Healthcare Reform

Sigh. I guess it's time to finally say something about this circus. About this distraction. About healthcare 'reform'.

The biggest thing I can say is that we're missing the point completely. The death panel debate is inane and shockingly uninformed and offensive, but it's really a shell game in front of closed-door deals that signal the true agenda of this bill and 'reform': window dressing for business as usual.

Obama, for all his rhetoric, looks to have sold the public down the river in order to mollify the big contributors, including for-profit hospitals, the insurance agency, and big pharma. How can I say this? Well, it seems obvious that he's agreed to limit contributions from the big players as covered by the NY Times and others. Now, conveniently the dialogue has shifted to co-ops instead of a public option; the 'death panel' idea has been dropped. The talk is about taxing health benefits, requiring people to buy insurance, and avoiding forcing drug companies into concessions on what they charge Medicare, all in the name of 'personal freedom'. These are all shifts away from what he said on the campaign trail, and away from meaningful reform.

The real show is going on behind closed doors. And if you're not outraged at that as a citizen you're missing the point. The big dogs are off making the real deal while we're busy yelling at each other like morons in 'town hall meetings'.

The real discussion needs to occur about the possibility of a single-payer, government run system. Unfortunately, with so much money and profit wrapped up in both politics and all aspects of media, it'll never happen. Does that help me as a doctor? Sort of. I'll keep making a higher salary, but I'll also be little more than a profit engine for corporations providing health care struggling to actually take care of patients. We'll still have uneven distribution of outcomes based on socioeconomic status, the CEOs of insurance companies and pharmaceutical companies and hospitals will still make enormous profits, and the president will get his speech. But, overall, very, very little will actually change except you'll be forced to buy crappy insurance.

What actually needs to happen is to get the monied interests out of the back conference rooms of the white house, and out of congress, and out of politics. When John Adams made his way to the continental congress before we were even a country, he had to do it for free, and he had to close down his law practice to do it. He did it because he loved his country, not for the bennies (which, for current congressmen and women, includes a great health care plan. Notice how they're not talking about giving that up). It's all about campaign finance reform and lobby reform, not health insurance.

Rat Poison

He finishes dinner with his wife, the first they've had in weeks as he's recovered from hospitalization. Both feel better. Renewed. Maybe a bit hopeful. His balance isn't what it used to be, he's still tired, unsteady at times. Weaker than he was. She finishes the dishes while he, complaining of being tired, heads for bed upstairs.

On the third step, he remembers something and, naturally, turns to go back down. His balance, though. Not what it used to be. He falls the three steps, foreward into the foyer. And weak; doesn't catch himself. His nose bleeds. And bleeds. Bleeds even after she holds pressure and calls 911, bleeds to the hospital. Bleeds with anterior packing.

By the time he stops bleeding with a postieror pack, he's intubated; mental status, airway protection, and all that. Multiple facial fractures are found. He's admitted to the ICU for a hopefully swift recovery. Opacity at the base of his lung is watched; perhaps he breathed blood. Hard to say.

By day 3 or 4, it's not hard to say. The lung fills in, the tube stays after the packing does. He spikes fevers. He doesn't wake up. Now 4 to 5 days without nutrition, fractured, infected, a tired body, issues layering on each other.

His wife knows that he wouldn't want all of this. Wouldn't want the tracheostomy, the feeding tube, the supportive care to see if he comes out of it. That's were we were. Stuck. Or, not stuck, because the family was sure of his wishes, and all of them agreed.

The Navy man who drove the boats for the landing on Guadalcanal had care withdrawn on the 4th of July. How terrible, you may opine. How macabre. But. The monitors were shut off. The tubes removed. His sons and daughter were there. His wife was there. They held his yellowed, bruised cool hands. Draped in a home blanket. They spoke to him, and we shut the door and the curtains, watching the monitor still on outside slow, and become more and more shallow until they stopped.

This is the situation the supposed 'death panels' were for. It was as good a death as we could offer for a good man. No bureaucrat showed up and told us we had to let grandpa die, nor would they if we had kept the 'death panels'. The family happened to know what he wanted, and because of that, we could let him go. What if they had been gone? What if they had disagreed? Weeks and months could pass, hooked up to machines and tubes, sustained, exactly as he didn't want to be maintained.

It's terrible when anyone dies. It's worse when they are treated with guesses as to their wishes. No one deserves guesses like that. The family is often asked to 'guess' what they might have wanted. Imagine, having to feel as though your decision will either end the person's life or lead to a full code and then the end of their life, not knowing if they wanted to leave quietly, or fighting to the last.