October 22, 2015 — What Makes a Cuban Afraid

Today I read an article from the New York Times profiling Elaine Diaz, a Cuban who has set herself up as an independent journalist in her country. Her news organization is called, in English, Community Journalism.

She’s a pretty gutsy young woman. While not exactly a dissident — she steadfastly refuses to adopt that title, so as not to get on the wrong side of the Cuban government — she does try to go her own way with the news stories she publishes. So far, the government is letting her proceed without too much harassment.

What really struck me about the article was a quotation near the end, in which Elaine explains what it is she most fears. It’s not what you think.

It’s medical care in the United States.

Really.

Elaine studied journalism at Harvard before returning to Cuba. The interviewer asked her, “How did your year in Boston change your perceptions of America and Americans? What were the most pleasant and unwelcome surprises?”

Her response:

“I realized American journalists suffer from many of the same kind of issues I faced in Cuba. I commiserated with them and realized the scope of the financial crisis our industry is struggling to overcome. The hardest thing was getting sick, and realizing that the deductible of my insurance policy was incredibly high. Once, I sent a photo of a rash on my hands to a Cuban doctor in Sierra Leone so he could diagnose it. I have never felt so afraid of getting sick as I did during those 10 months in the United States.”

Think about the implications of that statement. Cuba is a third world nation. Despite its many economic problems, its government has, for many years, put a great deal of money into healthcare. Cubans may lack many things, but good medical care is not one of them. So excellent is the Cuban healthcare system that Cuba has sent some of its best doctors all over the world, visiting other third world nations to help provide medical care.

So, when this Cuban student comes to the United States to study at Harvard for a year, her greatest fear is getting sick with an expensive illness.

Presumably, Harvard offered her some kind of student medical insurance as part of her financial package. Yet, even as an insured person she still felt the need to send a photo of her hands halfway across the world, so a Cuban doctor in Africa could diagnose the rash that had appeared on them.

If Cuba can build a world-class medical system on a shoestring budget, with care provided entirely by the government, then why can’t we figure out a way to make the move to single-payer healthcare?

April 13, 2015 — Bankruptcy Fears

Here’s a factoid I ran across today, in an article in Cure magazine. Over one-third of cancer patients, in a recent study, identified bankruptcy as one of the worst fears they’re facing as a result of their treatment.

Think about that: one-third! (Actually, it was a little worse than that: 37.1 percent). That’s an awful lot of worried, seriously-ill people, who are obsessing over something not directly connected to their disease.

Now, here’s the real kicker. From the article:

“Most of the [480] patients were covered by an employer-based plan or some form of Medicare; 18 participants had purchased their coverage through a health insurance marketplace; and five patients reported not having insurance of any kind and being unable to afford a plan.”

Most of the people who such worries about going bankrupt have insurance! So much for insurance providing peace of mind. What does that say about the quality of the insurance safety net so many are depending on?

Even worse than worrying about inadequate insurance is the worry about having no insurance at all. A great many survey respondents spoke of certain trade-offs they’ve had to make, to keep their medical funding in place, “such as choosing doctors based on co-pays, cutting back on food, activities — including education — to save money, and becoming isolated from family members. 'Even if I starve to death, I will not let go of my insurance. That is my life,' said one woman.”

It’s a sad commentary when a seriously-ill person is reduced to describing her insurance policy as her life.  For far too many in our country, medical insurance is indeed a life-or-death matter.

Time for national single-payer health insurance — such as nearly every other industrialized nation already has — wouldn’t you say?

February 22, 2014 — The French Way of Cancer Treatment

Today’s title is borrowed from a provocative Reuters blog posting by Anya Schiffrin, who describes her family’s experience in bringing her father to France from New York, to receive treatment for pancreatic cancer.

Now that may sound incredible to many Americans, because of what we’ve long been taught about our healthcare system. Doesn’t everybody know our healthcare is the best in the world? Why would anyone forsake Memorial Sloan-Kettering — a destination renowned worldwide by those lacking adequate healthcare in their own countries – for treatment on foreign soil?

Well, part of the reason is that Anya’s father, the writer Andre Schiffren, is a native of France (and presumably still a French citizen), who’s used to spending part of each year in that country. He insisted on going to France as usual, and his family gave in to his wishes. After some initial skepticism, they learned that healthcare in France is much easier — and cheaper — to obtain.

Anya compares the grueling all-day experience of bringing her father to Memorial Sloan-Kettering for chemotherapy — which required hours of idle time in waiting rooms — with the much more patient-friendly French system:

“So imagine my surprise when my parents reported from Paris that their chemo visits couldn't be more different. A nurse would come to the house two days before my dad's treatment day to take his blood. When my dad appeared at the hospital, they were ready for him. The room was a little worn and there was often someone else in the next bed but, most important, there was no waiting. Total time at the Paris hospital each week: 90 minutes.

There were other nice surprises. When my dad needed to see specialists, for example, instead of trekking around the city for appointments, he would stay in one room at Cochin Hospital, a public hospital in the 14th arrondissement where he received his weekly chemo. The specialists would all come to him. The team approach meant the nutritionist, oncologist, general practitioner and pharmacist spoke to each other and coordinated his care. As my dad said, ‘It turns out there are solutions for the all the things we put up with in New York and accept as normal.’”

OK, this is all about patient convenience, some may observe. What about the quality of care, the access to cutting-edge treatments?  There’s an answer for that, too:

“When the gemcitabine stopped working, the French oncologist said he would put my dad on another drug — one my dad’s U.S. insurance plan had refused to approve in New York.”

The cost to the patient for all this high-tech care? Next to nothing. Except for small co-payments (example: 18 euros for a doctor’s office visit), it was nearly all funded by the French taxpayers. It included house calls from nurses and the free loan of a wheelchair.

This approach has a staggering effect on overall healthcare costs:

“I had read many articles about the French healthcare system during the long public debate over Obamacare. But I still I hadn't understood fully, until I read this  interview in the New York Times, that the French system is basically like an expanded Medicaid. Pretty much everyone has insurance, it explained, and the French get better primary care and more choice of doctors than we do. It also turns out, as has been much commented on, that despite all this great treatment, the French spend far less on healthcare than Americans.

In 2011, France's expenditure on health per capita was $4,086, compared to $8,608 in the United States, according to the World Health Organization. Spending as a percentage of gross domestic product was 11.6 percent in France while in the United States it was a far higher 17.9 percent.”

Bottom line? We’re simply not getting good value for our healthcare dollars. There are too many people in our system — insurance executives, medical coders, financial clerks — standing there with their hand out. These people aren’t providing care, nor are they even supporting it. They’re supporting the powerful corporate interests who are deeply invested in siphoning off profits.

These corporate interests command a powerful public-relations machine that continually spews out lies about the alleged wastefulness and poor quality of publicly-provided, taxpayer-funded, single-payer healthcare in other countries.

Those like the Schiffrin family, with real experience of the best of those systems — France, Japan, Canada, Britain — tell a very different story. Sadly, it’s a story few Americans get to hear.

