Wednesday, October 28, 2009

To your health

Health care is not really that complicated. Right now, in this country, there's three kinds of health care, the kind before you get sick, the kind when you are sick, and the emergency my kid just flipped off his bike and his brains are leaking kind. There's also a HUGE army of people who support all of these folks, the thousands of nurses and technicians. Some of them are overworked and underpaid, some of them are well paid and have great working conditions. In all of these cases, they are ALL required by every society. From the mountainous jungles of Papua New Guinea to the urban jungles of Chicago and NY, everyone has moments (or loved ones who have moments) when they need the services of a well trained doctor.

As I understand it, the first kind requires a small army of people who can diagnose, read pictures, are compassionate and kind and have time for people, enjoy being exposed to colds, flus, and the chicken pox, and who don't mind popping boils or checking on hemorrhoids. This group used to include people who liked to birth babies, make house calls, and be there with the priest (or Rabbi) at the end of life, but not so much now a days. Now it's more about prescriptions and vaccinations, but the idea remains the same. In general, the costs from these visits is reasonably low, with the possible exception of some expensive lab tests which can run into the thousands.

The second kind require specialists but they ALSO have to be good with people. They deal with cancer, lupus, MS, CFS, CP, benign brain tumors, endocrine fuck ups, and a hundred thousand other chronic problems that people suffer from. They have long term relationships with their patients, like the first folks, but they are also only seen BECAUSE you are sick, like the 3rd folks. This coverage is typically much more expensive than your typical well check or pap smear; they perform more tests, and may offer new, cutting edge science to help with specific problems. Their role is to improve the quality of life of people, as well as save lives and detect illnesses. Nothing easy about this job, folks.

So then there's the 3rd kind, which is kind of like the 2nd kind, except these are the smarty pants who will fix your daddy's broken artery, who shave bones, mend burns, and play Lotto with nerve endings. Remember Lotto? Ok. So these folks really don't have to have the people skills of the first or second group. They work fast and furiously to save life or limb (or both), and have no time to connect to the patient as a whole person, it's all about the brains leaking out of the helmet, or controlling the stroke that is currently paralyzing that sweet old woman from down the block. They perform miracles, or try to, and are the front line of our critical care medical personnel. This part is UBER expensive, requiring every resource available, including ambulances (by air, land, and sea), surgeries, medicines, anesthetics, tests, pictures, etc.

How do other places figure out how to include 1) everyone who needs medical coverage (that'd be everyone) and 2) all the people in the first and third, and as many in the second group as humanely possible (do you eliminate the cancer specialists? the endocrine specialists? the dermatologists?) without breaking the bank? Evidently, France is the #1 country for health coverage (Bismark system) in terms of statistics, but the Nordic countries for customer satisfaction. Australia and Japan both scored well for survivor rates, and many Asian countries for combining a private/public system that stresses diet and exercise (gentle, like tai chi) as a method for dealing with stress, aging, and genetic propensity for disease. In Canada, there are abundant sport and leisure halls across the country, very low cost or free for residents. They generally include skating, swimming, and have gyms where people row, step, or walk/run according to their ability. They don't need a membership to an expensive YMCA or gym, they just need to walk or drive down the road. Kids are 30% leaner there, parents do more with sport on a regular basis (ok, a lot of this is hockey, I know, but still - they are getting out on the ice and mooooving!), and honestly, there is more FUN to be had within the family doing stuff than sitting around playing video games! They GET it!

It costs less to keep a healthier population healthy. Per capita, we spend way more than any other country in the world on health care (about US$17,000 per person per year), where as it's closer to US$6000 in Canada and US$4500 in Australia (possibly even less in France, where Viagra isn't covered because, as we heard, ze franchmen zey do not need zis!). And we still don't get it right! Have you known someone who went years without getting checked at the doctor (did they say outright that this is because of money? My friends won't say it outright, but a $20+ co-pay for every doctor visit sure adds up!), or kids who don't get mental health assistance, or parents who don't get marriage counseling etc etc etc. This is a long list, and we haven't even gotten to people who can't afford cancer treatment, who don't test their blood or take meds for diabetes or high blood pressure. It does come down to being the one who is responsible for your own health (and of the health of the people whom you love the most - parents, children, spouses, siblings etc.). If you choose to slack off every day, eat junk, and don't eat healthy foods (meaning foods that assist your body in being healthful), if you choose to eliminate organic from your grocery list because it's more expensive, realize that that choice may have very expensive consequences. Cancer is SO freaking expensive. But that's a far away bridge, hopefully one you don't have to cross ever, but god forbid, and worse, it happens to your son or daughter, you will have to live and die with those burdens.
There is no easy way to shift from a system that seeks only to get ahead and earn the holy dollar to one that respects the integrity of life of all Americans. Mistakes are going to be made. But basically there needs to be a card that says "this is me, and I am entitled to live here and be healthy". A beaurocracy already exists, Medicare and Medicaid already care for so many Americans. Tightening up this ship, and making this coverage available to every single American is not that far away - but it does depend on the heartfelt charity of our leaders, reverence for a high quality of life, and yeah, a little elbow grease from your average shlump. I will send out this prayer to your health, because you are alive, and you, just like me, have a body that requires fine tuning. Not being perfect relates to our physical and non-physical bodies. As hard as it will be to figure this out, there is almost nothing more important to the health and happiness, the potential productivity, future economy, and greatness, of this incredible nation than taking care of ourselves 100%.

