Wednesday, August 12, 2009

Health care--not spirtual

Who will explain to angry people that leaving their healthcare alone is not the answer? Who will explain that insurance companies give you the illusion of free choice, not the reality, and that people can't buy health care rationally the way they choose a brand of laundry detergent? That behind the scenes, doctors and hospitals and other providers of health care make all kinds of financial deals that have everything to do with maximizing profit and that providing good quality care is not consistently a byproduct of that process?

I am frustrated this morning by an insurance system that tells an old friend, in need of follow-up care after a serious mental health crisis, that she must see a new doctor a half-hour drive away from her home instead of going to an office six blocks away to see the doctor who knows her case well. This is crazy, and it is making her crazier than she needs to be right now. The New York Times this morning has an article on outrageous doctors' fees -- actually on a survey of doctor's fees conducted by America's Health Insurance Plans, an organization representing insurance companies. I'm imagining a press release headlined "Don't blame us--it's their fault!"

How can we fix something as complicated as healthcare when the public discussion deteriorates to a level where a proposal for Medicare paying for someone to help people make a living will is twisted into a "government death panel"? Most of the people screaming about this would probably acknowledge that at the end of life they don't want to be kept alive by a bunch of machines and tubes and that hospice care is a good thing. If someone supported them in writing a living will, they could control their own exit from this world. Yet the truth is distorted.

We live in a very complex world, where it takes some sophistication, some appreciation of both rationality and irrationality to understand the banking system, the health care system, international politics, government budgets. Yet we have these visceral debates. On the one hand, don't tell Sarah Palin that baby Trig does not have quality of life. On the other hand, don't raise anybody's taxes so that state governments can provide adequate services for people like Trig with developmental disabilities. (Disclaimer: this blogger has an eighteen-year-old child with Down syndrome.) This is a democracy, yes, where Senators and Congressmen work for the people who elected them. But the Founders, steeped in the Enlightenment, never imagined an electorate or a world like this.

Or did they? There was rabble and the fear of mob rule when the American republic was founded (and the populist, ignorant outcry against rational reform of the health care system is a kind of mob rule). The Founders believed that better minds could prevail, that elected officials could make good decisions, that collectively we could act in society's best interest.

It would be easy to watch this all from the sidelines, make cracks about the stupidity of angry white people of certain economic classes, and shake my head sadly about the whole mess. But I think I'm going to have do better than that.

For starters:'s "Top Five Health Care Reform Lies—and How to Fight Back."

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