Guaranteed Healthcare

Well, it's Sunday afternoon, and after working four consecutive 12+ hour day shifts in the ICU last week, taking care of the sickest, most vulnerable patients imaginable, I'll confess to being a bit tired and weary.  At home, I've begun sorting piles of laundry, and collecting the coffee cups that never seem to find their own way into the dishwasher.  MSNBC's Meet the Press is broadcasting in the background, and my boxer, Ginger, is dogging my heels and hinting that she'd really like to go for a walk to the park sometime today.   

My mind begins to wander back to some of the more poignant and intriguing memories of the past week. Yesterday afternoon three of my colleagues and I stood by with a 93 year old patient who was taking her last peaceful breaths less than 12 hours after her friends and family had prayed for her and said their last good-byes.  We watched her heart beat slow and then stop as her spirit left her body. We silenced and finally disconnected the monitor alarms that confirmed what we already knew.  She'd suffered a massive stroke just a few days after Christmas, and her family agreed that her wishes did not include aggressive and futile life support.  (Although a transfer to a medical bed or hospice care was ordered, none were available for her placement prior to her death.)

One of my colleagues who was serving as the designated Trauma response nurse was suddenly paged to the Emergency room.  A young man had been stabbed in the neck and was bleeding profusely. Major blood vessels were severed and the vascular team began preparing for immediate transport to the OR. The trauma room doc tried to control the bleeding by placing some temporary sutures and packing in the wound, when the young man began shouting that he didn't have insurance and that he couldn't afford to pay for any surgery. He said, "I don't want an operation, just let me go home."

Yes, he'd had a bit too much to drink, and was a danger to himself and not competent to make the decision to refuse.  The ER doc calmly explained to his young patient that he would die without the surgery.  Phone consent for treatment was obtained from his family. Two large IV's were started, and a bit of sedation was administered and emergency blood transfusions were initiated before the mad dash to the operating room got underway.  He would soon need that bed in the ICU.

And, on Meet the Press, David Gregory continued his interview of Senate Majority leader Harry Reid. Blah, blah, blah, Blagojevich, (the dish water is running), the war in Iraq...General Petraeus...the surge...and then, I heard Senator Reid express his opinion that George Bush is 'our worst president, ever.'

O.K. I thought, we all know how awful it's been. So, what then must we do?  I turned off the faucet; I was curious and began wondering, how's he going to justify his assertion?  What criteria, what example would have led him to that conclusion?  As the show was wrapping up, David Gregory fed Senator Reid a lead-in line, and it gave Reid the requisite opportunity to mention his recent book, The Good Fight.

"One pill makes you larger, and one pill makes you small," so begins the verse from Jefferson Starship's classic song, White Rabbit.  "And the one that AHIP's selling, won't do anything at all."

O.K., so that's not the way the verse really goes, but my subject, healthcare reform and the placebo politics that surround it is enough to make me mad as a hatter. Actually, it's made a lot of us angry, and we're getting organized for the fight of our lives. Our success and our ability to achieve true healthcare reform has everything to do with perception, placebos, and a good dose of myth-busting reality. 

When it comes to health care reform, any politician that welcomes insurers to the table as invited guests and expects them to behave like polite company, will be sadly, even tragically disappointed. Like the oysters in Lewis Caroll's classic, The Walrus and the Carpenter, we must be especially wary when the insurance industry repackages and markets itself as a solution to the health care crisis. "Now if you're ready, oysters dear, we can begin to feed."    

America's Health Insurance Plans (AHIP), are doing just that; they're gluttonously greedy and they're pandering for an invitation to 'fix' the crisis they created. Skyrocketing costs; marginal, reduced, detrimental-to-our-health 'benefits'; recissions, denials, exclusions, and huge profiteering by insurers has eroded and eaten away at our collective health like a cancer.  There can be no doubt about it. In medicine we have a term for that, pathognomic: distinctively characteristic of a particular disease or condition.  For example, lesions in the brain which are pathognomic of a cancerous glioma.

"So, what is that tumor or neoplasm thing in my head, nurse?" Senator Edward Kennedy might have asked that question of his trusted nurse, after his venerable doctors left the room. The short answer might have included a definition and an analogy to aid in the patient's understanding. "A neoplasm is best described as a new, uncontrolled growth of tissue that's serving no useful physiologic function.  It's crowding out healthy tissue and it's very greedy.  It doesn't share or play fair with the oxygen, nutrients, and the blood vessels that supply them.  That's why you're sick."  Like for-profit health insurers who serve no useful function in health care, they're shortening our lives and we're dying because of them.

