Sunday, January 15, 2017

Public Service and Health Care

Public Service, and Health Care

One of the things about being in health care, is that sometimes we are too close to the center, and cannot see the forest for the trees.  Another problem is when we get defensive about our own part of it.  What I want to focus on is that there was a general public WILLINGNESS to get to universal national healthcare.  It got subverted by the insurance industry.  But the WILL to do real national healthcare is probably actually coming forward more, now that we have some evidence of what it can do, even in this imperfect system where the pharmaceutical industry is outside of the running of the thing, and the insurers take a lot of money out of the system to give to stock-holders on Wall Street.

If we are serious about healthcare we should be able to marshal the whole country, including all the parts of healthcare, to the goal of "the common good".  We had another good indicator when the Mental Health bill passed, with bipartisan support.  People with mentally ill relatives really worked to help get that bill through congress.  We need vastly improved services for the mentally ill, and the truth is that it is part of healthcare, and should not be run mainly by the jails and the criminal justice system.

If patients, nurses, doctors, and families all come together, we should be able to pass universal healthcare.  What we need is to stick together, not to have side-deals and back-room carve-outs.  We also need to remind ourselves that the TAXPAYERS are footing the bill, and we owe it to ourselves as taxpayers, to have the most streamlined and most effective system, the biggest bang for the buck.
We who are on Medicare have been paying into the system with wages earned and taxes taken out of our earnings, all our working lives.  Social Security likewise is something we have PAID into, out of our earnings.  It is NOT an entitlement, as some of the congressional representatives have made it out to be.  It is solvent, but it will be more solvent beyond 2028 if we raise the cap so that upper income earners also pay into it.

The truth about the Health Savings Accounts is that no one has that much discretionary income. An ambulance ride is over a thousand dollars, and the visit to the ER might be between 5-10k.  Women have  a 1/5 chance of miscarriage and hemorrhage, and need access to hospitals.  Hospital stays are usually greater than 10k/day.
Pregnancy and childbirth are a big expense.  In California, about 50% of childbirth is being paid for by Medi-Cal, which is Medicaid for our state.
Family Planning is an important piece of the puzzle of healthcare.  No one wants to see schoolgirls pregnant.  We want people to get an education.  We also want parents to have skills and maturity in dealing with the difficulties of childrearing.    Family planning needs to be part of healthcare, and it needs to be covered so that people with no discretionary income can get it, and not get pregnant until they are ready.  There are many kinds of family planning and we need to give women access to care, so that the one that fits them best is available to them.
Screening and public health programs are really important.  Our public health departments respond when an outbreak of meningitis or flu, or any epidemic occurs; like AIDS, Syphilis, Swine flu, diseases which can wipe out whole populations.  They try to teach and show people many ways of preventive health and self-care and maintenance tools.  This is becoming even more important as more Americans are obese, sedentary, and have diabetes and heart disease.
One of the lesser pieces of the puzzle is that doctors need to be well-paid so that they can stay ethical and devoted to the healthcare of patients.  When doctors go bankrupt, or commit suicide, or the business fails, we lose valuable expertise.  When doctors can't make enough money to own a house or have a family, there is something really wrong.  Many of our doctors now are coming out of training with immense debt, which means they can't live the next part of their working lives in a good frame of mind, with generosity and compassion.
Just like the people who are coming out of college with massive debt, doctors will end up choosing to do something which pays enough to be allowed to have the life they want, instead of choosing to serve in underserved areas or in populations at risk.  In my generation, many doctors dedicated themselves to care for AIDS patients, because we came from an idealistic framework.  John F. Kennedy said "Do not ask what your country can do for you, but what you can do for your country."  Many doctors, like me, joined the Peace Corps, or Vista, or went to an underserved community in order to "give back" and to "pay it forward".
We all need to work together, as a country, to get to real healthcare reform.  We need to push through the obfuscation and resistance.  We need to stick to the main ideas, and "hold hands as we cross the street".
This is the greatest nation on earth, and we can do it, but we have to work together.  We have to have the vision and determination to bring it to fulfillment.  When FDR passed the big reforms which allowed us to begin to have social buffers, it was watching the faces in the pool with him at his Polio rehabilitation place in Warm Springs GA which gave him the pleasure and joy of being of true service.  Watch the film clips, and you will see it.