October 16, 2012 – Time to Close Down the Floating Medical-Insurance Crap Game

“We all make mistakes, and a humane government tries to compensate for our misjudgments. That's why highways have guardrails, why drivers must wear seat belts, why police officers pull over speeders, why we have fire codes. In other modern countries, Scott would have been insured, and his cancer would have been much more likely to be detected in time for effective treatment.

Is that a nanny state? No, it's a civilized one.”

The writer is the New York Times’ Nicholas Kristof. His subject is his college roommate, Scott, who just died of too-late-diagnosed prostate cancer.

The reason Scott waited so long to go to the doctor?  Lack of insurance.

The reason he didn’t have insurance? Because he was between jobs, and couldn’t afford to buy insurance on the open market. As Scott himself wrote:

“I didn't buy health insurance because I knew it would be really expensive in the individual policy market, because many of the people in this market are high risk. I would have bought insurance if there had been any kind of fair-risk pooling.”

I know other people who could tell similar stories. The one that comes most clearly to mind is a fortysomething single mother of 3, who discovered a lump, figured it was probably cancer, but didn’t go to the doctor because she was sure that, if a cancer diagnosis ever got recorded in her medical file, no company would be willing to insure her, ever again.  Instead, she immediately took steps to get into an employment situation with benefits, but that took a while.

By the time she finally did get back into a job with medical insurance a few months later, and saw a doctor, her unusually aggressive cancer had progressed much farther than she’d ever imagined.

The doctors are trying every desperate measure they can think of, but the bottom line is, she probably doesn’t have long to live. With an earlier diagnosis, things could have turned out differently.

She told me later she’d known she was gambling with her life. If she’d had one of the slower-moving cancers, she probably would have won the crapshoot. She would have had her cake and eaten it, too — avoiding utter financial destitution and getting reasonably timely and successful treatment, besides. She just didn’t bank on her odds being as bad as they were.

She was thinking about being able to afford college for her kids, when she should have been thinking about her own survival.

Not the wisest decision, in retrospect.  But, as Nick Kristof points out, how on earth can a civilized society expect a profoundly frightened person who’s just discovered a suspicious lump and has no experience dealing with cancer, to make a cool, calm, balanced and wholly rational cost-benefit analysis?

This is why the American Cancer Society now considers lack of insurance to be a risk factor for cancer. Just like cigarette smoking and working in an asbestos factory.

This is why those who are clamoring for the repeal of Obamacare are either deeply immoral individuals, or are deluded in thinking there is no moral dimension to this issue.

It’s a moral issue precisely because, if Obamacare is repealed, people like these two individuals will die needlessly.

What we really need is national, single-payer health insurance for everyone. Just drop the qualifying age for Medicare to zero. It’s as simple as that. And if Grover Norquist doesn’t like the tax increase that will be necessary to pay for it, patriotic Americans ought to shun him like the corrupt political boss he is.

Obamacare doesn’t go nearly far enough. But for now, it’s all we’ve got.

It sure beats the alternative.

September 5, 2012: No Other Name For It: Our National Disgrace

I saw an exchange on Facebook this morning about a much-publicized case from a year ago, about a homeless woman named Anna Brown. She died in jail immediately after refusing to leave a hospital emergency room near St. Louis, Missouri, where she had gone seeking treatment for a pain in her ankle. It turned out she had a case of deep-vein thrombosis. The blood clot in her lower leg  - which could have been identified by a  simple ultrasound test the hospital didn't give her - broke off, made its way to her lungs, and led to an agonizing, painful death on the floor of a jail cell. Then, she was taken back to that same emergency room, where she was pronounced dead.

The graphic video of her death was captured on a jail-cell security camera, and subsequently publicized by the St. Louis Post-Dispatch newspaper.

The video consists of four segments. First is from a hospital security camera, showing Ms. Brown on a gurney, awaiting transportation out of the hospital. Second is some footage from inside a police car, showing her complaining of pain and asking for a wheelchair that evidently isn't available, then the police officer and a jail employee carrying her from the car. Third is from a camera in her jail cell, showing her being carried into the cell, moaning in pain, then being left on the floor - right next to a bed the corrections officers didn't even lift her onto.  Fourth is a brief conversation, after her body had been removed, between the Richmond Heights, Missouri fire chief and a corrections officer, explaining that the reason the hospital staff had sent her to the jail was because they thought hers was a case of drug abuse.

No doubt, Anna Brown had a lot of problems. Her home was destroyed by a tornado, she lost her job in a fast-food restaurant and her two children were given over into their grandmother's care under the condition that Anna not live with them. It may well have been that she had some history of mental illness and/or drug abuse. Yet, the bottom line is that she was a human being, who presented herself at a hospital emergency room in pain, refused to leave after the hospital declined to treat her, and subsequently was physically carried to the floor of a jail cell where she died. Many have already commented on how her story is a case study of how our dysfunctional healthcare system fails the most vulnerable in our society.

Now, here's the greatest irony of all. The Richmond Heights, Missouri hospital that refused to treat Ms. Brown, St. Mary's Health Center, is a Roman Catholic institution, sponsored by the Franciscan Sisters of Mary. The mission statement on the hospital's web page reads as follows:

"Through our exceptional health care services,
we reveal the healing presence of God."

About the non-profit holding company that manages this and seven other hospitals, SSM Health Care - St. Louis, the website says:

"In accordance with the philosophy of the Franciscan Sisters of Mary,

we value the sacredness and dignity of each person.

Therefore, we find these five values consistent

with both our heritage and ministerial priorities:

Compassion, Respect, Excellence, Stewardship, Community."

This is not only a Roman Catholic hospital, but a Franciscan hospital. It's owned by one of the orders in the tradition of St. Francis and St. Clare, whose mission is specifically focused on sacrificial caring for what Jesus calls "the least of these."

Obviously, Ms. Brown's case is a massive failure of both the healthcare and the law-enforcement systems. Her death has touched off another round in the debate about single-payer national healthcare. It points out how the economics of our present system lead to sick people being neglected, even forcing religiously-based hospitals to join together in massive holding companies, like SSM Health Care, where they lose sight of their mission.

But, some will counter, a national health system would result in an even bigger conglomerate, where patients would be treated even less personally - wouldn't it?

Not true - at least not for the needy among us - as borne out by this testimony from a woman named Rebecca, who has personal experience living under Britain's National Health System. She shared it on Facebook, commenting on a posting by Jean, a minister friend of mine, about Ms. Brown's case:

There is very little overcrowding in the A&E (what the UK calls the ER) because people have regular access to a GP. From what I understand, a lot of the overcrowding in ERs is due to people going to the ER because by law they have to be seen, wheras a GP can turn you away if you do not have insurance. In the UK, everyone has insurance through the NHS - even an immigrant like me. The NHS, contrary to popular belief isn't solely funded through paycheque tax deductions. A Good portion is funded through sales tax (VAT in the UK), so everyone contributes something to it regardless of their employment status.

The NHS also has a service called the NHS Direct which can put you in touch with a nurse 24 hours a day to answer any questions you have. This nurse will then help you determine if you need to go to A&E, if it's safe to wait until morning to call your regular GP, or if you should make an appointment with the after hours/on call GP. All of this is done free of charge, inluding seeing a GP at 2 in the morning or speaking to a nurse at 5. When I was recently on holiday (vacation) in Wales, I needed to use the NHS direct service when I fell ill (got sick, sorry. My vocabulary has shifted largely to UK English!) and they were able to get me an appointment at a local GP.

