On the eve of yet another attempt

It is still 24 Feb 2010 (23:25 PST), and tomorrow, the President of the United States will sit down with the ranking members of both Chambers of the Congress (on recent track record, I hesitate to call them "The Congressional Leadership" so please excuse the circumlocution) and make what may be the last attempt to get some level of reform into a health system that kills more people each month than died on 9/11. 

Over the past three years, I have learned more about this system than I have ever wanted to know. I thought I had a pretty good handle on the subject before this. My father was condemned to death when the HMO system that masquerades as health care in California informed him he had used up his quota of Intensive Care hours, and could only extend his Cardiac Care hours by transferring 25 miles to a less costly facility. That bought him more hours; 30 of them. Not enough to for me to get there, nor my siblings. My mother sat with him when they  removed the heart catheter we could not pay for. Had he been able to stay in the better hospital, and complete the treatments, he might have had a chance.

My grandparents both died of cancer. They had good treatment through their respective ordeals, but it cost them their home. They had run through their insurance.

My wife of 26 years had to wait 6 months for a diagnosis of her breathing problems. We lived in an area where there weren't that many doctors that accepted TRICARE, and the system was still in "start-up mode" as we were told. So it was too late when we discovered her supposed pneumonia was a cancerous mass behind her heart roughly the size of a softball. The cancer didn't start in her lungs, but that was where the greatest threat was by the time we got her into the hospital. She had had a number of tests, but they were at another hospital, so we wasted time in having them done again. Hospital policy required it, since TRICARE would pay for it. Would it have helped had the hospital been able to start treatment a few weeks sooner? I'm not sure. From the number of doctors that apologized for the delay, I have my opinions. A little over a year after her death, I got a bill from the hospital on the lose order of $45,000. It seems they had marked several treatments/tests "approved" when they were not. TRICARE did not approve them at the end of the day, so, after much discussion, I got the tab down to $35,000. I am fortunate that my son is academically gifted, and that he was able to put together a package of scholarships, work programs, and student loans. You see, 30 of that 35K was the college fund his mother and I had put together of many years. Three years later, TRICARE moved from being an outsourced service to being a contractor supervised by the DoD. So that kind of thing doesn't happen now.

 I am in California taking care of my mother, who has Stage IV cancer. Last year, since I am spending more time here than at home in Oregon, TRICARE moved my Primary Care Provider to a clinic about 5 miles from here. At home, that's not a big deal. This is the Los Angeles area, and it's a half hour drive for most of the daylight hours. Secondary care is at Los Angeles Air Fore Base. four times the distance, but only 50% more time. Don't ask. I can't explain it. It has something to do with the freeway system and the traffic load at LAX.

Anyway, my point is that I have spent a lot of time in waiting rooms in a clinic that provides primary care for people who are on Medicare, Medic-Cal, private insurance, partial insurance, and no insurance. It's been quite educational. So was the opportunity to talk with the staff where my mother was getting her radiation therapy (until the cancer got ahead of it, and we called Hospice in). There were three techs working the various machines. They worked four hours at that clinic, and four hours at another clinic. They did not have medical benefits at either location. Neither of the clinics could afford to have full-time techs, mostly because of the cost of providing medical benefits. One of the doctors told me "We need four techs. With benefits, I can only afford two." They also had four administrative specialists. One of them kept the records unit going. The other three took care of liaison with the various insurance companies. The doctors were hoping for some kind of public option in the Health Care Reform. The assumption was that they could cut their paperwork in half. It would also drive a reduction in their professional insurance: fewer chances for paperwork glitches. Doesn't look as if that's going to happen.

It's after Midnight here. On the East Coast the dawn will hit Blair Han hour or so. Mr. Obama has this assumption that if you treat your enemies honorably or long enough, they will eventually respond. It is entirely likely that this is going to fail again. It's an approach called for by all three Abrahamic Religions, as well as by their various divisions. It falls apart when faced by the dishonorable. I have known people who would rather lie than tell the truth, even when the truth would serve them better. Most of them have not fared well in life. I often thought that was a fairly good example of the Universe tending toward balance. But the people who will walk into Blair House in a few hours have been quite successful. Mendacity has been their friend. Supported by people who can't stand the idea of President Obama, as well as by corporate interests unfettered by even minimal regulations, they have conducted the various levels of negotiation in a manner so duplicitous as to make the North Koreans blush.

At the end, even though the President's compromise pretty much consists of everything the Conservatives have demanded, this discussion will probably fail. No joy in that, for it will bring even more pain to the people who look to government to do for them those things they cannot do for themselves. But caring for the less fortunate, or even the less influential, or the less wealthy is a virtue of the Abrahamic Faiths, among others, and if there are any of their number among the Conservative Party, they are not obvious. I have read the various Holy Books, in their many versions and with a shelf-full of commentaries, discussions, apologia, histories, and speculations of each. I cannot find a way one can follow the practices of  the Congressional Conservatives without violating several of the precepts, practices, and principles that make one an observant Muslim, Christian, or Jew.

A slight delay between that paragraph and this. Mom had a coughing spell, and I was doing what I could to help. The people from Hospice have provided a number of medications, and quite a bit of equipment, but nothing seems to help much. She is in no immediate danger of death at this point. There is a possibility she may regain her strength and get have more time left that seems possible. Hospice exists outside of the civilian insurance structure, and functions very well with a combination of volunteers and thoroughly underpaid professionals. We have access to it as an extension of Medicare. Not that way everywhere. NOt even everywhere in California.

This nation needs a national health system. We also need a national education system. We also need a national financial system. We're not likely to get any of those in the near future. The Balkanized patchwork of the current systems do not come even close to serving the needs of the populace, but they do a dandy job of serving the needs of the people who can afford to pay their own medical bills, or who can send their children to private schools that actually are better that those available to the masses, or who have people who take care of their financial affairs for them. The collective term for such people used to be "The Aristocracy". These days, the terms are unclear, but I can't find one of them who isn't mobilizing the Conservative base against all those national programs we need.