Thursday, May 14

Crime Scene


OBAMA'S proposal of nationalized health care in America is like yellow police tape swathing a crime scene. While preserving the crisis area, it excludes people gathering at the perimeter.

In the context of medical needs, the crowd pressing up against the issue is much more committed than simple curiosity; they are waiting for services which are unavailable because the state says so.

The idealism of creating equality in health care access is inherently opposed to the happy result proponents claim. An overwhelming success-buster really does come down to numbers:

"...
Not even a carbon tax would pay for Obama's vast expanded welfare state. Nor will Midwest Democrats stand for a tax that would devastate their already crumbling region.
What is obviously required is entitlement reform, meaning Social Security and Medicare/Medicaid. That's where the real money is -- trillions saved that could not only fund hugely expensive health and education programs but also restore budgetary balance. Except that Obama has offered no real entitlement reform. His universal health care proposal would increase costs by perhaps $1 trillion. Medicare/Medicaid reform is supposed to decrease costs." (1)

Talk of 'community supported medicine' (2) likewise appears unsustainable. Americans don't like red tape. They really don't like being told what they can and can't do. And they will not tolerate waiting - for anything. However, on an issue as monumental as a radical transformation in American health care, the public response so far is hardly a hiccup.

Learning by example evidently is no longer reasonable and prudent. The European and Canadian standard of care stinks. They are loud about their frustration with interminably long waiting lists for unremarkable diagnostics like MRI's and elective procedures like hip replacements. There is no negotiation. The state has been allowed to dictate 'cost-effective' protocol for assessing what treatment options will be tolerated and which will be denied. You might be too young, or too old or too sick to warrant treatment. A green light for care is hardly timely; thousands of patients wait years for procedures which could certainly alter quality of life. Many have actually lost their lives in the process. The lucky and the privileged come to America and get it done right.

Closer to home, examples of government-run health systems gone bust are common place. Sadly, the indigent patient base they were intended to serve is also the most exploited by the bureaucratic failure which loses their files, hires miserably unqualified staff, treats patients with contaminated instruments and sub-standard equipment - or worse, doesn't treat them at all. One public hospital ironically was established in Watts after the race riots in 1965 to show good faith serving this vulnerable community's needs. Four decades and hundreds of millions of dollars later, the hospital had earned the gruesome nick-name of "Killer-King" for tragically accurate reasons. (3)


Ours is not a perfect system. The insurance and pharmaceutical giants are too powerful, and a disgustingly litigious society values lawyers for their ability to secure lavish settlements for spilled McDonald's coffee. Affordable health benefits are almost non-existent. Hospital emergency rooms have been choked into disease-spreading bottle-necks as they become primary care for illegals and the uninsured. Surgeons and OB-GYN's are retiring early or abandoning medicine because of prohibitive malpractice insurance. More patients who finally make an appointment with their doctor see a nurse practitioner instead. Skyrocketing costs are impossible to justify. I used to dream of becoming the Joan of Arc for health care change.

I remember an insulting new posting inside each exam room at our family doctor's clinic about 10 years ago (one of the rare times we had insurance!) that read: "Due to rising costs, please limit your concerns to one issue only during today's 15 minute appointment. For additional health issues, please schedule another appointment." This ~ after waiting for over 2 hours in his Disneyland-crowded reception room.

Or another incident, where I arrived with all 5 children for my appointment. They were violently sick with the same thing. I had been up literally all night. The receptionist crisply said, "You'll have to make additional appointments for each of the other children. I have one opening tomorrow..." Miss Organization was informed I was not leaving, and the doctor would see all of my sick children today. The doctor and his defensive staff were shocked by my appeal for collective diagnosis of all five kids, and corresponding antibiotic prescriptions for the same. Acknowledging current failures evident in the status-quo, I am nevertheless a witness for what our health care system does right.

Five years ago I ran into the paramedics who signed-off my little girl to the hospital. The handwritten report recorded their estimation her right leg would be amputated. "She'll be fine," they said smiling, "there was very little blood loss." None of us knew at that very moment she was suddenly losing half her blood volume in a matter of minutes. 14 year old Asia had sustained a catastrophic degloving injury,

(Behind knee; skin on shin still present, but dying - almost total loss a few days later. All muscle structure intact; a major surprise to the surgeons.)
a broken ankle (tendons bowed and laid-out), and multiple 3rd degree burns after a stolen truck in a police chase hit the bus stop where she was sitting. The 75 +mph impact did not rip-off skin and fat, but had evaporated it. The head of the trauma unit shut-down the emergency room after receiving Asia. He told us later he did not want to compromise the team of specialists he was summoning to emergency surgery.