Monday, October 26, 2009

What we don't know might just kill us.

This may not be popular (amongst whom - only a few friends read this, and I don't really think they would care) in general society, but I think the flu is a good thing. I think death is a good thing. I think it's GREAT to be alive, to live, to share, to make love and jump off waterfalls and relax in a hammock. I think it's amazing to birth babies and raise puppies and eat chocolate. I love that we get to do all this in a country where I can choose whether or not to vaccinate myself and my children (in conference w/my amazing husband, who just *might* be reading this). I love how much information there is out there, how many things people can do to make this a better world to be a part of, and how we can share or withdraw ourselves as our moods sway. But I also think it's ok to go back to being part of that BIGGER something, that spiritual only realm that some call god and others energy and even others call Nirvana. I am not afraid of death, and all the people I know who have died (most of whom were old) were not afraid to die. They, and I, are/am afraid of SUFFERING. Medicine was once the realm solely (no pun intended) of retroactive care - I hurt, how can I fix this. Dentistry, surgery, oncology, even mental health are all predominantly in the realm of retroactive health care. GP's are one of the lone surviving groups who can and do care for people proactively, but they are the dying breed. So much of allopatric medicine is focused on specialized (retroactive) care, that the GP can't earn much in comparison. It's the garbage man (I mean sanitation engineer) of the medical establishment - that if you can't cut neurosurgery or handle the emotional weight of oncology, oh go be a GP. Sad sad sad. Dying now means not having to pay bills, take pills, get cleaned up by some nursing staff, be a burden to your family, get Alzheimers, or wonder whether you will fall on this trip to the bathroom, or the next. It's sometimes a blessing when you are in chronic pain and your option is to be chronically doped. It can bring peace to your loved ones and offer solace to those in constant mental pain. Fear of this unknown place, death, is not real, not tangible, but frightening in that something is there, in the dark, a monster waiting for me, kind of way. Will it hurt? Will I like it after I get there? Will I be alone? If we don't know, we don't know. That doesn't make it a bad place. Losing people (me, my children, my husband and parents and siblings included) is ALWAYS sad and hard, but it's not always bad. Selective use of that awful badness of death for children, for those who are murdered by terrorists or crazy people, for those who would never have chosen that outcome, feels appropriate to me, but let's let people die who are done with this place. It's not the only place, in all likelihood, we just don't know.

Tuesday, October 06, 2009

How much green
can a green thumb green
if a green thumb
just ain't

I spent the morning wiping O's nose, making soup, reading Olive Kitteridge. It wasn't the easiest read for me, and Orin was busy w/Legos. Come afternoon, regardless of the last 12 pages I have left to read, I decided to venture outside. Miraculously, his nose stopped dripping, we found the hedge clipper in the new back shed (duh, took me a while), and hopped to it. I hadn't gotten two bushes in, before the neighbor's lawn care professional showed up - possibly 19 years old - donned his mask, poured, walked, sprayed. I could smell it from across the street. So could Orin. Send him inside? Hope the wind blows? Resent? Leave a note? It was all so overwhelmingly disgusting to me that I sort of panicked and cut a little deep into the third bush.

Hard decisions are not normally a part of daily life. If we decide to get the chemo, it's not a big debate, usually. If we switch banks or buy a new window, it's not huge. Even the car buying grief I endured three years ago seems trivial next to the future health of my children, and their own progeny. Possibly prodigy. Not likely if we commit them to an earth filled with poison, worms who endure toxic spray multiple times per lifetime. We put up with the voles and moles, quite happily; they don't actually DO much beside tunnel and eat insects. What's not to like? Why do they need to inject poison to be rid of them? What are those people doing on their lawn that they can't have moles co-exist? There is only one old man, maybe beyond his 80's now. I am in disbelief.

It's not that I didn't know that my own neighbors were doing this all along - those bright yellow flags, undated, stick around for days and weeks after a spray. We can't walk the dog much for a few days. And I can really smell the stench of chemicals, like being back in the Greeley lab about a week before end of term. The flags are good - they let the unwary neighborhood traveler know not to get too close, especially those with canine companions. They let kids know that they shouldn't retrieve that football, just go play some tennis. They should be dated, they should be removed with some regularity. But it's better to have them than not. Except that they seriously raise my ire, bright spots of disgust in a world, currently, filled with scarlet maple leaves, scurrying squirrels, and clear blue skies. How to wreck a perfectly good afternoon? Watch that kid dump a bag full of nasties right in front of your lawn, in front of your preschooler, dribbling it into the street and onto your own lawn, while knowing that it is a truly unnecessary evil.