We need to have what the ACA promised; a program which would not kick you off when you got sick, would not eliminate you for pre-existing conditions, would cover you through the beginning of young adulthood and hopefully employed and covered by insurance in your employment.  We need family planning without co-pays, and we need bargaining power for medications so patients can afford to take them and stay as healthy as possible.  We need a FEDERAL program, not block grants to states.  We need federal money to cover the costs for the program.  It should be evenly distributed from sea to shining sea. Prudent financial sense means we also should get the best deal we can for ourselves as taxpayers.  Oversight by federal administration has to be built-in, with accountability and transparency.
Congress should be working to get funding for this universal national healthcare.  When taxpayers see accountability and  transparency, and funding well-spent, although we may grumble, we will pay the taxes.
Many of us are Christians.  Today in church we were singing a song, which brought in that line from Jesus, quoted in the gospel of St. Matthew;  "whatever you do for the least of these, you do for Me."  Our nation was built on that consciousness of the call to be servants to each other,  to be friends to each other.
We must be committed to service to the common good, to the care for the poor, the elderly, the children, the vulnerable.
Our Constitution says "in order to provide for the general welfare... and to care for the common good".    These are the foundational values in support of national universal healthcare.  Every other developed country on earth has managed to get there, and we should get there too!  

Wednesday, January 4, 2017

Christmas as the Birth of a Baby

Christmas reflection: I always come back to the fact that God chooses to come as a baby-- a just-born infant with eyes opening onto the big wide world--- and it fills me with such intense awe--- that God comes without words or dogma, in human skin-- baby skin, which smells heavenly-- and in those tiny hands and feet, those big eyes, full of wonder. And such vulnerability--- no armies of angels in full battle gear! God is willing to come to us, to let us be abusive parents, in all our self-absorbed egotism; God lets us fail to see the miracles. He waits for us to get it. He lets time spin out like yards of ribbons, or like the blown dandelion seeds in the dry summer--- waiting for us to come closer to the moment when we hold the baby in our own arms, let it fall asleep on our shoulder, or nestle it against our breast.
No other religion really focuses on the human baby. No other religion really brings our attention to the quality of our parenting a baby-- the thought of Joseph taking Mary into his home, because an angel told him to. How Mary and Joseph together raise this child, in the hidden years--- and hide him from Herod and the slaughter of the innocents. Most religions start with a person in adulthood, exhorting us to connect our spirits to the Great Spirit. But Jesus is also that baby. He is coming in the most vulnerable, innocent, helpless way He can, to let us possess God, in the child.
Last night we had singing carols before Mass. A guy with a great voice sang "Mary, did you know that your baby boy..." with several verses. It makes me cry. I think that we do not know. We certainly do not know that our children are going to be piercing our hearts with sorrow and fear. We think they will bring us joy, and we hope they will bring us honor. We do not want to consider the way of the cross. We certainly cannot contain, in our becoming parents, the suffering likely to come, as our children move forward toward God in their own journeys, falling and failing as we have fallen and failed. And yet, Jesus has given us the path, shown us, in a few brush-strokes of the story, what we must endure. "Did you not know that I must be about my father's business?" Even if the child does not know it is about his father's business, even if he thinks he can do it with his own WILL, God will be the alpha and omega of his path. We are in our orbits, like atoms, on our pilgrimage toward the God who made us. I have walked the labyrinth with this so clearly in mind-- that I am being called back to the center. The still-point in time, the mystical rose, the existential moment, the Eternal NOW. And my child is also called, though he does not know it clearly, is not watching for signs, is not following the stars, is not sure of his way. And maybe that is also the point. We see the stars, we begin to watch for wise men, we begin to hear the message in a deeper way, a new way. We begin to think it is amazing and miraculous that shepherds were the ones to see the glory first. We begin to understand that you have to be cold and lonely and outside at night, to SEE the stars. And that when you are watching the stars, you begin to hear choirs of angels! And that you have to listen to your dreams, like Joseph did. It is amazing that the messages that come in the dreams are the most important guides to your life. And that the baby will be born without a safe place in the world, because God is always being born in new and amazing ways, outside the ordered world, outside the circle of power and influence; NOT born to the Rabbi; NOT born in the Temple precincts or the palace. The whole thing is amazing. The whole thing calls us to be filled with wonder and awe. I circle around it again, and am glad I was able to sing along, in the cold night, in our everyday community, filled with people struggling to be good; with those dear carols I have loved all my life--- especially the one which says "gloria in excelsis Deo!"