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.

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.

Not the Best Health-Care System

A few minutes ago, I happened to catch a few minutes of news coverage from the U.S. House of Representatives. Members of Congress were taking turns reading from the U.S. Constitution. This was the first time in history, the newscasters informed us, that the entire Constitution has been read aloud on the floor of Congress.

It took me back to my old Sunday School days. Our teacher used to ask us kids to take turns reading through a passage of scripture aloud, with each person reading a single verse.

Have we come to this? I know remarks have been made about the Tea Party movement treating the U.S. Constitution as a fundamentalist might treat the King James Version of the Bible, but when I saw it in action just now, the effect was chilling. John Calvin called the human race "a perpetual factory of idols." It would seem we've found ourselves a new one.

The U.S. Constitution is a remarkable historical achievement, and a model for democracies the world over. It is worthy of our respect and honor. But, to treat it as holy writ? I think there's a reason why this is the first time in history this stunt has ever been pulled: because previous generations - including the framers of the Constitution themselves - had better sense. I can imagine Ben Franklin rolling over in his grave right about now.

One commentator has estimated the cost to taxpayers of this little publicity stunt at $1.1 million.

Let's see, now... what does this story remind me of? Could it be when, in Nehemiah 8, Ezra the scribe reads the law to the people of Israel, freshly returned from exile to a ruined Jerusalem? Isn't it just a wee bit of hyperbole to imply that a mid-term change of party leadership in one of the two houses of Congress is a parallel situation of nationwide repentance from apostasy?

"And Nehemiah, who was the governor, and Ezra the priest and scribe, and the Levites who taught the people said to all the people, 'This day is holy to the Lord your God; do not mourn or weep.' For all the people wept when they heard the words of the law." (Nehemiah 8:8)

Oh, pull-eaze!

What really concerned me, though, was to hear the new Speaker of the House, John Boehner, lambasting the recently-enacted healthcare reform legislation and vowing to repeal it. I don't recall him ever mentioning the words "healthcare reform" without prefixing it with "job-killing." I lost track of the number of times he said "job-killing healthcare reform."

Is that all they've got? Just take their talking-point and repeat it again and again, ad nauseam? I don't recall potential loss of jobs being a major debating point when the legislation was first passed. Why didn't the opposition make a point of it the first time? Even if a significant number of jobs were to be lost because of this legislation - seriously doubtful, but let's grant the point for a moment - is preserving a modest number of jobs worth it, if most of working America continues to be just one medical crisis away from destitution?

Come to think about it, in making the job-loss argument, isn't Mr. Boehner conceding that the healthcare-reform legislation is, in fact, creating a system that's more cost-efficient than the one we've presently got? Wouldn't the elimination of a limited number of administrative-support jobs be, sadly, necessary, in order to accomplish the financial efficiencies that everyone agrees must be the goal if healthcare is to become affordable again?

Mr. Boehner, by the way, is the same man who, in the midst of a debate on tobacco-growers' subsidies in 1995, personally distributed campaign-contribution checks from tobacco lobbyists to his fellow members of Congress on the House floor.

Yes, he did. On the House floor. (He later apologized for it, explaining that it wasn't technically against House rules, then led a campaign to reform the House rules to prohibit what he'd just done. To protect the country from people like himself, I suppose.)

Mr. Boehner went on to repeat another phrase endlessly: "the best healthcare system in the world" - as in "they are trying to take down the best healthcare system in the world."

Mr. Boehner can be admired, perhaps, for his patriotism, but it's blind patriotism when it ignores the facts. The last time the World Health Organization published a healthcare-ratings table of the nations of the world, in 2000, the United States ranked 37th. France was number 1 - something even the conservative magazine Business Week admitted, in 2007, is a pretty impressive achievement.

In claiming the U.S. healthcare SYSTEM is the world's best, our new Speaker of the House is at best mistaken, and at worst engaging in a baldfaced lie. Yes, the healthcare available to certain people in the United States, and to certain well-heeled foreign nationals who fly here for treatment, is among the world's best. Yes, our nation is at the forefront of medical research. But our healthcare system - the overall structure whereby healthcare is delivered to the citizenry at large - is costly, inefficient and just plain broken for huge numbers of sick people. Worst of all, the sicker you get, the more you pay.

(That, by the way, is one thing the author of the Business Week article cited above admires about the French system. In France, the sicker you get, the less you pay.)

I don't seriously think this move to repeal last fall's landmark healthcare bill will succeed. There are still enough votes in the Senate to protect it. Contrary to the anti-healthcare talking-points, a huge majority of the American people still favor it. This is mere political posturing, just as reading the Constitution aloud on the floor of the House is political posturing.

