Monday, August 31, 2009

Is anyone hearing the healers?

Today I ended up calling a friend of mine who I've known since we were both ten. I think in really long friendships there are times when you talk more than others, and we've been friends for three decades. We hadn't really talked much this summer.

The conversation turned to health care, partially because it's rare for me to have a conversation lately that doesn't, but also because my friend is a nurse. I think that's part of the reason I haven't really sat down to talk to her about health care reform before today. It's her livelihood, and I wasn't sure how to approach the subject with her.

We hadn't been talking long before she told me she likes my blog, particularly the posts about health care reform. That was a huge relief, and opened the door on a long conversation.

It was really fascinating to talk to someone working in the current health care system. I don't really want to get into too many details of my friend's work, because we were speaking candidly about problems within the health care system. Since it is her livelihood, I wouldn't want anything we talked about to have a negative impact upon her.

I do wish that wasn't the case, that people within the industry could speak openly, but if you work within the current system, suggesting that it needs to be changed can be perilous.

We talked about patient loads, and scheduling difficulties. The impact of red tape, and how managing health care is currently treated like managing manufacturing. We also talked about care she's received, and the burden upon the patient to keep track of all health care options. That's not quite the same as being an informed patient, by the way. We were talking about the fact that there came a point in the treatment of a chronic problem, that she found herself researching something her doctor had never suggested, or rather that had been suggested, but a nearby resource never being brought up by the doctor. She changed the scope of her treatment when she discovered this, by herself.

I wish that more health care providers could contribute to this debate, without fear of repercussion.

In the town hall meetings we've had so few health care workers contributing on either side but when I asked my friend, "Do we need a reform, or a full scale restructuring?" she answered that we need restructuring.

I was again thinking about what happened to Dr. Ezekiel Emanuel in his own support of reform. This debate has become so heated, we aren't hearing from care providers. It seems that really, these people would be excellent sources of information about what really isn't working, what is, and what needs to practically be reinvented.

It's a pity that these discussions tend to happen privately because of fear of public reprisal. Since this all began, I've been thinking about health care reform every single day, and well into many of the nights.

I've talked about it here, and elsewhere, but somehow, that was the first exchange I had with someone currently in the field. After I hung up I realized something. Everyday I sort through news pieces. There have been days where aside from doing household chores, this has been all I think about. In between chores I hop on the internet, I read blogs, every article I can find. If I think about something else for four hours at a stretch, that's incredibly rare.

I realized after I hung up the phone, that I can count on the fingers of one hand, pieces I've read from doctors, nurses, medical administrators.

Aren't these the people we need to hear from, and at length?


The Bug said...

I agree - I've come really close to asking my doctors what they think, but I'm a coward & don't want to listen to an opinion different from mine. I don't like it when people don't agree with me LOL.

Amy said...

Alene, Last night I caught the end of an interview on C-Span - a surgeon and a CEO of a major hospital in Virginia. One point they made, which resonated with me, had to do with the hyppocratic oath that all doctors supposedly adhere to. That is that they treat anyone who comes through the door equally (to the tune of $30 million per year for patients who can't pay). Those who can pay and don't have insurance work out a payment plan they can afford to slowly repay their bill. Maybe I'm cynical, but I've always thought the level of care is staggered according to your means (and insurance). So for me the question remains - where is the accountability? We all have bills to pay; insurance happens to be one of them even though it's completely out of control. If there's a service I need, I know it's not FREE, and I have a choice to pay for it or not. Maybe I'm over-simplifying these complex issues; I feel like you in that I think, think, think about these issues (my grown children tell me I "overthink") - fortunately we have lots of information sources, even though some of them may be questionable. Another reason to stay healthy in mind and spirit, right?

Land of shimp said...

I haven't asked the two doctors I personally know for much the same reason, The Bug. I'm almost afraid to hear the answer, yet, part of me thinks I really need to hear their answers.

Amy, the Oath is great in spirit, but ends up having pitfalls in practice. A few years back my doorbell rang, it was when I lived in a metro area, and to my great shock, a pregnant woman was standing on my doorstep, informing me she was in labor.

I almost fell over. I've had a baby, but even if I could deliver one, it's not my first choice! I immediately offered to call an ambulance. She asked me not to because ambulances are required, by law, to take patients to the nearest hospital which in that case was a private hospital.

She didn't have insurance, and needed to go to one of the two hospitals in area that had a program in place for people who did not qualify for Medicaid, essentially, low cost wellness care at a teaching hospital.

Displaying the bravery of a great wimp, I called a taxi for her, and paid for it right there. I didn't offer to go, I didn't offer to drive her. I swear, I almost would have paid her hospital bill to keep her from having a baby in my living room.

