Monday, November 17, 2008

Support the Baucus Universal Health Care Plan

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Max Baucus (D – MT, Chair Senate Finance Committee) has proposed what we basically call “Universal Health Care.” I believe that the time has come for a single-payer system in the United States, and I wanted to post on the topic.

I had intended to include a lot of statistics. Everything from the unintended costs to human beings, medical institutions, and society in general when close to 50 million Americans do not have paid access to health care. A lot of comparative stats on how here in America, despite the “best” treatments available, our numbers for infant mortality, lifespan, chronic diseases, etc., place us well behind other industrialized countries, and in some cases, unindustrialized countries. And eventually, I’ll pull that data for you and post it.

I had wanted to make the case for Tom Daschle for head of HHS, based on his work in the field, and his dedication to making health CARE better.

But most of my weekend was taken up by something else. A micro example that in many ways makes the case for universal care. So everything else waits.

A little background. I have a friend. She is as close to me as a sister. Pretend her name is Glenda.

Last January, on a Saturday night, Glenda, her boyfriend, and I went to all-you-can-eat-pancake night at the local IHOP. On the way over, she and I had a good natured fight in the car about hair dye. At the restaurant, her boyfriend attempted to have a conversation with me about the upcoming election: 58 years old and he’d never been registered to vote. (It’s a long aside, but on November 4th 2008, he voted for the first time, and that January night at the IHOP, he made me list out all the states, and their capitols, because he didn’t believe anyone actually knew either of those two lists.)

On Sunday, she called me, complaining about how sick she felt. I pointed out that if I had eaten 4 plates of pancakes with butter, syrup and more butter, I’d be sick too. She made fun of the fact that I’d rather do anything than eat, we laughed, and I recommended she eat some peppermints, and I’d see her the next day.

Monday night, I took her to the emergency room. She was in terrible pain, and there was just something very, very wrong. By Tuesday afternoon, they had diagnosed ovarian cancer. On Friday, they operated.

Glenda is 60 years old; she’s worked full-time since she was 18. She has never done anything “wrong” – she never smoked, never drank to excess, eats low on the food chain, exercises, and has always lived a healthy life. At the time of diagnosis, she was between jobs and on COBRA. The surgery was extensive, and it was followed by chemo.

We applied for Social Security Disability for her because here in Pennsylvania, there is no extension to COBRA, and if one qualifies for Disability, and lives long enough, he/she can get Medicare prior to age 65. Stage 3 or 4 ovarian cancer (hers was on the line) is an automatic “yes”. The approval is automatic for her condition, and a list of others, because based on actuarial tables, there is not a huge percentage chance of living 12 months past diagnosis.

The chemo was successful in that she entered remission. “Remission” being perhaps the most cruel word in the entire English language. “Remission” means a lot of expensive tests to find any cancer resurgence as soon as possible. “Remission” means waking up every morning wondering if today will be the day that things go horribly wrong.

She cannot work, because she isn’t healthy enough to hold a job. Her COBRA has run out, so she must buy individual insurance. Most carriers will not accept her, or if they do, they won’t cover any cancer-related charges (including diagnostic CAT and PET scans) for at least a year, in most cases two years. If you have ever tried to find insurance when you have a pre-existing condition, then you know. If not, try to imagine living the book Catch-22.

Which brings us to Friday, 3 days ago. Glenda ended up back in the hospital in intractable pain. It might be a secondary tumor, it might be a bowel obstruction. The tests, so far, are inconclusive. One thing I have not mentioned, but which is relevant. Over the years, Glenda had a number of silent TIAs, which have caused a certain amount of minor brain death. In simple terms, certain parts of her brain can no longer process certain types of information. That, in combination with ‘chemo-brain’ means that she does not completely understand everything about her condition, nor the treatment options.

She is between insurance carriers. While her COBRA ended on 31 October, she could not get new insurance until the COBRA carrier issued a certain certificate, which they intended to not issue until 30 November. She should have been in the hospital a week earlier, but instead held on hoping she could convince the COBRA people to issue the certificate. She did not truly grasp the importance of treating things as quickly as possible.

In the hospital, she cannot be trusted to answer questions honestly: if she owns up to her pain level, then she will be given pain killers. She fears taking pain killers because she is afraid she will get addicted. She hates the side effects of the pain program. She fears if she needs additional surgery, she will end up homeless because if insurance doesn’t pay, the hospital will sue her and they will take her house. There is something morally wrong with this picture. A patient should not have to need to juggle the pain, the illness, and come to grips with dying along with the potential of crushing financial strain.

I am not her doctor, but I am her friend. I understand what the chart says, I understand “medical speak”, and I can translate to regular English. I can look her in the eye and tell her to say the truth: that it’s okay to do so, and make sure she knows that I am speaking truth to her. I can help with palliative care. I can make sure that the small things that bring her an ounce of joy are always available to her; her favourite cookies and hand cream, funny movies, a recap of the news. I can advocate for her. I can call the insurance company on her behalf. The single thing I cannot do is save her life.

I can, however, advocate for universal health care. I can ask you to call you Senators and tell them that the time has come for them to support the Baucus plan. Will it be modified as it goes through process? Sure. Does the plan address everything, including the intricacies of implementation? No, not yet. But it is a step in the right direction.

There are millions of people, right now, here in America who are dying, and putting off care because they cannot afford it. There are people with chronic illnesses like diabetes, high blood pressure, high cholesterol, asthma, and others who are not getting basic care, and will therefore need more expensive and extensive care when secondary problems set in. There are many people with severe mental and emotional limitations, who cannot navigate the current insurance programs, if indeed they qualify.

I could write for miles of column space of patients I have met who suffered terribly because they didn’t get care until it was too late, or almost too late, because they had no money and no insurance. Sometimes, these people died. Back in April, part way through chemo, and it was pure torture, Glenda requested an absentee ballot for the PA primary: she did not know if she’d live until the General, and wanted to vote for Obama because she believed that if he was elected, the world would change enough so that no one who came after her would have to worry about making the decisions she was making in the spring: medical co-pays vs COBRA payments vs. food vs. mortgage vs. breaking into her 401(k) which, even then, was losing value every month.

As a country, we need to fix our economy, change our standing in the world, re-affirm our Constitution, get out of Iraq, deal with global warming. The likelihood is that the Obama administration will start with the economy. The Baucus plan, coming from the Senate, aims to start fixing health care in 2009, without diverting the attentions of the administration from the economy.

For the millions of Glendas, let’s all work together to get this done. Now.