Yet, those of us who are concerned for the health of all Americans - not just the holders of Cadillac medical-insurance policies like members of Congress - ought not to be complacent. This move is a major threat to the health, happiness and survival of millions of hardworking people. It seeks to perpetuate a corrupt system whereby big-business interests siphon off billions of dollars in profits, while poor and middle-income people die unnecessary deaths.

Remember, this is the man who once handed out checks from tobacco lobbyists on the House floor. That shows whose side he's really on.

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.

August 3, 2010 - Clinging to the Tail of Possibility

On vacation in the Adirondacks, I read a remarkable article from the August 2 New Yorker magazine. I was tipped to the article by my brother, Jim – though I later learned from Claire that members of her hospice team have been passing it amongst themselves, causing lively discussion in their weekly staff meeting.

I think “Letting Go: What should medicine do when it can’t save your life,” by Atul Gawande, may set off at least as much debate as his June 1, 2009 article, “The Cost Conundrum: What a Texas town can teach us about health care.” (which I discussed in a July 20, 2009 blog entry, “Where Not to Get Sick.”)

Gawande is a general surgeon who practices at Boston’s Brigham and Women’s Hospital, and who teaches at Harvard Medical School. He’s operated on a lot of cancer patients. Some benefitted mightily from his expertise, and others’ last days would likely have been more tolerable without the invasive procedures. Yet, hindsight is always 20/02, and ahead of time it’s always a tough call.

It’s his physician’s perspective that leads Dr. Gawande to question the lack of agreed-upon procedures for end-of-life decision-making in America. For a country with some of the most advanced medical care in the world, our practices in this area are remarkably haphazard.

Gawande points out that the financial costs of successful cancer treatment can typically be graphed as a bell curve: there’s a steep climb from the time of diagnosis to a sort of plateau, as very expensive scans and treatments are deployed. Then, there’s a drop-off in costs as the patient recovers. In the case of patients whose treatment is unsuccessful, the frequent result is half a bell curve. We throw some very big money at solving problems that are – statistically speaking – unlikely to be solved, sending the line of the graph soaring upwards. Because it’s a human life at stake, doctors typically follow the lead of patients and their families, ordering such last-ditch treatments if that’s what they want. In many such cases, the patient dies anyway, often after many days, or even weeks, of intensive care. If the ICU stay is long, those days can end up costing as much as – sometimes even more than – the cancer treatment itself.

These are agonizingly difficult decisions, some of the toughest in medicine. When to pursue extraordinary, experimental treatment? When to throw in the towel and admit that maintaining a reasonable quality of life for the patient whose health is in a tailspin is more important than the increasingly quixotic search for a cure?

Gawande remarks that nearly all categories of dying patients and their families – with one exception – are ill-prepared to wrestle with such complex, emotionally fraught decisions. When, as too often happens, everyone’s energies are single-mindedly fixed on the search for a cure, doctors fail to raise the what-if question of death at all. It seems to them premature. Yet, when that likelihood suddenly looms large, and quick decisions have to be made about such interventions as feeding tubes and ventilators, patients and families scramble to wrap their minds around the new state of affairs. Unable to achieve unanimity, a great many families fall back to the default position, which is to press on relentlessly in search of a cure – even though the doctors may know, full well, that chances of extending such patients’ lives by more than a few weeks are slim.

Granted – as Claire reminds me, based on her hospice ministry experience – there are some cultural and ethnic traditions that inform this process. Orthodox Jews, for example, typically make decisions within a moral framework that nearly always opts for treatment, no matter what the chances of success. African-Americans and Hispanics, bearing cultural memories of parents and grandparents to whom the system too often denied advanced care, are more likely than others to press for it, even against medical advice.

Referring to science writer Stephen Jay Gould’s oft-quoted 1985 essay, “The Median Isn’t the Message” – in which Gould tells the story of how, upon learning he had mesothelioma, he decided to take his place among the tiny percentage of patients who survive, and did – Gawande speaks of the “tail” of the statistical curve. That’s the narrow portion that stretches a good distance into the future, and includes the fortunate few patients who manage to beat the odds and survive a deadly cancer. It’s good to remember, when faced with such stories, that the statistical median is just that – a median. Always, there are some who do better than clinical expectations, others worse. An awful lot of people, though, are trying to ride the tail of statistical probability – far more than will end up actually being on it. Gawande writes:

“I think of Gould and his essay every time I have a patient with a terminal illness. There is almost always a long tail of possibility, however thin. What’s wrong with looking for it? Nothing, it seems to me, unless it means we have failed to prepare for the outcome that’s vastly more probable. The problem is that we’ve built our medical system and our culture around the long tail. We’ve created a multimillion-dollar edifice for dispensing the medical equivalent of lottery tickets – and have only the rudiments of a system to prepare patients for the near-certainty that those tickets will not win. Hope is not a plan, but hope is our plan.”

