We’ve been meeting as a group for 18 months now — writers, lawyers, editors, a doctor, a gallery owner, a business executive and a Navy man turned truck driver. We’re mostly Midwesterners, and politically we mostly lean liberal.
Once a month, we have dinner and discuss the “big questions” of life. You could call it a secular version of Sunday school, only less frequent and with a lot more wine. The host rotates, and picks the question for the salon, as we semi-jokingly call it. In the past, we’ve easily discussed war, the ethics of cloning, and what we would become if we were 18 again but knew what we know today. Yet it was last Sunday, when the topic was health care reform, that we had by far our most frustrating and least illuminating get-together.
We talked about the flaws of the current system, the experience of other countries, cost, tough calls — some of the same issues that have surfaced at town hall meetings across the country. And what I kept thinking was: If this smart, engaged, and relatively like-minded group — all of whom actually like each other! — was having trouble discussing and figuring out the health care reform morass, what must it be like for the nation as a whole?
Disgust with our current system was our one common ground. A woman whose late husband had three heart bypass surgeries complained about the time she spent on the telephone with insurance reps. How much it cost to give a man three heart surgeries that couldn’t save him was not addressed. That’s not to say he shouldn’t have had them, just that the concept of the “greater good” is not one that comes easily to people, especially if it’s your kin. Or yourself.
Someone brought up the disadvantage of having to switch doctors every time your insurance changes.
“Are you willing to pay for concierge medicine?” someone else replied. Say you have a family practice doctor on retainer for a flat rate for a year. You have her e-mail, cell phone, everything for the nickel-and-dime stuff, for maybe $1,500 per year. Everyone found the idea intriguing, but no one said they’d be willing to pay the fee.
Some countries have what appear to be crackerjack systems. But left unaddressed was how end-of-life issues are treated in those countries, not to mention babies born severely challenged. When someone pointed out that England saves money by disallowing dialysis after a certain age, the discussion quickly moved on.
There’s a waiting list – or rationing as it’s known in the news lately. The one Canadian in our group, familiar with her country’s single payer system, said Canadians do get tests, but only when necessary.
“But who decides what’s necessary?” the doctor in our group asked. Someone still has to make the tough calls. Someone has to decide: No, you can’t get this or that care because it costs a lot and it probably won’t help you anyway.
Someone suggested the notion of long waiting lists and Canadians crossing into the United States for medical treatment was exaggerated. “It’s not exaggerated,” said the doctor. “Believe me, they’re doing it.”
Even our Canadian agreed there may be trouble ahead for her home country. She’s heard rumors of planeloads of Chinese landing, “and once you’re on Canadian soil…” she said, her voice trailing off ominously.
What about tort reform? In some countries you can’t sue doctors. “Yeah,” said a lawyer in our group, “but when doctors know that nobody’s watching, you start to see problems.”
It’s not so much the medical malpractice lawsuits or even the insurance premiums that are driving up costs, the doctor said, as the CYA ordering of tests. “If everyone in this room had a stomachache and went to the Emergency Room,” the doctor said, “I guarantee you that eight out of 10 would have a CT scan before the night was out.”
Some believed the only problem in health care was insurance company profits and executive salaries. Remove those and you remove all problems, they said. Oh, if only. I’m afraid that no matter how you slice it, health care is much more complicated than delivering the mail, with much more at stake too.
The Veterans Administration health care system works, someone said. But, let’s be honest, the VA is a benefit for people who risk their lives in the military. The VA is subsidized.
Medicare works, someone said. But, let’s be honest, Medicare is going broke. The premiums paid in by subscribers do not cover costs. Medicare is subsidized, too.
“People want Cadillac care for the price of a Yugo,” someone said, and I fear he’s right. I fear the gridlock we saw in our Sunday night microcosm is fully transferrable to Congress and the nation as a whole. About the only thing our group could all give a thumbs-up to was government-funded scholarships for medical students. A good idea, sure – for the next generation.
Some 20 years ago I found a great family practice doctor and I stuck to him like a grassburr. I’m an eight-year survivor of ovarian cancer, and I believe I’m alive today because of him. Maybe it’s foolish, but I think that even if I lost my insurance tomorrow, and even if my cancer came back, my doctor would find a way to treat me.
In the end, it’s about sick people and those who accept what is (to me, anyway) a sacred calling. They’re healers. They can’t always stop death from advancing, but they try. Most people can’t even bear to talk about or look at disease, much less get their hands bloody. The men and women who go into medicine deserve better than a system that blames them for the impossibility of perfection. And so do their patients, who must take responsibility for their health and their lives. And their mortality; all the medicine in the world can’t change that.
Sunday I left our Big Questions meeting with one question answered anyway: No matter what we do to our health care system, a lot of people will be left out, one way or another.
[originally published by Politics Daily in 2009]