I was diagnosed with Type 2 Diabetes this past March after having blood work done for something unrelated. Since then, I have had three further blood glucose tests, seen a diabetic specialist nurse, a dietician, a diabetic eye specialist, a podiatrist, and I have an appointment with a diabetic ob/gyn speciaist at the end of this month. Would any of this have happened if I were still in the US? Probably not, unless I had loads of money to pay for all the specialists. 

The NHS saved my father-in-law's life when he needed a kidney transplant 6 years ago and his kidney was donated by my mother-in-law. My husband's little brother had Leukaemia in the late 70s/early 80s. My in-laws would have been unable to pay for the level of care that he needed, but the NHS was there and his little brother beat cancer, but sadly died after contracting pnemonia due to his weakened immune system. My husband's grandmother was in hospital for 6 months before her death, and instead of being worried over who was going to pay the hospital bills, our family was able to celebrate her life. Grandad is still going strong at 95 thanks to his NHS care, which includes a carer who comes to his house daily to assist with dressing, bathing, and other daily functions he is unable to do for himself. By coming to his house it enables him to remain at home instead of a care home and has undoubtedly contributed to his longevity.

Oh, and if you're worried about not being seen right away because of the "long waits", you don't have to. The NHS operates on a priority system based on needs, not when you get put in the queue. You also can purchase US-style private insurance and see private doctors and specialists sooner if you really don't want to wait.

In the US, young women pay out anywhere from $20 to $60 per month for birth control. In the UK, birth control is free for all, including visitors. And if you do get pregnant, all your needs will get taken care of by the NHS and you will be assigned a midwife, who will visit you in your home after the baby is born for the first 6 months of its life to prevent the baby from picking up germs at the GP office.

Suffice it to say, I love the NHS.

Now, here's what my friend Jean writes, in response:

Thanks, Rebecca, for setting the record straight. I think most Americans have an irrational fear of socialized medicine based on hearsay and propaganda by our pharma/medical industrial complex. The truth is socialized medicine provides better care at lower cost. When people say we have the best health care system in the world they are really talking about the most advanced procedures that the vast majority of people in this country don't have access to or can't afford. There is absolutely no excuse for a woman with a blood clot to be forcibly removed from the ER because they will not do the medical test that would confirm her suspicion that she was seriously ill. That would never happen in a state with socialized medicine. I also believe we need to have a serious conversation about how we unnaturally prolong death long past the time tests have shown that treatment is futile. It is crazy how those who want to get medical care can't and those who have money can do whatever they want regardless of the cost/benefit. Now I'll be accused of promoting "death panels." I've told my children I don't want their inheritance wasted on prolonging my death if I have a terminal disease. I've held hands too many times with those who have gone down that road and it is not for me!

In all the frenzied political debate about so-called "socialized medicine," there are many falsehoods promulgated about the alleged poor quality of care in all the other advanced democracies - like the U.K., Canada, France, Germany and Japan - that offer government-funded universal healthcare to their citizens. Most are based on either unsubstantiated rumors or outright lies. Yet, only our system creates the abysmal constellation of unfavorable conditions that can lead a Franciscan hospital to turn away a poor woman of the very sort Francis of Assisi devoted his life to caring for, allowing her to die on the cold, concrete floor of a jail cell.

August 24, 2012 – What Would Jesus Not Do?

One of the most brilliant things I’ve seen lately, related to the healthcare-funding debate, is this little satirical item that Rabbi Michael Lerner sent around in his latest Tikkun e-newsleter. (Same last name, but he’s no relation to my oncologist, as far as I know.)

The author is Fr. James Martin, S.J., and it was published today in the In All Things group blog on the website of America, the Roman Catholic weekly.

This item’s not even a day old, at least in its present iteration (I don’t know when Fr. Martin wrote it).  Yet, it’s already got quite an ecumenical life, it seems.  Written by a Jesuit, passed along by a Reform rabbi, and now picked up and republished by a Presbyterian.

Here it is, a very unauthorized translation of Luke 5:17-26.  Let those who have ears to hear, listen:

The Lazy Paralytic

1. When Jesus returned to Capernaum after some days, it was reported that he was at his home. 2. So many gathered around that there was no longer room for them, not even in front of the door; and he was speaking the word to them. 3. Then some people came, bringing to him a paralyzed man, carried by four of them.  4. And when they could not bring him to Jesus because of the crowd, they removed the roof above him; and after having dug through it, they let down the mat on which the paralytic lay. 5. When Jesus saw this he grew angry, "Why did you wreck my roof?  Do you have any idea how much that cost to install?  Do you know how many tables and chairs I had to make in my carpentry shop to pay for that roof?  The reeds alone cost five talents.  I had them carted in from Bethany."  6. The disciples had never seen Jesus so angry about his possessions.  He continued, "This house is my life.  And the roof is the best part."  The disciples fell silent.   7. "It's bad enough that you trash my private property, now you want me to heal you?" said Jesus, "And did you not see the stone walls around this house?"  "Yes," said the man's friends.  "Are these not the stone walls common to the towns and villages of Galilee?"  8. "No," Jesus answered.  "This is a gated community.  How did you get in?"  The man's friends grew silent.  9. Then Jesus turned and said to the paralytic, "Besides, can't you take care of your own health problems?  I'm sure that your family can care for you, or maybe the synagogue can help out."  10. "No, Lord," answered the man's friends.  "There is no one.  His injuries are too severe.  To whom else can we go?"  11. "Well, not me," said Jesus.  "What would happen if I provided access to free health care for everyone?  That would mean that people would not only get lazy and entitled, but they would take advantage of the system.  12. Besides, look at me: I'm healthy. And you know why?  Because I worked hard for my money, and took care of myself."  The paralyzed man then grew sad and he addressed Jesus.  "But I did work, Lord," said the paralytic.  "Until an accident rendered me paralyzed."  "Yes," said the man's friends. "He worked very hard."  13. "Well," said Jesus, "That's just part of life, isn't it?"  "Then what am I to do, Lord?" said the paralytic.  "I don't know.  Why don't you sell your mat?"  14. All in the crowd then grew sad.  "Actually, you know what you can do?" said Jesus. "You can reimburse me for my roof.  Or I'll sue you." And all were amazed.  15. "We have never seen anything like this," said the crowd.

August 21, 2012 – Our Hidden 30% Tax

Here are a couple of figures related to our dysfunctional healthcare system that made me sit up and take notice, when I saw them recently. Both are mentioned in the short video below (sorry for the annoying commercial that precedes it, but that’s what you get with CNN).




The first statistic is that 137,000 Americans died over a 7-year period due to lack of insurance.

I've known some of those people. I’ve heard their firsthand stories in the course of my ministry: people who delayed getting medical treatment because they were uninsured, only to find out that – once they either got insurance, or pain finally drove them into the emergency room – it was too late, and the doctors could do little for them. These are heartbreaking stories, especially when you’re looking into the faces of the people telling them, as I have done.

Lack of insurance can literally be a matter of life and death.

