President Obama began his speech with a couple of stories. Here’s one: a woman’s insurance company denied her coverage when she was in need of a mastectomy because she’d neglected to report that she’d received acne treatment. By the time her coverage was reinstated, the cancer had grown. Eric Pape wrote a story for Newsweek about his wife giving birth in France, and how it differed from friends giving birth in the United States: in essence, in France, where health care is provided to all, they were not worrying about anything other than the baby. Contrasting their experience, Pape described friends whose childbirth choices were dictated by concerns about cost.
We all know such stories. My friend, Suzanne, for example, gave birth to two children, one in England, one in the States. She says that with the first, not only did NHS (National Health Service) cover the costs, she wrote a birth plan with her midwife and had six months paid maternity leave ahead of her, follow-up nursing care and automatic support from a lactation consultant; with the second, in our local hospital in Western Massachusetts, a bureaucratic mistake had the billing office calling her within two hours of her son’s birth, pulling her attentions from a joyous moment to a billing error.
Beyond the science of understanding how the human body works, most of medicine is essentially experienced as a series of human stories. Sometimes, those stories have dramatic arcs—someone falls ill, the cause is unknown, the cause is discovered, a cure is given, health returns—and other times, less so. In May, the good doctors at County in Chicago went off the air; those docs on NBC’s long-lived ER revealed medicine as a series of dramas for fifteen years. The people they treated were very often without resources—homeless veterans, people living in housing projects, single parents, the elderly—and they came with stories. The overworked, underpaid, shot at, yelled at and vomited upon very fine doctors and nurses continued to work at the ER not for money or comfort, but to serve people. It sounds trite, perhaps, to bring them up, but I found myself thinking about them this week. Each week, they reminded millions of us that medicine is about helping people. The system that actually can care for all patients won’t consign unwilling docs to County nor will it be open loads of opportunities for high-priced plastic surgeons.
Because there is a bottom line here: when seeking medical attention, anxiety over the cost of treatment itself seems like it should be the least of one’s worries. We all know that private insurance alone does not guarantee a lack of worries about costs (anyone who has spent the full-time job it is scheduling appointments and hassling with insurance issues during treatment of an illness—when available energies should go to, perhaps, healing—knows Blue Cross or Tufts or Pilgrim are not necessarily your allies in recovery). Equally, insurance alone isn’t enough to help anyone through a medical odyssey: there may be leave time involved, items not covered by insurance to acquire, and if there’s discomfort—from something as common as mastitis for a new nursing mum to risk of infection from stem cell or bone marrow transplant—there may be additional costs—as inexpensive as a cabbage leaf, as pricey as a detailed and professional cleaning to take out all possible contagions to all things in between. Single payer coverage won’t bring you a professional house cleaner or a cabbage leaf. What single payer coverage—if truly accessible for all—will really do is provide preventative and well care across the board, assuring that every person has access to the mammogram and the vaccination, the colonoscopy and the blood sugar test, and that a terrible cough does not go untreated until it mushrooms into pneumonia. All this, to my mind, should go without saying. And yet, it’s far from the reality for an increasing number of Americans. Feeling like ticking time bombs is much closer to the truth for thousands more each day. Even with insurance coverage, given all the particulars insurers refuse to cover, more of us—both insured and uninsured—are living very dangerously. The system, as it works now, is not sustainable for either those able to purchase health insurance or those without it.
There’s more than a bottom line here, too: we can choose to live in a society that operates every man for himself (and it’s undoubtedly a phrase that cannot be made gender neutral, given how, with this ethos, women and children are overridingly left vulnerable) or we can choose to live in a true democracy (synonym: social equality). In a democracy, as I understand it, we look out for one another. The whole votes… a collective, as in, “we the people,” ensures that our children receive access to shelter, food, health care, and education, this because “we” do not want to leave any children behind, not even one.
President Obama quoted Ted Kennedy’s achingly beautiful and inspiring letter to him, written in May to be delivered to the President upon the Senator’s death. In it, said Obama, “He repeated the truth that health care is decisive for our future prosperity, but he also reminded me that ‘it concerns more than material things.’ ‘What we face,’ he wrote, ‘is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.’"
When I talk to my children about what they want from life, the adult version, I encourage all of their dreams. Yet, I hope—to the extent that we live a life engaged in our concerns for others and for the environment—our sense of being part of a compassionate society—and being active participants in making the world better for all—comes through. It is most certainly what I hope their President and representatives talk about and how they legislate. What I hope my children will grasp about this era is that government supports public good rather than exploiting public good for private gain.
Remy, my six year-old, has watched entirely too many (yes, wholly inappropriate) “doctor shows” with me while I am exercising on my elliptical machine. He’s seen those ER docs in action (he hides his eyes for the bloody parts) and appreciates the staff as helpers to people in need. We spent the summer enjoying the far less graphic fantasy world of Royal Pains. It’s about a nice Jewish ER doctor fired for saving a black kid rather than giving VIP treatment to a hospital benefactor; our guy, Hank, finds himself unintentionally ensconced in the tony Hamptons as an earnest concierge doc for the summer. Hank is kind of like the doctor version of MacGuyver, able to save people with common household items. Remy sees the excess of the Hamptons’ mansions, and the grounded good-heartedness of our nebbish-y doc and his silly puppy of an accountant brother. Until Hank, Remy most enjoyed Grey’s Anatomy. Why not? At Seattle Grace, the doctors seek out the most interesting cases and they love one another. There, medicine is involving and not always all consuming, even when it sucks up most of your waking hours. May my children find—in whatever they do—a happy middle ground between the worlds of ER and Royal Pains.
Opponents to health care reform—the same people proposing less aid to women and children, less monies for school lunches, less support for schools—place a higher premium upon bootstraps, as in pull yourself and yourself alone, up, and less in the kind of generous society that emphasizes caring for one another and compassion over profit (even within a capitalist system). The fear of big government has paved the way for privatization of the sort that’s yielded ridiculous profits coupled with inferior services. Those who support smaller government have bandied about insults and threats freely, from taunting crowds by carrying guns openly to calling our President everything from a non-American to a killer of elderly people; the worst thing about this name calling and harassment is that no one has stood up tall to say, simply, “Stop bullying us.” It’s like the research on bullying in school settings that identifies the onlookers as the group that most needs attention, in order to comprehend that simply watching such menacing behavior without voicing your opposition to it is tantamount to condoning it, but that you can have a voice, you can take a stand. And that is really what’s needed here. We need to trust the sincerity of what’s right. And this week, I think President Obama took an important step in that direction.
President Obama: “We did not come to fear the future. We came here to shape it. I still believe we can act even when it's hard. I still believe we can replace acrimony with civility, and gridlock with progress. I still believe we can do great things, and that here and now we will meet history's test.”
