Thursday, June 18, 2009

Health Care: The Tipping Point

Until I was old enough to qualify for Medicare, I couldn’t afford to get sick. And I was lucky. I stayed well enough to avoid doctors and hospitals for nearly 35 years.

But in early May, 2008, my luck ran out. I began to experience chest pains that didn’t ease up or go away.

I reported to the nearest hospital emergency room with my Medicare card in hand, and, after nearly three months of less invasive treatments involving four separate hospital stays of several days to a week, the doctors operated to replace a mitral valve in my heart, whose damage they described as “moderate to severe.”

Now, a year later, I’m doing quite well. I could say I’m my old self, except I’m really not. I’m more like a modified version, altered in both body and mind. Serious illness has a way of reconstituting your consciousness, for better and for worse.

As my ordeal wound down and I began to realize, to my great joy, that I was physically able to resume a normal lifestyle, I made a rough tally of all my hospital and doctor bills, which had cost me around $4,000 in co-payments, not including prescription drugs and living expenses, during the four to five months I wasn’t able to work.

The total bill was in the neighborhood of (for me) the staggering sum of $150,000. And by now, with all the follow-up visits and maintenance tests I’ve gone through since, the total is probably a few thousand higher.

What would I have done without Medicare?

Since 1974, supplemented by an array of part-time jobs, I’ve made my way in the world as a writer and actor. I had health insurance for one year only, through Actors Equity Assn., but, not in the habit of going to doctors, I never used it. The rest of the time, until Medicare kicked in, I had no insurance. The times when I could have afforded it were sporadic and usually brief. If I’d bought the insurance then, I would have had to drop it soon after when my job situation changed.

I could be faulted, I suppose, for my career choice. Actors and writers, unless they make it big, which happens for relatively few, don’t earn much money. But is that a capital offense? A great many people in this world don’t earn much money. Does society mean to tell us that if we get sick it’s our own tough luck?

I mention all this as prelude to my thoughts on the health care debate, which every day is looking more like total war as passions stoke up in Washington.

In one way, I’m a dispassionate observer, since I now have health insurance through Medicare (without, however, any supplemental or pharmaceutical coverage). That’s not too likely to go away.

In another way, though, I am not dispassionate because I have an interest in a different—and I would say “better”—society than the one I’ve lived in up to now. And there’s much more to the topic of how to improve health care than the question of who’s going to pay for it and how.

For example, is standard western medicine, which depends heavily on prescription drugs and surgery, the best model for keeping us healthy or the only one to be recognized for funding?

Does our polluted environment or manufactured food, laced with salt, sweeteners, fat, and mysterious chemicals, play any role in ill health, and, if so, who’s liable for it?

Are our doctors trained to treat whole human beings or just body parts?

Are there mental and spiritual components to health which we can learn to activate for healing without medical intervention?

These questions connect fundamentally to our health care. They also probe assumptions at the heart of our western social contract and philosophical understanding, such as the superiority of science, technology, invention, and industrial mass-production over more organic, intuitive, and folk-based approaches to healthful living.

But they are not part of the debate. We’re focused instead on figuring out how our present system can be organized to take satisfactory care of the most of us for the least amount of money.

Despite that limitation, the system we finally come up with will reveal the kind of civilization we collectively represent. That alone makes health care a crucial issue, perhaps ultimately the most crucial issue of our time. It puts us at a tipping point in our evolution.

For while powerful insurance and pharmaceutical companies move in to remind our elected officials what those enormous campaign contributions were for, the evidence keeps piling up that, unless the gothic monstrosity of a health-care system we’ve been used to is fundamentally changed, there won’t be any health care reform to speak of at all.

And that would not only be very telling. It would be tragic.

Up to now we Americans have been the culmination of a proud western culture which, for far longer than anyone can remember, has advanced itself through the politics of war. War is very expensive, but only a few dare argue that it’s not necessary or that a country should not be prepared to wage it. For that reason we don’t question that we must pay for it out of the common treasury.

Health care is also expensive, but not as expensive as war and apparently not as necessary either because we’ve not been willing to pay for it collectively, as we do for our “common defense.” In fact, while we increase what we spend on war by billions every year, we protest that any plan for universal health care would run us into bankruptcy.

Meanwhile, since the 1960s when Medicare and Medicaid were mandated, we have provided health-care funding for the elderly, the disabled, and the poor. Building on the establishment of Social Security in the 1930s, these programs are significant departures from the rugged individualism enshrined in pure capitalism. They affirm a place for compassion in our competitive, sink-or-swim social contract.

They have also been under continuous attack ever since they were adopted, subject to consistent pruning of benefits in the name of “fiscal responsibility” while the present system of private insurers generates huge profits, even as increasing numbers of our citizens are uninsured.

However, health care by its very nature is a compassionate pursuit. I noticed this when I was in the hospital. The great majority of nurses and nurses’ aides and also some of the doctors carry an aura of selfless caring for others that seems to be the hallmark of the healing professions and a common bond among most of their practitioners.

War, on the other hand, while not excluding compassion, is hardly dedicated to it. If it were, there might be less war, whose foremost objective is to make an enemy suffer to the point of surrender. This purpose conflicts with the primary objective of health care, which is to relieve suffering.

We now spend trillions of dollars on war. To make a meaningful commitment as well to health care for all is to set the stage for a reordering of priorities. The argument for compassion then begins to have some weight against the age-old cry for battle, if, indeed, we can’t pay for both at our present rate.

Should we, as conservatives argue, leave health care to the private sector—meaning the for-profit insurance industry—which will then charge the government for the shortfall of those who can’t afford it?

Should we adopt a moderate plan, bringing the government into the system as a competing insurance agency which, because of its non-profit status, will force costs down for everyone?

Or should the government become the only insurer under a totally not- for-profit, single-payer insurance agency providing Medicare for everyone, as many health professionals themselves argue?

If, in the final vote, we decide that all of us must have access to the health care we need, recognizing we must all share the cost, we will have embraced compassion as an important national value. Giving compassion that sort of recognition will signal a change in our group consciousness concerning what’s important in a society. And if we persist in a commitment to that change, we will begin to ask ourselves how much of that Pentagon money could be better spent on the practice of compassion than on the politics of war?

As Abraham Lincoln said, a house divided against itself cannot stand. Once a nation makes a firm commitment to compassion, it will find it simply can’t afford to indulge an excessive appetite for war.

That’s the tipping point. Either we’ll take a step in our evolution toward a more refined civilization, or we’ll fail to take that step and be washed away in just one more of history’s repeating nightmares of empires rising and falling in blood and tears.

Is that all we can ever be?

How we decide health care will tell us how far we’ve really come, and how much farther we’re likely to go, in creating a sustainable civilization rather than one which consumes itself in endless wars.

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