Actually, I think that 137,000 figure is probably low.  Lots of people are filled with shame about their uninsured status, and hesitate to speak of it, even to a pollster promising anonymity. Some of these premature deaths-by-insurance (or lack of it) no one will ever know about.

Second is the statistic that we have a de facto 30% tax on every healthcare dollar spent in the U.S.

“What kind of a crazy tax is that?” you may ask. “Healthcare is expensive enough.  That’s one tax we’ve got to dump right away!”

It’s not so simple as that.  This is not the sort of tax you can complain to your Senators and Representative about, asking for a repeal.  It’s the largely unnecessary administrative costs related to health-insurance coverage and billing.

We’ve got a massive industry in this country that siphons money out of the healthcare system for private gain. These are very large, publicly-traded companies, whose executives earn multi-million dollar bonuses and that make huge campaign contributions to politicians and Super PACs. Not all of that 30% is shareholder profit, to be sure.  Most of it is the “overhead” cost of a bloated industry that exists for one purpose only: to allow those profits to be earned.

Countries with single-payer healthcare systems – that’s virtually every other developed country in the world, except for ours, as you’ll see from the World Health Organization statistics in the chart below  – avoid most of this 30% “tax,” simply by eliminating medical billing altogether and picking up the tab for all medical care. We're not exactly getting good value for our money, according to several significant benchmarks:

Of course, as the video makes clear, real taxes would have to be increased to pay for the somewhat lower actual cost – as opposed to the insurance-inflated cost – of medical services delivered to everyone. But at least these new taxes would pay for something real and useful, and not simply subsidize an industry that doesn’t actually produce anything.

The current presidential-election debate is cast in terms of “Obamacare” vs. free-market care. What’s seldom mentioned is that Obamacare is a watered-down compromise (based, ironically, on the system Governor Romney established in Massachusetts, although he furiously denies it).  Obamacare still includes the wasteful 30% “tax,” because it continues to protect and coddle private insurers.

Obamacare is a weak political compromise, the only thing the President and his supporters could sell to the few members of the obstructionist opposition party willing to reach across the aisle. Although Obamacare shakes up the inner machinery of the present medical-insurance system a good bit, it doesn’t tinker with the feature that allows all those for-profit companies to tap into the flow of dollars and siphon off one out of every three, for their operating expenses and profits.  A true single-payer system – one that would begin with the relatively simple reform of extending Medicare to everyone – isn’t even on the table in this election campaign.

“But we must have competition!” cry the free-marketeers. “Only competition can keep costs down!”

Oh, really?  Enough to offset the cost of the one-out-of-every-three healthcare dollars presently circling the drain?

Those are the costs we need to eliminate.

“But that’s socialism!” cry the wild-eyed Tea Partiers.

OK, by some definitions of the word - but not most - it is.  But no more than Medicare is socialism. Or Social Security. Or taxpayer-funded police and fire departments, or just about any other government service you’d care to name. I don’t think anyone but the lunatic fringe has the slightest fear that government-funded services such as these shove us onto some imagined slippery slope that ends up with jackbooted soldiers parading before the Capitol and brainwashed schoolchildren singing Marxist labor anthems. That hasn't happened in Britain, or France, or Australia - or Canada, for crying out loud! So, why should taxpayer-funded medical care be any different here?

Every other developed nation in the world looks on, dumbfounded, unable to figure out why the United States of America allows such blatant waste to continue – and why we allow so many of our citizens to die unnecessarily.

July 1, 2012 - A Tale from the Insurance Wars

Just thought I'd pass along this little item someone sent me on Facebook, which speaks for itself:

"This is my duaghter JoJo. United Health Care dropped her from my group plan in 2009 and gave us no reason. That same year the CEO of UHC-Group made $770,000,000. It would take the average family physician 4,400 years to make the same amount.


Part 1 of "Obama Care" in 2010 saved my daughter's life. It made it illegal for insurance companies to drop people for no reason. She got the brain surgery she needed. United Health Care was ultimately fined $10,000,000....


Yes we can..."

I don't know anything about that CEO who accepted such obscenely large compensation, nor how he sleeps at night. If you met him on a golf course, he'd probably be a likable person. Somehow he must manage to compartmentalize this stuff in his mind, so he doesn't have to face the twisted, self-serving ethics that are deeply embedded in his company's corporate culture.

It's not just an isolated case of corporate wrongdoing. The UHC-Group compensation case may have been the most egregious example of runaway executive compensation in the healthcare industry, but there are plenty more stories like it.  It's a systemic issue. And it's the system that needs to be fixed.

As the people of our nation rally the political will to do that, personal stories like this one help.

June 4, 2012 – The High Cost of Dying

An article in the June 4 & 11 issue of Newsweek lays it on the line, as far as the high cost of medical treatment in this country is concerned.  Case in point: Terence Foley, who died in December of 2007 after years of treatment for a rare kidney cancer. His wife, Amanda Bennett, tells their story in an article excerpted from her new book, The Cost of Hope: A Memoir (Random House, 2012).

Simply as an exercise in accounting, the figures for Amanda’s husband’s final month or so of treatment are jaw-dropping: $33,382 for one hospital stay, $43,711 for the next, and $14,022 for his final three days of life.

Amanda doesn’t begrudge the more than 90 grand her family and their medical insurer laid out in order to buy her husband a few more weeks, even though his quality of life was poor. She says she would have given approval for even more spending, had someone convinced her it would bring any real hope of achieving a remission or cure.

But that’s the root of the problem.  The higher you climb up the pyramid of the medical-treatment establishment and into the rarefied air of physician egos - not to mention the threat of legal liability - the more reluctant many specialists are to admit that any of their patients are likely to die on their watch.  They find it easier to simply order another MRI and hope it reveals something different than the last one did.

In a related video on the Newsweek/Daily Beast website, Amanda passes on a bit of practical wisdom one of her husband’s doctors shared with her, in a rare moment of candor: “We’ve got a terrific medical establishment. We do great things.  But we’ve never made anybody immortal.”



Several years after Terence’s death, Amanda gathered up her late husband’s medical records as she began researching her book.  As she commenced reading, she became aware of something no one had noticed at the time.  Everyone on Terence’s medical team knew his chances of survival were slim, and getting slimmer.  Yet, no one had been perceptive – nay, courageous – enough to blow the whistle and say, “Wait a minute, I think some of this may be getting excessive.”

In Amanda’s words: “I didn’t realize that they had prodded and X-rayed and scanned and tested him even though they thought he was dying.  Soon.  The discharge record after his four-day stay expresses regret that they could offer no more than ‘comfort care.’”

But still, during those days the tests and procedures just kept coming.

It’s true, we’ve got an amazing medical system in this country – especially in teaching hospitals like the University of Pennsylvania Medical Center, where Terence received his care.  I feel the same way about Memorial Sloan-Kettering, and even – for more routine needs – about our excellent community hospital, Ocean Medical Center. The problem is, in whatever hospital, once a crowd of specialists starts milling around a patient, each putting shoulder to the wheel of the aggressive-treatment juggernaut, it’s very difficult to stop it, nor even to slow its progress enough to assess whether every possible treatment is a good idea.