Before I could see her, I had to sign an array of papers for state insurance since we were uninsured. For three days we did not know if her leg could be salvaged. She was so critical they could not do a CAT-scan until the 3rd day. She had 5 major surgeries in a little less than 2 weeks. Over the next 3 1/2 years she would have 9 more surgeries and a continually open wound. She lost 750 square centimeters of skin and fat. This, and the donor site on her thigh for numerous skin-grafts meant a ghastly wound from the top of her foot to her panty-line for the first year at least. Her leg was so involved, that the home-care nurse who came to teach me how to dress the wound looked at it and said, "I've been an RN for 15 years, and a home-care nurse for 16. I have never seen anything like this. I need to call my supervisor."

If this had happened in my mother's day, it would have been fatal. If it had happened to me, I would have lost my leg. But something miraculous was developed and ready for the public and Asia around 1995. It is called "Integra". It is the most ideal substance for substitution as human fat. It is made out of shark or bovine collagen and synthetic material. This matrix product encourages blood vessels to quickly integrate into it until it essentially becomes part of the body.

It is the reason Asia's leg has been spared from immobilizing scar tissue behind her knee, and why a more natural contour has been achieved. Integra is the miracle darling of burn units and reconstruction medicine. It has an unbelievable 90% success rate. If it doesn't 'take' the first time, a second application usually succeeds. Integra is also obscenely expensive.

Once we were given 2 little portions of it about 3 x 2" each in a specimen jar to take home and keep in the fridge until Asia's next surgery (thanks to the gross ineptitude of state insurance which automatically assumes a patient should be healed after 18 months and kicked Asia out of the wound specialist's clinic and into a generalized children's rehabilitation program which failed to stock anything a plastic surgeon would need). The doctor joked with us that our little jar was now worth about $3,500.

Had we been in the U.K., the use of Integra likely would have been denied. Had we been in a nationalized health care system, a bone-deep staph infection she suffered might have progressed to the point of no return since treatments are rationed. Fentanyl is an expensive, heavy-hitting pain-killer enormously more powerful than morphine. It was in Asia's I.V. and also in a lollipop form with warnings on the wrapper that contact with just the wrapper might be fatal to pets and small children. This was the drug of choice preparing Asia for her first dressing change in the hospital. It didn't seem to touch the pain. Two of the 5 nurses struggling to dress her leg were in tears. Too many times to count, Asia needed critical care that could not wait. She needed materials on the cutting-edge, and specialists who literally were premium in their field. Under nationalized standards, amputation likely would have been deemed "cost-effective". A million dollar little girl is hardly fair to the needs of the larger community.

I am ever thankful ~ despite the onerous dysfunction of Arizona's AHCCCS (public health care) "Mercy Care" and all its accompanying over-paid moronic case-workers who were positively stunning in their stupidity, a ridiculous re-qualifying schedule, an insulting exclusive contract with a corrupt medical supply company which made ordering bulk gauze a WWF event, (to name only a few) ~ I am deeply thankful we had the benefit and miracle of American medical technology and standard of care. I am grateful we had surgeons and nurses who were motivated
and competitive.

I believe there is a better way to reform American health care, reduce costs and preserve the sacred trust between doctor and patient, and to keep research in medical advancements - including generic pharmaceuticals - alive and well. Anything that interferes with this is a crime.

By the way; the U.K. allots a degloving the same compensation as for an amputation.

* See CPR for alternative health care proposals, and for testimony from those who suffer in nationalized environments.

1. Charles Krauthammer, "The Road to Health Care Rationing" 25 April 2009
2. Jennifer Hathaway, "Single Payer or CSM?" OpEdNews
3. John R. Graham, "Martin Luther King Jr. - Harbor Hospital Shows the Cost of Government Monopoly Health Care" 18 March 2009

6 comments:

two forks said...

i am forever grateful to the medical team that took care of wooly!!

Yaj said...

Well put as always! People generally don't think this deeply or clearly -- all people will want is
"free" health care. No one understands that the costs are not simply financial...

I made a comment similar to this post on my blog last week. I went to buy stamps. And didn't get much for my effort -->

http://jaymarkanich.activerain.com/

Bandanamom said...