The two major party candidates for President of the United States have extended that "invitation" anyway. It's party-convention time, and we the people are seated at the table. It's time to shed our naivete.  AHIP is not unlike the fabled Walrus and Carpenter; they're waltzing in with their buckets of campaign cash, profits they took at our expense. They're hoping we won't recognize them for who they are and they're hoping to control the party's platform. They're hoping to keep control of a system that works for them, and they're hoping that Harry, Louise, and the rest of us believe their  love affair with our premium dollars will be enough to sustain a long term relationship that's been in their best interest, not ours.  "It seems a shame, the walrus said, to play them such a trick." In reality, AHIP has no shame.  A bandaid for your cancer, Senator? Salmonella on your salad, anyone?

  During a speech from the White House, in October, 2002, President Bush remarked, "Facing clear evidence of peril, we cannot wait for the final proof the smoking gun - that could come in the form of a mushroom cloud."

  In March, 2003, as WMD inspectors were leaving Iraq, U.N. spokesman Hiro Ueki said, ”I think all the inspectors and support staff have done our best."  Basically, they investigated the hints and allegations, and came up empty-handed.  

  It's been five years since President Bush declared, "mission accomplished" in Iraq, yet the fighting continues.  While he's tilting at windmills, the cost of war has created a sinkhole, with "clear evidence of peril" that is causing our public health and safety infrastructure to implode.  Speaking of shock and awe, how many credible witnesses and how much clear and convincing evidence will it take, before our "pro-life" President and his posse of right-winged politicians recognize the fact that hundreds of thousands of people have died in this country as a result of insurance company WMDs?

  In November of 2007, during his acceptance speech for the Sydney Peace Prize, former WMD Chief Inspector, Dr. Hans Blix, made some compelling remarks worth noting.  "In the case of Iraq much of the evidence invoked was what has been termed ‘faith-based’. Indeed, some of it was even ‘fake-based.’ The inspection reports of the UN inspectors that I headed (UNMOVIC) and the IAEA were ignored. My inspectors carried out some 700 inspections of some 500 different sites, dozens of them proposed by the intelligence organizations, we had reported no finds of WMDs. Quite to the contrary, we had expressed doubts about some of the evidence that had been presented."

  There's no faking this claim: the insurance WMDs comprise the mushroom cloud that hangs menacingly over our healthcare system. The fact is that we are at ground zero, in the people's war for healthcare. The UN inspectors would find evidence and smoking guns all over the place. The perps are not hiding with them in caves in another country, either.  They're right here, out in the open, for all the world to see.     

  On December 19, 2007, a bereft, yet courageous Hilda Sarkysian, made the following exhortation,”Focus on here. The war is here you guys. We have a war here."

In 2003, Senator Barack Obama addressed the AFL-CIO 'CIVIL, HUMAN, and WOMEN'S RIGHTS' Conference.  In his 2003 speech, Obama said, “I happen to be a proponent of a single-payer health care program. I see no reason why the United States of America the wealthiest country in the history of the world … cannot provide basic health insurance to everybody … . A single-payer health care plan, a universal health care plan. And that’s what I’d like to see."

You don't have to be an RN or an MD to understand the fact that as human beings age, we may be predisposed to acquiring one or more chronic diseases, such as diabetes, hypertension, emphysema, and heart disease, to name but a few.  We are also more accident prone due to poor eyesight, hearing loss, delayed reflexes, and impaired mobility. It's been said that old age isn't for sissies and clearly, longevity is not without risks. However, most of us prefer it to the alternative.

The headline in the Sacramento Bee (5/30) reads, "CONSUMER REPORTS rates hospitals on aggressive or conservative late-life care".  Forgive my cynicism, after nearly 34 years as a critical care nurse, but I'm here to tell you that the patients who arrive in the hospital these days have run out of choices, and have nearly lost their lives because they couldn't afford primary care, or they've had the misfortune of being the victim of violence, or involved in an accident. And, they don't have the time or the money to go shopping for care, nor the education and expertise to determine which treatments will be therapeutic, safe, and effective at restoring them to their optimal level of functioning. For that, they depend on their doctors and nurses.

'Tis the season!  And President Bush delivered the equivalent of a lump of coal to the nation's children.  You're a mean one, Mr. Grinch.  In vetoing the SCHIP legislation (for the second time in as many months), Bush stated, " it moves our country's health care system in the wrong direction."  Perhaps the problem is with the President's moral compass...

As a vehicle for health care reform, Mitt Romney's flawed Massachusetts' plan is breaking down after a year on the road.  The plan fails to deliver the health care reform goods as promised. There ought to be a law against repackaging and reselling this lemon to the public. 

No child left behind?  Congress reauthorized and expanded funding for the State Children's Health Insurance Program (SChip) which President Bush has threatened to veto, leaving millions of children with no health insurance and millions more underinsured.