Amanda found that, in a major medical center like UPenn, it can be hard to simply keep track of all the people who are making medical decisions: “Over the stay, at least 29 professionals – nurses, physical therapists, a nutritionist, and nine M.D.s – attended to his needs.  We had never met any of them before, and I don’t recall meeting the majority of them even then.”

Typically, the specialists deal with only one tiny segment of the patient’s medical issues, reserving judgment on other problems that belong to a colleague’s turf.  OK, maybe a cardiologist wants to order a CT scan to take another look at how the heart’s doing – but is that costly scan really better than less-expensive diagnostic methods, if the patient’s kidneys are about to shut down for good?  Amanda began to suspect she was “the only person seeing Terence as a whole person instead of just a single piece of his body that needed attention.”

Moreover, Amanda found that most doctors have only the sketchiest awareness of how much certain tests and procedures are going to cost.  Medical insurance in America has evolved into such byzantine complexity that another sort of specialist – an insurance expert – is required to run the numbers.  This rarely happens until after the treatment has been ordered and completed. The consequence?  It’s all but impossible for patients and their families to make intelligent decisions, in real time, based on what certain treatments are going to cost.  Heck, the doctors themselves don’t even know.

It’s no wonder they don’t, because every insurance company is allowed to function like a vacationer shopping for a weekend hotel deal on Priceline.  Each company’s got their own William Shatner “Negotiator” character, whose job is to intimidate doctors and hospitals into allowing the insurance company’s executives to name their own price.  The result?  In going over her late husband’s medical records, Amanda and her researcher found that “the same CT scan, in the same hospital, cost $776 or $2,586, depending on which insurance company was paying.”

Is this free enterprise?  Sounds more like piracy to me.  (Although, in fairness, maybe that’s too strong a term.  “Privateers” is more like it.  Students of naval history know the privateers functioned more or less like pirates, except for the fact that their captains carried government-issued Letters of Marque allowing them to “name their own price” for captured enemy shipping.  Arrrgh, mateys, haul down the Jolly Roger and raise the comely pennant o’ Blue Cross/Blue Shield!)

In the overcrowded insurance marketplace, our medical-billing machinery has achieved such a level of complexity that it’s become a major cost center in and of itself.  Amanda cites a figure of 31% for the average cost of paperwork, much of it related to billing.  That’s nearly one-third of every healthcare dollar.  Granted, some paperwork will always be necessary, but even so, a shockingly high portion of every health-care dollar is devoted to paying for the insurance companies’ overhead, just so we can fool ourselves into thinking we’re maintaining free enterprise in an open marketplace.

Does preserving competition in the world of medical insurance result in such massive savings that they offset this absurdly-inflated cost of paperwork?  Not a chance.  But few people ever think about that.  We’re paying to solve one problem, only to create another that’s costing us even more.

I know from personal experience (based on the years we lived in Britain) that a single-payer system like Britain’s National Health System doesn’t have that problem.  That’s because there’s no patient billing, no multiple mailings, no collections. The government gets the bill, not the patient.  Think of it: No patient billing. Just imagine how much that would save us in paperwork!

But, no, we couldn’t do that.  Not here in America.  That would be – cover your tender ears, now, children, because I’m about to utter an ugly word –  “socialism.”

(Of course, everyone in America who's older than their mid-sixties already benefits from a government-funded medical-insurance system – Medicare.  I suppose it must stop being socialism, though, once the recipient passes the golden age of Medicare eligibility.)

Amanda points out that, in the last Presidential election, Sarah Palin stirred up a tempest of outrage with her dire warnings about “death panels” – which were, in fact, merely Medicare’s proposal that the confusing, ever-shifting constellation of medical professionals treating seriously-ill patients sit down and talk with each other every once in a while.  Amanda has a very different take on it: “The scary phrase suggested a harsh group of executioners ready to pull the plug on Granny to save money. I began to think of it in a different way: wouldn’t it have been great, as death became inevitable, to have had some help figuring this all out?”

She ends her article by observing that the cumulative, seven-year bill for her husband’s care was a whopping $618,646.  While she admits she honestly doesn’t know – had they realized the true cost – how much of his treatment they would have declined, she does know this about the kind of person her husband was: “I believe he would have liked the chance to play a more active role in how we spent enough money to vaccinate 600,000 children in the developing world.”

Were I in his place, I think I would, too.

December 30, 2011 - More on Out-of-Reach Zevalin

Dr. Vance Esler, oncologist and blogger, posted a comment on my last entry that's worth my cutting and pasting it here:

"Carl, it is an oversimplification to say that oncologists don't refer patients for Bexxar or Zevalin because it isn't in their own personal arsenal. In fact, a fair amount of the treatment is done by the medical oncologists.

Every day medical oncologists take financial risks. We buy and administer expensive drugs, hoping that the insurance carriers will reimburse us enough to cover the costs. We are used to this.

But Bexxar and Zevalin are administered by nuclear medicine physicians, and they are NOT used to taking the financial risks. Furthermore, they don't know how to bill for such drugs, and they are afraid to try.

So no one in our 600,000 person service area offers the treatments. The medical oncologists are not licensed to dispense the drugs, and the people who are licensed are afraid to take the financial risks.

Thus, the medical oncologists are forced to look for alternatives."

Interesting perspective Vance has: that it tends to be the nuclear-medicine doctors who aren't up to speed on administering radio-immunotherapy agents like Bexxar and Zevalin, and are therefore more likely than oncologists to be at the root of the problems these effective medications have had in making their way into the marketplace.  Vance knows a lot more about this than me, so I'm happy to say that I stand corrected.

I find it pretty shocking that his 600,000-person service area in Texas doesn't have a single qualified specialist who's stepped up to the plate to offer these treatments to patients who could use them.

Still, to me this points out, once again, the shortcomings of our free-market, entrepreneurial approach to healthcare funding, that puts doctors in the position of having to assume unacceptable financial risks in order to deliver proven, effective treatments to their patients.  Those who are determined to keep the government out of healthcare funding are continually spouting the line that, left alone, the invisible hand of the market will eventually even everything out.  This is a clear example of just how false such economic dogma is, when applied to cancer treatments.

September 28, 2011 – The Morality of Health Insurance

Alarming statistics this week from the world of health-care financing: a new study by the non-profit Kaiser Family Foundation has revealed that the cost of medical insurance has been rising at its fastest rate in recent memory.  According to a New York Times article on the study, “the average annual premium for family coverage through an employer reached $15,073 in 2011, an increase of 9 percent over the previous year.”

In this economy?  With so many people unemployed or underemployed?

This rise is, of course, much higher than the inflation rate.  That’s nothing new.  The cost of health care has been rising faster than inflation for quite some time now.  The Times article continues: “Over all, the cost of family coverage has about doubled since 2001, when premiums averaged $7,061, compared with a 34 percent gain in wages over the same period.”

Did you catch that?  Over the past decade, the cost of medical insurance has grown twice as high, but the average gain in wages is only 34%.  That’s a huge discrepancy.  Lots of people have been forced to let their medical insurance go, but those employees who have managed to hang onto it have surely had to make savage cuts in the family budget in order to do so.

Remember, those statistics apply to group-rate insurance provided through employers.  Self-employed people, who lack the negotiating clout big corporations have, are in an even worse position.

