Ups and downs

I wrote a couple of posts ago about the passing of my mother. Before I forget, a few quick thoughts about what happened in terms of health care in her final days might be instructive. It was my first time through the process, and there was good news and bad news.

Mom had gone in for dialysis when a problem with her port was discovered. She was sent to a hospital for treatment and possible surgery. Fine. Some days later, the good people at dialysis noticed that Mom hadn't made her usual appointment and wondered what was up. So a staff member called the hospital to act.

A nurse there told the dialysis clinic that Mom was refusing treatment, food and water. That was a shock, so the worker called my sister and asked if the hospital had called to tell her. No, so my sister called me and delivered the same shock. In hindsight, I was a bit surprised that such an action didn't set off alarm bells all over the health care system. I suppose we would have found out something eventually, but it sure seemed like someone dropped the ball.

On the other hand, big credit goes to the dialysis clinic for taking action.

I had asked to speak with a social worker about the situation, in order to fulfill my mother's wishes. One eventually called a couple of days later, but she was amazingly clueless. She told me about plans for Mom's discharge, and that plans for physical therapy were recommended for my mother. I found that stunning.

Upon arrival in Florida, my sister and I smoothed out the transfer of Mom to a hospice. The people were there were absolutely terrific, making it as good an experience as possible. I must make a contribution when everything settles down.

Still, there was one last surprise the next day. I discovered the primary care physician knew nothing about the situation until his office received a fax about her death that morning. In fact, a nurse had been trying to track her down for a while.

Our health care system is big, and I expect things to fall through the cracks or act less than logically. Still, I'll try to remember that there are people that care, and care deeply, all along the way.

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Feeling ill

Here's the basic problem with health care reform in this country:

Something around three-quarters of Americans get good quality health care right now, and they don't want to change it. They don't want to go bankrupt in the face of a major medical crisis, so they are happy that they are covered through insurance via their employer -- even if they have to kick in up to 25 percent of the cost of premiums.

How, then, does anyone bring major changes to a situation in which a wide majority are satisfied customers?

You don't, at least not easily.

That strikes me as the key point in the discussion. When the Clinton Administration tried to make some fundamental changes back in the 1990's, it was shouted down quite quickly. This summer's debate has echoes of those discussions.

There are other factors floating around in the current argument. There is plenty of money at stake here, and the lobbying about where it might go -- particularly in the formative stages of legislation -- is frantic. That leads to misinformation about current plans.

I particularly like the idea that some sort of federal panel will decide whether you live or die under a proposed bill; the reality is that Medicare would simply offer counseling for end-of-life circumstances at least once every five years. It's an added benefit, not a death sentence.

But tell that to former Alaska Governor Sarah Palin, who issued a statement saying, "The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care. Such a system is downright evil."

Then there's the matter of the cost of any new health care reform package, which as far as I can tell is unknown at this point. Claims about the number, however, are all over the map, perhaps because nothing has been written in stone yet. We're a little leary of a government program that could, emphasis on could, cost billions and billions over the next decade, particularly in the light of recent government moves into private business like automobile manufacturing and banking.

Plus, there's still some left-over steam about the election from the right. You remember the talk last fall that Obama would put us on the road to socialism, and the usual media outlets are still blabbing about this -- again, without knowing what the final reform might look like.

Even those in good health in the current system, though, realize that we have some big problems. As Glenn Locke pointed out in his blog, you're only as secure as your job, and you may have learned just how secure you are in the past 18 months. There's the issue that some administrator in an office in Nowhereville can decide your preconditions disqualify you from health care, without your having an appeal.

And that doesn't include such matters as doctors who are so afraid of being sued that they order unnecessary tests just to cover themselves. Or of the poor who can't afford to get basic checkups under the current rules but have to get expensive emergency care that the rest of us end up paying for. Or people who lose insurance simply by moving to another state.

The idea of discussing all of this strikes me as healthy. A rational discussion about benefits and costs sure is a good idea. This Wall Street Journal article from today seems like a valuable addition to the dialogue.

But what has been shown at "town hall" meetings with representatives has been far less than that. Some of the citizens have come across as rude, uninformed, and unwilling to listen. It takes all types, which -- as I'm fond of saying -- is a shame.

It makes me a little ill to hear the nasty tone of the conversation. Good thing I have health insurance.

A salute

Sometimes vacations aren't always fun. For the past few days I've been down in Florida, checking up on Mom who was carted out of her home three months ago by EMT's and who should be back in familiar surroundings shortly.

Many of us have spent a little to a lot of time with loved ones in hospitals over the years, and there's obviously an urgency to the setting. I'm not as familiar with nursing homes/rehab centers. So spending parts of a few days around one is an eye-opener.

Just walking in the front door can be difficult. During the day, patients were often in wheelchairs, either waiting to be taken somewhere or just getting a little different scenery than their rooms. Every single one of them is a story of some sort, and probably not a happy one. You just don't know how many are ever leaving the building again, and how many ever have visitors.

But the uplifting part comes with dealing with the staff. These workers do things on a daily basis that the rest of us would prefer to avoid, thank you. And they do it with a constantly upbeat attitude. I can't say I encountered anyone that wasn't friendly and encouraging.

It's a tough job, and somebody's got to do it. It's good to get a reminder of that every so often. This is just another way of showing appreciation.