Good and Great

Watching the health care debate, I feel humbled. Each of the many sides presents articulate and compelling arguments. I'm critical of Dennis Kucinich and Eric Massa for voting against the House bill, but I grant that I'm touched by their objections. Same with the Republicans and the Blue-dog Democrats whose concerns about the cost of the program are not to be scoffed at.

As a moderate, I am grateful for those who stand to my left and to my right. The former give voice to the compassion and indignation we feel when the humanity of the poor is assaulted. The latter demand that we not forget what the years have taught us about human culpability.

Bertold Brecht, a Marxist, grappled with the dilemma of charity versus prudence in his farce The Good Person of Szechwan. In it, a woman protects her small business, while serving her charitable impulses, by appearing alternately as her compassionate self and her strictly frugal cousin.

Willy-nilly, the insurance companies play this dual role today. Sometimes they are heartless; sometimes they serve us almost too well. But for those who believe the real problem lies in the fee-for-service structure of the health care industry, insurance companies potentially can be an ally in effecting change. The trick is first to get everyone covered.

I place my hopes on long term development rather than sweeping re-invention. It will take time. The House bill is a start.

The Art of Healing

Permit an analogy. When Thomas Eakins painted The Gross Clinic, he meant it as a tribute to the advent of corrective surgery. The canvas is of heroic dimensions and the composition is classical, with the doctor attending and lecturing in a halo of light. Dr. Gross doesn't merely hold a scalpel in his bloodied hand, but the future of medicine.

Looking at this scene today, however, we are more likely to recoil, like the woman on the left. The physicians are in street clothes and there is no attempt to keep any part of the procedure sterile. We don't see the future of the healing arts, but their crude and brutal past.

Today we are faced with reforming health care in America, and as the President told us last night, we are the last developed democracy to do so. We have a system that permits insurance companies to cherry-pick their clients, charge wildly varying rates, deny benefits in bad faith, and circumscribe doctors. And yet, a vocal minority in America resists change.

It's difficult to know what part of the present system conservatives are trying to protect. Perhaps they believe that medicine will become more impersonal, more vulnerable to political machinations, maybe even more expensive. Perhaps they're simply frightened of the unknown the way all of us fear doctors and hospitals.

I think the present system is untenable and will one day look as primitive as Dr. Gross and his operating theatre. Change will come. The question is: will our nation be healed by it, or overtaken?

The Gross Clinic by Thomas Eakins, 1875; 8' x 6.5'. Click on the picture for a closer look.

Seven Thoughts About Health Care

1) The critics are right: government run health care is a thing to be feared. I see the VA hospital system as an example. My treatment by a VA dentist resulted in permanent damage to my jaw. He was a nice guy, but I'll bet he graduated last in his class and that's why he was drilling for the government.

2) A government run health care delivery system would be vulnerable to political influence in hiring and promotion, supply purchases, location and construction of facilities, maintenance contracts, transplant waiting lists, perhaps even triage.

3) And can we ever forget those rats that infested Walter Reed?

4) But Harry & Louise type critics are disingenuous when they claim that health care reform will insert bureaucrats between the doctor and the patient. The bureaucrats are already there, courtesy of the insurance companies, and they're ever alert to rationales for denying benefits to the sick.

5) If we don't address the problem, health care will bankrupt us. I noticed in my recent out-patient surgery that there were nine profit centers in for a slice: the surgeon, the anesthesiologist, the hospital, the medical laboratory, the hospital pharmacy, the retail pharmacy, my physician and his medical group, Blue Cross-Anthem HMO, and a sub-contractor whose sole function was to process the paperwork. Mind you, in this case there was no assistant surgeon, no imaging or diagnostic testing, no physical therapist, no nurse-practitioner visiting my home, no prosthetics, and no hospital stay, just to name a few items that could have ramped up the cost.

6) I still get solicitations from insurance companies for cockamamie policies that target single diseases, such as certain cancers or "death and dismemberment". Such policies turn insurance into a crapshoot wherein the client bets on how he is most likely to die. They don't tell people that the number one cause of death is heart disease, not cancer, and that the most common debilitating ailment is back injury, not amputation.

7) I have three good friends walking around right now with no insurance and no prospect of ever getting insurance due to pre-existing conditions. I say three, but I fear the real number is much higher. Having no insurance is not something people want known.

Sketch for "The Pharmacist" by Norman Rockwell, 1939. Click on the picture for a closer look.