Now, hold that thought, and recall that incident from the September 12 Republican Presidential candidates’ debate, when the moderator, Wolf Blitzer, posed a case-study question to libertarian Ron Paul.  What if a healthy 30-year-old decides he can’t afford health-insurance premiums, falls ill, and goes into a coma?  Who’s going to pay for his care?

Paul’s answer was, it’s not the government’s job.  That approach he branded “welfarism and socialism.”  To the delight – and applause – of his fans, he went on: “That’s what freedom is all about, taking your own risks.”

“But Congressman,” Blitzer probed further, “are you saying that society should just let him die?”

The TV soundtrack records several loud voices in the audience shouting, “Yes!”

Paul may have been energized by the cheers, but he wasn’t so stupid as to echo their sentiment.  “No,” he replied.  “I practiced medicine before we had Medicaid, in the early 1960s, when I got out of medical school. I practiced at Santa Rosa Hospital in San Antonio, and the churches took care of them. We never turned anybody away from the hospitals.”

More applause.

“And we’ve given up on this whole concept that we might take care of ourselves and assume responsibility for ourselves. Our neighbors, our friends, our churches would do it. This whole idea, that’s the reason the cost is so high. The cost is so high because they dump it on the government, it becomes a bureaucracy.”

Jon Stewart, in his September 26 Daily Show interview with Ron Paul, lauded him as one of the few Presidential candidates not guilty of flip-flopping, who’s been utterly consistent over time.  That may be so, but Mr. Paul’s remarks reveal he’s also living in some kind of alternative universe and is utterly out of touch with reality.  He expects the churches to pick up the slack for people like the hypothetical uninsured 30-year-old in a coma?  The churches?  Why, the entire annual budget of the 500-member church I serve would only cover a few months of intensive care for that comatose 30-year-old – and that would only be possible if the church would lay off all its ministers and other staff, cease giving to mission causes, disconnect the utilities and close its doors.

Mr. Paul – himself a medical doctor – is living in an imaginary world, in which medical care is delivered by the beloved family doctor who comes to visit patients in their homes, accurately diagnoses their ailments solely by poking and prodding and without resorting to diagnostic scans, cheerfully treats the poor in exchange for in-kind gifts of agricultural produce and livestock, and somehow manages to remain master of the entire vast library of medical literature.

Surely there’s a lot of waste and fraud in the medical-insurance world – including the insurance companies themselves, who do nothing for patient care but push paper and skim off profits for their shareholders – but there are some good reasons why the cost of insurance has risen so much.  It’s because the actual cost of medical care has risen, as well.  High-tech scans like the ones I get every few months are wonderful technologies, but they cost lots of money.  Hospitals pay millions for those machines, then spend years paying them off.  New-generation drugs, like the Rituxan that may have saved my life, do amazing things, but they cost millions to research and produce – and not all of those million-dollar babies make it through the clinical-trial process that declares them safe and effective to use.

We’re living in a different world than the world of Mr. Paul’s childhood, of his homespun stories of working in the local pharmacy as a kid, going off to medical school and hanging out his M.D.’s shingle.  Maybe back then, on those rare occasions when kindly old Dr. Feelgood had to refer a patient to the university medical center, the churches of the town could get together and hold bake sales to help pay their neighbor’s bills.  But those days are long gone.

A retired friend and former colleague of mine, Gene Straatmeyer, addresses this topic in a recent blog posting. He reminisces about the old days growing up in the upper-Midwest farm country,
about how he went largely without medical treatment as a kid despite suffering from asthma, how both his father and his father-in-law dropped dead from heart attacks at relatively young ages. “I remember,” he continues, “when an appendectomy was major surgery. I remember a cousin whose limbs were gone by his early 30's from diabetes. I remember when 70 was a ripe old age....”

“Right now I feel helpless,” Gene admits, “in the face of what may be coming. So do many others. I certainly hope and pray my grandchildren and great grandchildren aren’t tossed back to the time of my childhood because medical care will not be affordable for them or their children.”

Yet, that’s precisely what Mr. Paul, and many politicians like him, are calling for.  When leaders like him admit that some sick people are just going to have to die because they can’t afford medical insurance, and debate audiences gleefully applaud such a callous remark, it raises questions of morality that have so far been left out of the contentious national debate.

We’ve made ourselves such individualists in recent decades, here in America, that we’re losing the last vestiges of the social contract, discarding any idea at all that we have a corporate responsibility to care for one another.  That's not "welfarism or socialism."  It's simple Americanism, merely the 21st-century incarnation of the community values that Mr. Paul and his ilk pretend to admire, even as they're trampling all over them.  The very doctrine of individualism – that seems to have become an article of faith for some people – is elevated to such a height in their minds that it trumps all other questions of morality, including even the explicit teachings of Jesus, the prophets of Israel and other great religious leaders, who declare over and over again that caring for the poor is part of our job as a society.

Mr. Paul’s response is to throw such questions of morality back on the churches, saying in effect, “You think we have a community responsibility to care for the poor here in this land?  OK, if you feel that way, then you do it!”

Would that we could.  But medical care just isn’t that inexpensive anymore, nor is the community’s financial support of the churches strong enough to make that happen.

Guess that comatose 30-year-old’s ventilator has just gotta be unplugged.  Hard luck, fella.  You gambled and lost.

If it is unplugged, it will be Mr. Paul and his immoral admirers who will be left holding the cord.

Universal, government-provided health may not be the easiest option before us.  Yet, the more I hear of this situation, the more I become convinced that it’s the only moral option.

July 11, 2011 – A No-Brainer

On Friday I had a routine follow-up appointment with Dr. Lerner. It had already been rescheduled once, because of difficulties in getting my routine CT scan approved by my insurance company’s pre-screening agency, Care Allies, acting as an agent for the Presbyterian Church’s Board of Pensions. Well, the delay in approval turned into an outright denial. When I asked if I should postpone my appointment yet again, Dr. Lerner sent word through his office staff that he still wanted to meet with me, even without the scan results that were to have been the focus of our conversation.

When he came into the examining-room, Dr. Lerner explained that he had just called Care Allies on my behalf, and had spoken with the doctor who had denied his request for the scan. It appears that doctor was baffled by the fact that I would be having scans of my neck, chest, abdomen and groin after a thyroidectomy.

Dr. Lerner explained to his counterpart that the scans are not for my thyroid cancer, but for my lymphoma, which is an ongoing, chronic situation that needs to be carefully monitored.

“Oh,” the insurance company doctor harrumphed, “that wasn’t made clear to me.”

“Well, it was right there on the script I wrote, authorizing the scan, which was sent to you. What could be clearer than that? As far as I’m concerned, approval for this sort of scan ought to be a no-brainer.”

“Well, there are many factors that have to be considered in making this sort of decision...”

“The reason I say it’s a no-brainer is because if you don’t approve it, people could assume that you have no brains.”

I doubt the Care Allies doctor was amused. But he did issue the approval, and I expect to go for the CT scan in a week or so. That will be a couple of months late.

Good old Dr. Lerner. He tells it like it is.

I told him I felt bad that he had to spend so much time on the phone chasing down and disproving this frivolous denial of coverage.

