back on those visits, and the treatments and hospitalizations that resulted, I realize that they occurred under socialized medicine. Military healthcare is universal healthcare, conducted on a first come, first seen and as need basis. I rarely saw the same doctor, often in fact was treated in a different hospital due to our many moves, but I never felt a lack of concern or care. When I became an adult and joined the Army Nurse Corps, then became a military wife, I never thought of the care as inferior or wanting. It was all I knew. How can anyone object to that kind of care?
Last week when I mentioned this to a retired navy captain he agreed that the care was basically socialized medicine, he even agreed that it was excellent, what he didn't agree with was the idea that everyone deserved the same level of access to care. " Yes," he said, "You are right. But I don't want everyone having that kind of healthcare." I was so shocked by this response I had no rejoinder. What does one say to someone who thinks they deserve more and better healthcare because of some position they hold in society?
I grew up as an enlisted man's child; the army was segregated by rank and as a result there were many social restrictions we experienced. I saw those restraints from a different perspective when I became an army officer and then married a career army officer. But I never experienced them when receiving or administering healthcare. Administering preferential healthcare was against the oath we all took as medical deliverers. So why does the AMA fight so hard against universal healthcare?
As a nurse I worked both in military and civilian hospitals. In military hospitals care was delivered regardless of rank or position. In civilian hospitals, particularly in the neonatal intensive care units in which I worked, care delivery seemed to be ubiquitous, no matter what the parents could afford. However much of what we were doing with the very sick and immature infants was supplemented by not for profit organizations. The delivery of care, and the level of care, never included discussions about what insurance a patient had. Later as doctor owned hospitals became big business and healthcare costs began to skyrocket, private insurance took charge of delivery; who got it, when and how much. In care conferences the question of what the insurance company would allow became the new standard.
That was my experience when in the 1990s I worked as a child psych nurse in a hospital setting with emotionally disturbed children. Whereas previous to my tenure children were admitted for treatment that lasted as long as six months, with multiple caregivers and in depth family involvement, I saw in-patient treatment dwindle from a month when I began to four days when I quit. At the time I left, the length of patient treatment was dictated totally by insurance companies, not doctors. Supportive modalities such as play therapy, family therapy, art therapy were all eliminated and replaced with drug treatment. The idea that a child was part of a unit, a family, and could only be as healthy as the unit was abandoned in favor of short, inexpensive hospitalizations and follow-up with fifteen minute drug management appointments.
As an aside I cannot help but wonder how many of these children, whose mental health depends solely on drug compliance, are the mentally ill adults we see today walking into the naval yard, post office, theater of your choice with a loaded rifle.
Healthcare did not become less expensive as a result of insurance company managing the delivery; different people got rich. Doctors, who at one time were the wealthiest citizens in any community, are more likely to be members of the upper middle class today. Unless they have managed, as some I know, to build their own private care centers, delivering care that ranges from radiology to day surgery to primary medicine. For instance one physician in this town owns at least five primary care centers, along with a diagnostic center and a surgery center. Medicine as big business.
Another doc friend, who is a diagnostician, talks about how little he gets paid for his skills; all the money is in procedures he says. MRIs, CTs, colonoscopies, etc. You get the idea. So painful has practicing medicine become for those who worked prior to the insurance takeover, that we are seeing some family medicine and internal medicine docs, where procedures are mostly referred out to specialists, abandoning private practice to work for the Veteran's Administration where they are paid a salary. Socialized medicine.
As I think about this I wish the debate would move on to the delivery of healthcare to our citizens and away from overturning Obamacare. As I contemplate the size of this country, and the immense wealth of some of its citizens, I wonder why we continue to have this debate. Providing the means for every person to have healthcare insurance is only the first step; but it is a necessary step in controlling healthcare costs and making it affordable for both employers to provide insurance and recipients to utilize the healthcare system.
I am not a proponent of big government. But it seems that when the healthcare providers, physicians, insurance companies, pharmaceutical corporations are unable to control costs, unable to limit their greed, it is time for the government to step in and protect its citizens. To me it is one of the reasons to have government; to deal with corruptness and greed and equalize access to power. Access to healthcare is a necessity if one is to become a contributing member of society and not just used up and thrown on the trash heap of history.
Interesting isn't it, how those who object to big government and want to lower costs never talk about the defense budget.
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