But that's just one example of where the spirit of equal treatment actually falls flat on its face. Porter hospital was the nearest, but if she went there, she'd rack up a huge bill, because private care cost so much more. If she'd been critically injured, the law would have dictated she be treated equally, but the pricing of a private institution vs. a teaching hospital would cripple her financially.

That's just one example out of the many out there where the intent of the law is good, but the practice of the medical community doesn't really best benefit the patient.

Years ago, almost twenty years ago, because I was pregnant at the time, a friend of mine had Lyme's disease. She didn't have insurance, and at one point she needed to be given an MRI in another hospital building. The nurse stood there and said, "Can you give her a ride? I'm not supposed to have an ambulance take her because she doesn't have insurance. Or you could walk."

The person in question had been having seizures, by the way. I'd like to think care has improved since then, and that a hospital wouldn't so obviously treat someone like a second class citizen, in front of her face, referring to her almost as an object.

However, from all the stories I've been hearing, and reading? The appearance of equal treatment has been upped significantly, but not the actual care provided. The weirdest thing about that story? That nurse did my friend a favor by figuring out how to spare her the cost of the ambulance.

She was a young woman in her twenties, waiting tables while going to school at night. By the time she was released from the hospital, she had a 70k bill, almost 20 years ago.

Costs have done nothing but rise. Sure, hospitals are required by law to work with patients that are uninsured to allow them to pay off bills slowly. That's good, but the bills themselves are the size of mortgages.

Added to everything else in this nightmare, the cost of those that cannot pay impacts the cost of health care for people who do end up paying.

We don't live in the Third World. Being financially crippled for a lifetime because you aren't quite poor enough when your life needs to be saved is not equal treatment.

We think that driving on safe roads is a right of living in well structured society. If there are too many potholes, we take offense, and wonder when they will be fixed.

Yet, as a society, we don't think of health, and access to the ways to maintain that, as part of the right of all citizens.

Safe roads? Absolutely! The ability to go in for regular checkups...that's viewed as a privilege. It's so strange, it's like adopting the rules of serfdom.

Land of shimp said...

Sorry, Amy, I completely forgot to add what was foremost in my mind when I started answering:

Yes, it is a reason to try and remain healthy in body and spirit! Admittedly, the Catch 22 is that access to the ways to remain healthy are limited, cause stress, then cause illness...

Boy, if I could have a Genie, and only one wish? I swear to the universe, this would be the thing I'd choose to fix for our country.

PhilipH said...

This health question rumbles on and on in America, like a bad case of ibs, irritable bowel syndrome.

It will take a lot of effort to get Obama's targets to fruition and to keep the 'antis' lobbyists at bay.

Amy said...

Alene, I so agree with all of your points and I haven't read your current post yet. I'm hopeful that when the reform or restructuring or whatever takes place, we will still be able to have a "healthy" relationship with our doctor(s). That doctor/patient dynamic is key to prevent disease and promote good health. I know I'm painting with broad strokes, but I feel strongly that we need to focus, not only on what a plan that would afford care to everyone would look like, but also, what we do not want. And, frankly, I don't think the government is the vehicle to make decisions that my doctor and I have made for these many years.

Another concept that I've heard bandied about is the one of "charity hospitals." Charity begins at home - another reason to give the states the power to make important changes in our system. The more local the entity, the purer it gets, if that makes any sense at all. What is wrong with old fashioned charity? I know I'm probably stirring up a can of worms, but I am a strong believer of helping my fellow man (or woman) when they need a "leg up." I find the Christian concept much more palatable than the one of "entitlement." Though I sure do agree that adequate health care should be on par with our road system!

The Bug said...

But Amy - your doctor is hampered by your insurance company in the type of care he can provide! I don't think I want a corporation deciding what's best for my healthcare either! When I was getting my shoulder issue diagnosed my doctor didn't prescribe certain tests because he knew the insurance company wouldn't pay for them. Of course, I could I have done them & tried to pay for them on my own...

Amy said...

The Bug, Point well taken. I've probably had a pretty normal, benign relationship because of my general good health. After reading some of Alene's posts and comments, I took out my policy and read the fine print carefully. To think that insurers can drop policyholders in good standing, except for a medical condition (which in itself can be totally traumatic), is mind boggling! I've read that the insurance companies are highly regulated, but it certainly doesn't appear to be the case when you read these horror stories. I'm really, really trying to keep an open mind - it's naive and not fair to oversimplify - with an issue like healthcare, it's also hard not to be emotional.

I agree with Alene - it's time to take the time and write letters to our representatives.