He responded, with a sigh, that it’s just part of his job these days. He strongly suspects that insurance companies routinely disapprove a certain percentage of these requests, for whatever reason they can justify. They do this, knowing full well they’ll eventually grant approval, in most cases, on appeal. Along the way, he continued, some less persistent people may grow weary and give up. That’s what the insurance companies want. It’s not good for those patients’ health, but it saves them money.

I suppose, also, that these doctors on the insurance companies’ payroll have to fill a certain quota of denials, to justify their jobs. My case will probably be counted, somewhere on this doctor’s personnel evaluation, as one of a number of appeals he generated – which, in the eyes of the insurance company’s bookkeepers, shows he’s looking out for the company’s interests.

My insurance company is the Board of Pensions of the Presbyterian Church (U.S.A.) – a non-profit that’s nominally under the oversight of the denomination, but acts quasi-independently, for the benefit of plan members like me. The Board hires Highmark Blue Cross/Blue Shield to manage its medical-benefits program, and Care Allies – a contractor specializing in cost-control – comes in there somehow as the pre-screener of certain costly medical procedures. How involved Highmark is in recommending Care Allies to the Board, I couldn’t say.

I think well of the Board of Pensions. Based on the individuals I know who have served on the Board, I believe their highest priority truly is the welfare of plan members. Yet, when decision-making is outsourced to contractors like Highmark (ostensibly a non-profit, but with a big-business corporate culture) or Care Allies (a for-profit consulting firm), something of that charitable concern is undoubtedly lost.

What happened to me is no different than what happens to countless other people around the country every day. Add this incident to so many others like it, and the amount of wasted time, wasted effort, wasted expertise, wasted money is simply staggering.

Any healthcare system that involves a multitude of private insurance companies - and their contractors - competing for profits will continue to generate scenarios like this. I’m lucky to have a concerned, experienced doctor who’s willing to go to bat on my behalf against corporate greed. Not every patient does.

Universal, single-payer healthcare can’t come soon enough.

I’m No Healthcare Consumer

Yesterday's New York Times contained a very sensible column by Paul Krugman. He asks a question that’s really rather obvious – so obvious, in light of our national healthcare-funding woes, it’s escaped the attention of a great many who ought to be asking it:

“Here's my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as "consumers"? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car - and their only complaint is that it isn't commercial enough.

What has gone wrong with us?”
– Paul Krugman, “Patients are not Consumers,” New York Times, April 21, 2011.

This is more than a mere quality-of-life question. It’s got big implications for economics, as we continue to struggle through our national healthcare-funding debate:

“Consumer-based" medicine has been a bust everywhere it has been tried. To take the most directly relevant example, Medicare Advantage, which was originally called Medicare + Choice, was supposed to save money; it ended up costing substantially more than traditional Medicare. America has the most ‘consumer-driven’ health care system in the advanced world. It also has by far the highest costs yet provides a quality of care no better than far cheaper systems in other countries.”

The problem is that there are an awful lot of people out there who profess an unquestioning, fundamentalist faith in what economist Adam Smith called, way back in 1759, “the invisible hand” of the market. For him, it was probably just a metaphor, but for his latter-day followers, it’s become a virtual deification of free enterprise. Attached to that invisible hand, in their fantastic imaginings, is a new Olympian god, who effortless regulates human affairs through astute transfers of capital.

That would be of little significance, were not living, breathing human beings mightily affected by such transfers.

That makes it, as Krugman correctly points out, a moral issue.

September 9, 2010 - Defensive Medicine

The headline reads, "Cost of Medical Malpractice Tops $55 Billion a Year in U.S." But it's misleading.

It's not the cost of malpractice that's the problem. It's the cost of the medical world's hyper-defensiveness in trying to stave off lawsuits.

The troubling figure, according to a recent, comprehensive study described in the article, is: 2.4.

That's 2.4 per cent of annual healthcare spending that's related to malpractice, including medical practitioners defending themselves against potential lawsuits.

Think of it - you write a check to your doctor for a $35 copay. No matter how expert your doctor is, no matter how meticulous he or she may be about leaving no medical stone unturned in diagnosis or treatment, 84 cents of what you're paying that day goes to cover the cost of other doctors who aren't so good at what they do.

Multiply that by every check written to every doctor and hospital around the country, and we're talking some really big money.

It's not so much the bad doctors out there who are the problem. Their numbers are very small. It's our fear of them that's the problem. It's a fear that leads even the best doctors to shell out big bucks for malpractice insurance, and that causes us to pay big bucks for marginally necessary tests.

They call it "defensive medicine," and it's costly indeed.

I hope the medical reform now working its way through our government includes some measures to reduce the adverse impact of this largely unreasoned fear.

It's a lot of money. It's not the whole answer to runaway medical costs in this country, by any means, but it's significant.

February 10, 2010 - Bean-Counter 1, Oncologist 0

Snowed-in today – or, to be more accurate at the moment, sleeted in. It’s a “wintry mix” out there – a real mess.

So, I have a little time to do a blog entry.

I just happened upon a link to a blog posting by a pediatric oncologist, David Loeb, who works at Johns Hopkins. It’s called “Why David Hates Health Insurance Companies.” Here’s some of what he writes about one of his patients, a young woman diagnosed with liver sarcoma:

“My patient will need a chemotherapy drug called ifosfamide to treat her tumor. This drug has a significant risk of infertility associated with it. After consultation with a reproductive endocrinologist, we decided that the best way to try to protect her fertility would be to use a drug called Lupron. Unfortunately, Lupron is expensive, so it requires prior authorization from the insurance company. I just received an email from our clinic coordinator that read, in part, ‘It won't be covered if it's for fertility reason (per her case manager).’”

“So... I have some choices to make. Do I lie and say the drug is being prescribed for another indication? Do I tell the truth and risk the family having to pay $750 per dose out of their own pockets? Or do I choose a different drug, one that will not work as well, and know that I am not providing optimal care for this young woman, and am increasing her risk of infertility?”

The rest of the blog entry indicates how hard this doctor has been working, documenting all the complexities of the case, emailing copies of medical-journal articles to insurance-company drones – trying to convince them to make an exception. Bravo to Doctor David for going the extra mile for his patient. I hope he gets someone to listen to him.

Who can put a price on a young woman’s fertility? The very notion of it boggles the mind. Yet, this is the Godlike power our broken health-care system places in the hands of insurance-company functionaries.

Think about it: an insurance-company clerk at a computer terminal vs. an oncology specialist at Johns Hopkins. The clerk is supposedly advised by a consulting physician – who’s on the payroll of the company and who receives bonuses for declining claims – who may not even be an oncologist. And who’s this “case manager,” anyway? My case manager, when I had one, was a nurse. A very capable and helpful person, but certainly not the equal of a Hopkins oncologist when comes to making treatment decisions.

This is the nitty-gritty of our present healthcare mess. This is where it gets up-close and personal. Those rageaholics at Tea Party rallies, ranting on about mythical “socialized medicine,” are perpetuating a system that forces highly-trained specialists to take precious time away from caring for patients to educate insurance-company bean-counters.

It’s not that this is an occasional aberration. This sort of Kafkaesque scene is replayed day in and day out, in hospitals across this land. It’s why our healthcare dollars buy so little patient care.