I mentioned above that Gawande identifies one category of patients and their families who are better prepared for end-of-life decision-making. He’s talking about those who have received hospice services. Alone among the specialties of modern medicine, the hospice movement is not afraid to face death head-on and talk about it with patients – well before the anxious moment in the little family waiting room just off the ICU, when a doctor (or, just as likely, a critical-care nurse) sits down on the vinyl-covered furniture with the family and informs them a decision needs to be made about discontinuing life-support.

Patients who have signed on for hospice care have already decided they’re not going to cling to the slim tail of possibility any longer. They’re going to strive for the best quality of life they can construct in the here-and-now, placing their hope somewhere other than joining the tiny percentage who defy medical expectations.

I can’t begin to recall the number of grieving family members I’ve spoken with who told me they wished their loved one had gone on hospice earlier. Claire confirms for me, from her experience working with bereaved family members, that this is a nearly-universal comment. Curiously, the vast majority of hospice patients live no longer than a few days. That’s not because hospice care is somehow bad for them – quite the opposite. It’s because, by the time most patients make this decision, they’re already so far gone that hospice functions as little more than a transfer-station between the hospital and the funeral home.

It’s not meant to be that way. The hospice ideal is for weeks or even months of active, but mostly palliative, treatment. The hope is that the hospice experience will provide a gracious space for patients and their families to work through the full range of issues – medical, emotional, spiritual – they need to deal with at the end of life. Surprising as it may seem, there are even some patients who go on hospice for a time, then go off it – their improvement has been such that the “six months or less to live” criterion of hospice admission no longer applies to them.

So, signing up for hospice care is not giving up, as some fear. Far from it.

The key to a higher quality of life for the dying, Gawande points out, is communication. One of the things hospice team members do exceptionally well is to encourage patients and their families to share their thoughts and feelings about dying, then to listen attentively and respectfully to what they say. Next, they help them think through what goals they have for the rest of their lives, and do whatever they can to help them attain them. “You don’t ask, ‘What do you want when you are dying?’” explains one expert. “You ask, ‘If time becomes short, what is most important to you?’” Gawande observes:

“People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and to say what they have seen, who will help people to prepare for what is to come – and to escape a warehoused oblivion that few really want.”

The asking of such questions was meant to be a central part of the new health-care legislation recently passed by Congress, but politics blocked it. The Tea Party mob ignorantly slapped the label “death panels”on the funding for these vital conversations, then pressured Congressional leaders to excise it from the bill – which they did, so as not to lose the bigger battle. This is a terrible miscarriage of justice for the dying: the sacrifice of a proven care approach that offered real promise for enhanced quality of life.

When the only goal worth talking about is to beat the disease, Gawande concludes – no matter what that may mean in terms of unproven, experimental treatments – the statistical outcome in nearly every case is going to be disastrous. Which general would you rather have leading the troops into battle? George Armstrong Custer or Robert E. Lee?

“Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when you couldn’t, someone who understood that the damage is greatest if all you do is fight to the bitter end.”

This article is a good read, for anyone whose life has been touched by cancer – either their own or that of a loved one.

February 25, 2010 - A Time to Act

Today I received an email from Lance Arm- strong’s Livestrong organi- zation. It begins with this call to action, issued in coordination with the American Cancer Society Cancer Action Network:

“Today, our elected leaders in Washington are gathering to continue their debate on overhauling a health care system that fails far too many Americans. We’re hopeful they do the work we elected them to do: break through the gridlock, work together and leave the partisan posturing at the door.”

“Partisan posturing” is right. Along with a great many other Americans, I’m feeling appalled by Congress’ growing dysfunction, especially on the matter of health care reform.

Poll after poll has indicated that this is the number-one priority for the electorate. What’s wrong with our elected officials, that they can’t make any progress on this issue – which for a great many of the uninsured is literally a matter of life and death?

Not that our Senators and Representatives know much about that. Personally, they’ve got some of the best medical insurance around. No part of their health care system seems broken.

Nowhere is this clearer than in an incredibly boneheaded comment House Republican leader John Boehner made to the President at today’s healthcare summit. He gestured towards a copy of the Democrats’ proposal and grumbled, “This right here is a dangerous experiment. A dangerous experiment with the best health care system in the world.”

What planet does that man come from? “The best health care system in the world?” Sure it is, for members of the well-insured elite like Mr. Boehner. Not for most of the people who elected him: whose taxes bankroll his princely medical benefits, that allow him to continue to dwell in such a fantasy world.