I guess what I am wondering Cindi is what do you think the solution is? I certainly don't have the answers. We have wonderfully all-inclusive insurance, but I pay over $800 a month in premiums. In addition I still have a potential out of pocket cost each year for my family of $5,000. Luckily, we can afford it. But when we were making less money it was very frustrating. We weren't poor enough to qualify for any sort of state of federal aid, but we also weren't rich enough to afford a monthly insurance premium. When we had Holden we had no insurance. Medical costs are the number one reason for bankruptcy (or at least they were before people started borrowing so much on their ridiculous mortgages). Our health care in this country is quite miraculous - but it's only miraculous if you are lucky enough to be on state aid or lucky enough to afford high premiums. Lots of people fall in that middle category where I once was - and no matter how wonderful the advances, they are not available to you. And at that point, Canada seems wonderful.

We have friends who live in the UK and are very happy with their health care there - ditto friends in France who absolutely can't say enough good about their system. It seems to matter who you talk to or who's reporting the problems.

I don't know what the answer is, but I don't think ignoring the problem is that answer. Obama may not have all the answers, but at least he's trying. Health care costs are choking the economy at this point, and we can't afford to ignore it anymore.

So what would you propose?

two forks said...

like with many political, social and financial issues the common everyman does not need evidence to substantiate an opinion. opinion does not necessitate solution.

everyone has acutely different experiences in this life - i am 31 and have only had insurance twice in my life equaling 6 years, all of which, after i left home.

the beauty of our system is that the bandanamoms and calizonas of this country don't have to make these decisions... but they will likely continue to debate them.

CaliZona said...

Having already made the claim our health care system is flawed, I stand by my references. The CPR link has a variety of proposals that are entirely viable w/o excessive taxing or the creation of a massive, rogue welfare state.

As for the experience of few others overseas; I would venture their health needs have thankfully not as yet involved a catastrophic injury or illness.

Again, my references sited are not just random, unverified opinions, they are real-life health care disasters in real-time. The documentation of what has gone terribly wrong in Europe and Canada and elsewhere is plentiful and more than alarming.

While living in Mexico, Robin had to buy the medication she needed for a serious illness at the pharmacy, and then travel a distance to the Red Cross for a nurse to administer the injection. In Brazil, she had to wait in a very long line for hours in the tropical heat for a dengue fever shot. Her husband, while living in Italy, saw his companion wheeled from surgery by a phalanx of chain-smoking staff. David witnessed similar hospital issues even in modern, Westernized Japan.

Common sense ought to be the bottom-line: when the richest people in world need a critical medical procedure - they come to America to get it done. There is a reason for that. Likewise, there is a natural law that says innovation cannot germinate in an environment that destroys competition.

People don't apply to medical school (or law school, or business school, etc.) because they want to drive a Volkswagen. Neither do they pursue a degree for purely altruistic reasons. There is something magical about the freedom of personal achievement available here like no where else. America is cutting-edge precisely because we do not limit specialists to a government paycheck, we do not tell them which materials they cannot use, or tell them which procedures they cannot prescribe in the best interests of their patients.

Eliminating the flagrant corruption in existing public health programs would absolutely revolutionize the system - just for starters.

Bandanamom said...

I'm not trying to be contrary, I just really am looking for answers to the problem.

Anectodal evidence is not the best evidence to be sure - but our friends in France moved there for two main reasons 1. The educational system and 2. the healthcare. Our friend John is a doctor and he lives there by choice. Maybe he is truly just one of the most altruistic people we know and therefore his experience and choices are to be discounted on that basis. His wife Dakota has since had cancer treatments there and has suffered with an early breast cancer (she was diagnosed at 33) - currently she seems cancer free. At any rate they live quite well. Certainly I am sure he could make more here - but they make well over $200,000 a year and live quite well. I think they feel when the benefits are factored in, on balance, they prefer it there. But it's anectodal to be sure. As are Kirk's experiences in Scotland (all positive by the way - with the exception of the dental)

Other facts to consider are:

The Center for Disease control reports there are 54.5 million uninsured people on any given year. That number rises every year.

The US ranks consistently 37th of 191 countries on health performance inspite of the fact that we spend the most of any country of our GDP according to the World Health Organization

The CEO's of insurance companies are some of the most highly compensated CEO's - earning as much as 33 million in salary according to the Washington Post.

There are four times as many lobbyists for insurance companies as there are members of congress. (opensecrets.org)

Canadians live 3 years longer on average than we do (United Nations Human Developement Reports)

The poorest person in great britain can expect to live longer than the richest person in the US. (AMA, 2006)

The United Nations Development Statistics list the average life expectancy (2006) United States 77.5, UK 78.5, France 79.6, Canada 80.2

Rich people may come here for services, but when only the rich can afford those services, what good are they?