In a comment on Dr. Loeb's posting, his clinic coordinator chimes in:

"Why do physicians have to charge a high rate for service? They have to pay for me! On a daily basis, I have at least 20 cases on my desk to try and convince an insurance company to approve treatment and/or medications that will improve the patient's quality of life. This is distressing for the unfortunate loved ones who have to deal with the sometimes long wait. As if a child with cancer is not enough to deal with!"

We all know it’s a wasteful, inefficient system. Yet, there are also hidden costs, like this doctor’s and this clinic coordinator's time, that don’t show up on the usual balance sheets.

I wish every obstructionist Senator could read Dr. David’s blog entry.

This is our national shame.

October 19, 2009 - The Gloves Are Off

Today, following a Facebook link, I come across this video of the President speaking on health care reform. The gloves are off. “No drama” Obama is stepping up at last, to identify the heart of the problem with our health-care funding system. It’s the insurance companies:



The insurance companies are richer than rich. They’re powerful. They channel huge amounts of lobbying money and campaign contributions to Capitol Hill.

There’s one thing they can’t change or influence, though. As the President says in this message, a large majority of the American people is in favor of change, and elected him in order to bring it about.

The coming weeks and months will tell whether America is still a democracy, or whether it has become a plutocracy – a system in which money talks so loudly that even our democratically-elected representatives dance to its command.

Keep at it, Mr. President. A great many of us out here are behind you all the way.

September 18, 2009 - Worse than Drunk Driving and Homicide Combined

It's worse than drunk driving.

It's worse than homicide.

It's worse than drunk driving and homicide combined.

What is it that causes more Americans to die each year than either of these two fearful scourges?

Lack of medical insurance.

So says a new study released by Harvard Medical School. If these numbers are correct - and with a Harvard cachet, most would conclude they probably are - our country's healthcare crisis is worse than nearly all of us imagined.

It's a stark number: 45,000 deaths a year. That's how many American deaths the Harvard experts attribute to lack of medical insurance. One death every 12 minutes.

About a year ago, one of our daughter's high-school classmates was struck and nearly killed by a pickup truck, while crossing the street in a designated crosswalk. She survived, but with brain damage, blindness in one eye and mobility issues that could result in lifelong disability (we continue to be hopeful for recovery). A friend who was walking beside her was knocked off balance but escaped virtually unscathed. The truck's driver - who tried to flee the scene but was later apprehended - was reportedly very, very drunk.

The community was outraged. Their outreach to the family, both in terms of fund-raising for medical expenses and simple human kindness, has been awe-inspiring. (The family does have medical insurance, by the way; it just wasn't enough. What private-insurance policy would be, for such devastatingly high bills?)

Yet, where is the outrage when another family's house goes into foreclosure because of unpaid medical bills due to lack of insurance - or even due to a policy that looked good on paper but came up lacking, once Big Insurance's casuistic cost-cutters had sharpened their knives?

Where is the outrage when a young mother, just told she has Stage IV breast cancer, admits she felt several lumps months before, but delayed going to the doctor while she was between jobs? She waited too long. The cancer had advanced.

She knew, she confided in me later, that if she received a diagnosis while still unemployed and without insurance, her treatment for a pre-existing condition would probably never be funded. Never.

Knowing breast-cancer treatment can drag on intermittently for years, she did a grim mental calculation and concluded it was worth a roll of the dice. She lost. Yet, why should a human being, a child of God, ever have to roll such dice at all?

These aren't mere statistics. These are people I know personally. What's more, such stories could belong to any of us.

Any of us. (Unless we happen to be super-rich.)

I'm not an activist by temperament. I have political convictions, but on most issues I try to keep them to myself, not wanting to limit the reach of my ministry. Yet, I'm a cancer survivor who's looked into many a careworn face on the far side of a doctor's waiting room. I'm also a pastor who's held many whispered consultations with family members at the foot of hospital beds. I'm aware of how huge this problem is, how deep its personal bite can be. The Harvard statistics confirm what I've long known, on a gut level, to be true. Some - maybe even some of my parishioners - may wish I'd remain above the political fray on this issue. But, I can't. Lives are literally at stake.

It's not that those who oppose increased government involvement in healthcare funding are bad people. They have their own convictions, their own ideologies. Some honestly believe, as a matter of principle, that the private sector can do medical insurance better than the government can (despite compelling indications that Medicare beats the average private-insurance policy hands down, on most metrics). Yet, when it comes to the large number of Americans who have reasonably good insurance and who've never faced a major health crisis, they have no idea. They simply have no idea how close they or their loved ones are to the abyss. Each and every day.

As my daughter's friend has discovered, it's as close as one second in time when stepping out into a crosswalk.

This morning I was reading an eye-opening article, "No Country for Sick Men," in the latest issue of Newsweek. The author, T.R. Reid, makes a number of telling comments:

"'You have to understand something basic about Canadians. Canadians don't mind waiting for elective care all that much, so long as the rich Canadian and the poor Canadian have to wait about the same amount of time.'

In that last sentence, [Saskatchewan Medical Society official Marcus] Davies set forth the national ethic of health care in his country: medicine is not a commodity to be sold to the highest bidder, but a right that must be distributed equitably to one and all. In short, the Canadians have built a health-care system that neatly fits the Canadian character: ferociously egalitarian, but thrifty at the same time."...

(It's a question of fundamental values, in other words.)

"But the most important influence of national culture can be seen in the most basic question facing any country's health-care system: who is covered?

On this fundamental issue, the United States is the odd man out among the world's advanced, free-market democracies. All the other industrialized democracies guarantee health care for everybody - young or old, sick or well, rich or poor, native or immigrant. The U.S.A., the world's richest and most powerful nation, is the only advanced country that has never made a commitment to provide medical care to everyone who needs it."...

(Are we really so narcissistic in this country that we think we can be so right, and so many other nations so wrong?)

"Those Americans who die or go broke because they happened to get sick represent a basic moral decision our country has made. All the other rich countries have made a different decision: they cover everybody. A French physician, Dr. Valerie Newman, explained it this way: 'You Americans say that everybody is equal,' she said. 'But this is not so. Some are beautiful, some aren't. Some are brilliant, some aren't. But when we get sick - then, yes: everybody is equal. That is something we can deal with on an equal basis. This rule seems so basic to the French: we should all have the same access to care when it comes to life and death.'"...

(Isn't that just common sense?)

"That principle seems so obvious to people in Europe, Canada, and the East Asian democracies that health officials asked me over and over to explain why it isn't obvious to Americans as well. 'The formula is so simple: health care for everybody, paid for by everybody,' a deputy health minister in Sweden told me. 'You Americans are so clever. Why haven't you figured that out?'"...

(Oh, to see ourselves as others see us!)

"In the U.S.... some people have access to just about everything doctors and hospitals can provide. But others can't even get in the door (until they are sick enough to need emergency care). That amounts to rationing care by wealth. This seems natural to Americans; to the rest of the developed world, it looks immoral."

Yes, there are legal, economic and political aspects to America's bitter healthcare debate. Yet, I'm becoming increasingly convinced that the line of argument that dwarfs all these others is the moral one.

As a preacher, that's my department. And that's why I refuse to keep silent.