Republicans, it’s time to put people ahead of politics and stop your random, mindless obstructionism. Democrats, it’s time to find some nerve, and negotiate from the strength of your majority - filibuster or no.

I invite you to join supporters of Livestrong, the American Cancer Society and myself in signing this bipartisan petition to Congress, urging them to break the deadlock and move forward.

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.

September 14, 2009 - We're Number 37

My friend and fellow pastor Rob Elder shared this video on Facebook. Some guy's written this satirical ditty reporting that the World Health Organization has ranked the United States #37 out of all the world's nations in providing health care to its citizens:



From the WHO's press release on the subject:

"The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The United Kingdom, which spends just six percent of GDP on health services, ranks 18th. Several small countries – San Marino, Andorra, Malta and Singapore are rated close behind second-placed Italy."

We can do better.

Yes, we can.

September 7, 2009 - Happy With Your Health Insurance?

Today I heard a phrase I’ve been hearing a lot lately in news reports about the health-insurance debate. It’s the concept of people who are “happy with their health insurance.”

Are you one of those satisfied consumers? Are you truly happy with your health insurance?

You’d think there must be an awful lot of happy Americans out there, the way Washington politicians have been spreading that phrase around, thick as manure.

I suppose there may actually be a few pleased policyholders out there. The nature of insurance, after all, is that some people need it more than others. Those who don’t submit many claims tend to be happy with their coverage. They take comfort in holding that wallet card. They feel protected.

Even if their medical safety-net is spun from pure fantasy, they feel protected. Maybe even happy.

The true test comes with hard times. I wonder how many who are happy with their health insurance have chronic medical conditions? These are the people who deal with the real world of medical insurance, not fantasy.

I’m fortunate enough to be doubly covered. The Blue Cross/Blue Shield insurance I receive through the Presbyterian Church is pretty decent. The secondary Qual-Care spousal coverage we purchase at group rates through Claire’s employer, Meridian Health, is a valuable back-up. It takes a big bite out of my 20% Blue-Cross/Blue Shield co-pay – which, when it comes to things like PET scans, can add up to a pretty penny.

Even so, I’m not happy with my health insurance. I’m not happy because I know I have to watch both insurance companies like a hawk. I know their profits are dependent on their denying customers’ claims. I know they reward their employees when they find reasons to deny or reduce payments – if not with outright bonuses, then with favorable performance reviews. I know there are so many middlemen and -women involved in the whole unwieldy process, so many paper forms, faxes and e-mails flying around, that there’s a huge potential for error. Just one omitted or misplaced pre-certification, one out-of-network service booked in error, and I could be left holding the bag for big bucks.

That unwieldy insurance bureaucracy – so complex, even the doctors’ professional claims-processors can’t make sense of it – adds as much as 30%, by some reckonings, to the cost of my medical care. Ultimately, that’s the cost of employing an army of people to push paper and tap on computer keys, not to mention squeezing quarterly dividends out of the system to keep insurance companies’ stockholders happy. It has nothing to do with the quality of my medical care.

I’m not happy with that.

Then, when I imagine the prospect of pursuing cancer testing and treatment without any medical insurance, I’m even less happy – not so much for my own sake, as for the sake of my at-risk neighbors who must do exactly that. I’m not happy being the beneficiary of a system that values stockholders more than sick people.

Dr. Len Lichtenfeld, a physician, has it right, in an August 8, 2009 blog entry on the American Cancer Society website:

“We have too many instances-and too many bankruptcies-where ‘satisfied’ people suddenly found themselves not so ‘satisfied.’ I am willing to bet that you (and me) have no idea whether or not your insurance will be a facilitator or a barrier to your care if you or someone you love becomes seriously ill with a disease like cancer. You just don’t know.

So don’t stand there and rail against your Congressman or Senator because you are ‘happy’ with your health insurance. I wonder how many of you have had a serious, prolonged illness in your family. If your experiences have been positive, terrific. But don’t discount that many others have not been so fortunate.”

Those yahoos shouting their Senators down at town hall meetings don’t seem to realize that this issue transcends any individual right to happiness. Are you happy with your health insurance, Mr. Redface Shoutington? Too bad. Your happiness can’t come at the expense of your neighbor, who worked just as hard as you did over the years, but who was either self-employed or whose employer wasn’t as beneficent as yours when it came to health benefits.

It’s a moral issue. Never before, in human history, has care of the sick been viewed as sick people’s own problem. It’s always been a community responsibility.

Some anthropologists, I’m told, date the rise of the human race according to the first skeleton they ever dug up that had a broken bone someone else had set.

We’re all in this together. That’s where true happiness comes from.