Monday, July 20, 2009
After 16 years of elder-care responsibilities, Kay and I have entered a new era in our lives in which all the family members of our parents' generation have now gone to be with the Lord. With the passing in May of the sole survivor at 102 that makes us now a part of the oldest living generation in our families.
During those 16 years we had our own health issues as well as had to watch over the health care needs of six different relatives. That gave us a lot of first-hand experience with America's health care system. We learned many lessons—much of which is now being played out these days in the national debate on health-care reform.
I am rather amazed at how some of the conclusions I reached during the past 16 years—that health-care reform is absolutely necessary—are now center stage in the public health-care reform debate. My positions on this issue track better with the Mainline Protestant denominations than with my historical Evangelical roots. Sadly, the two groups are severely polarized today on this issue, with the Mainline groups lining up for reform and the Evangelicals running pitched battles against it. Rather than looking for the "right" position or the biblical position, unfortunately today's Evangelical leaders seem unmovable in their allegiance to any position the Republican Party pronounces, including medical-care reform.
Take, for instance, the matter of the primary-care physician, a centerpiece in the reform discussions. Over the years we've chauffered elderly loved ones to just about every specialist you can imagine. But their primary-care physicians always remained our favorites. They were there through thick and thin, through one illness or trauma after the next, while specialists entered and left the stage in a dizzying cycle. Managing the medical bills for most of our crew, I always noticed one consistent fact: how much more the specialists got paid when contrasted to the primary-care doctors. And ofttimes I couldn't figure out why. I also wondered why we had to use specialists instead of requesting that the primary-care physicians treat all matters.
On a repeat visit to one specialist, the doctor asked our elderly loved one to hold up her hands and move her fingers back and forth. That was all. Very little conversation. No new prescription. Just show me that you can move your fingers. "Take Tylenol if the arthritis flares up again," the doctor said. A total of two minutes in this doc's presence. The bill: $200.00, most of which Medicare and her supplemental insurance policy paid and which was more than double what the primary-care doctor would have charged.
My favorite story about a specialist involves a young ob-gyn physician who was called in to evaluate something unusual on a hospital x-ray. Apparently he'd never before seen a partial hysterectomy, which was popular back in the 1940s—his grandmothers' era. He puzzled over what the remains he saw on an X-ray could be. Then much to everyone's surprise he recommended our elderly loved one start taking hormones to see if her long-dormant menstrual cycle would start again. Quipped the loved one, "Young man, don't you realize I am nearly 100 years old; that's the most ridiculous idea I've ever heard! We are absolutely not going to do that." The displeased doctor stomped off, leaving all of us in the room laughing and me dialing my cellphone to ask the primary-care physician to make sure the "specialist" was released immediately from the case.
Just because a doctor can do something and it's covered by a medical insurance doesn't mean he or she should do it! Common sense needs to prevail.
Besides the inequity in the payments to the primary-care physician, what I remember most were:
1. How a single-payer system would certainly save trees and lots and lots of confusion and time on the part of the individual and/or his/her caretaker. The blizzard of paperwork I had to sort through trying to make heads or tails of all the medical bills and all the paperwork doctors, hospitals, Medicare and the insurance companies could generate was ridiculous.
2. Clearer, simpler rules certainly need to be mandatory. Medical rules and mistakes today can be extremely confusing, contradictory, and very costly. For instance, doctors often forget to mention things such as Medicare's requirement that the oxygen level be 88 or less for Medicare to pay for oxygen—while nursing homes require doctors to unprescribe oxygen before they will remove it from a resident, even when their oxygen level returns to normal. So, guess who pays when oxygen is provided that Medicare and insurance companies say is not necessary and won't cover?
3. Health care ought to be a right rather than a privilege. Today money buys health care. Mention that an elderly person has both Medicare and a good supplemental health insurance policy and adequate resources and no doctor blinks twice at signing up the person for anything. And I mean anything! No test is spared when the financial formula is right. (Contrast that to a time more than 20 years ago when I was unemployed and without health insurance and a medical secretary demanded advance payment immediately for a minor checkup!) Ethically money should not be the determining factor in deciding whether someone gets medical care.
4. Clearer, cleaner, less how-much-money-can-the-medical-community-make rules are needed for end-of-life issues. A medical directive, medical power of attorney, and living will are all absolutely necessary today in order to avoid costly, unnecessary medical intervention. Medical personnel will bombard a dying loved one with every medicine, idea and device they can possibly think of regardless of cost, practicality, or reasonableness until someone screams "Enough is enough is enough!" Medical decisions need to be based on what is right, not on how much money medical institutions and personnel can make off people and their insurance providers at the end of life.
Do we need health-care reform in this country? Absolutely! The National Council of Churches recently rolled out an impressive array of religious leaders in this country who say the time is long overdue for a revision. On this particular issue, these religious leaders clearly are pointing in the right direction. They need to be heard.