Health care mandate in the United States

At a health care town hall last year, our representative said that US citizens have not given Congress a mandate for health care.

I raised my hand. “I beg to differ. The mandate is already law. The law says that no person in the US can be refused care at any emergency room. We have the mandate. Unfortunately the emergency room is the most expensive and cruel and last minute care that we could possibly choose.”

Expensive: any ER visit costs more than a whole day of visits to my rural family medicine clinic.

Last minute: the emergency room doesn’t do chronic care. Their purpose is to 1. try to stop someone from dying and 2. decide if the person should be hospitalized or should follow up in clinic. They do not do prenatal care, treat high blood pressure, treat diabetes, depression, high cholesterol, alcoholism. They do not do chronic care and aren’t meant to.

Cruel: you can go to the emergency room to try to keep from dying. Say you go coughing blood. They find a lung cancer. Now, you have a choice: be treated and maybe you will survive or maybe you will die anyhow and your house will be sold to pay for the medical care. Do you choose to go home instead and die so that your family inherits the house?

The United States spends twice as much per person as the next most expensive health care system in the world and they have universal health care and we don’t. We care more for corporate profit then US citizens and visitors health. I cringe when the discussion is about health INSURANCE not health CARE.

I am a physician but I also own my own business. As a small business owner, I think that I will soon have to close. Why? I am in my 50s with a daughter. I think that within two years my HEALTH INSURANCE will cost more than I pay myself. And I will close the clinic.

We need health CARE not health INSURANCE. The Obamacare law said that health insurance companies can ONLY keep 20 cents of every health care dollar they collect, down from 22.5 cents. They have to spend 80 cents on health care. For medicare the overhead is 2-3 cents per dollar.

Medicare for all, single payer. Put 97 cents of every health care dollar to health care instead of only 80 cents. Or shall we continue down the road to small business and local government collapse and citizen health collapse?

Congress, you can’t wheel and deal your way out of this one. We want health care for our dollar not insurance.

For the Daily Prompt: wheel.

Dream log: June 20, 2017

I am with my father and my sister. My mother is not around. I am not sure if she’s gone or dead. Dead, I think.

My father has gone off. My sister is 3 or 4 and I am 6 or 7. I am taking care of her. We are at a park and I am trying to get food. It is Thanksgiving. It is not cold, it’s warm. There are large family groups at picnic tables.

My technique is to move in on a family group. We play near them and I listen for adult names. We play close enough that I can hear but not close enough to impinge on the group. When they start to clean up and take things to the cars, I am ready. I slip in and hold my hands out for a bowl. The adult looks at me. “Aunt Norma’s.” I say confidently, because I know which bowl belongs to each adult. And which bowl I want. The adult hands me the bowl. They can’t remember which kid I am, but I know Aunt Norma’s name….I head confidently with the bowl towards the cars and quickly slide it under my loose sweatshirt. I bypass the cars and head around to my sister.

Now the game changes a little. We have a couple bowls so she guards them. I work the next table alone and score a left over turkey.

The problem now is that we cannot carry it all to the car in one trip. I debate about safety. We are living in the car. I tell my sister to stay with the rest of the food and I leave her, carrying the turkey. It’s still light and there are still a lot of people around. She is sitting on the curb, bowls behind her, between two family groups. I will get the turkey to the car and then run back to her. The two of us can carry the rest of the food in one trip. Then we will have food for a while. She should be safe.

I wake up.

I took the photograph within the last month. What and where is it?

 

prayers for children

This is my daughter, five years ago, at Lake Matinenda in Ontario. I cried when I read about the baby thrown from the London fire.

Prayers for the children in the London fire and their parents and grandparents. Prayers for the refugee’s children, that they are not lost and drowned. Prayers for the Congresspeople shot yesterday and their families and friends.

Prayers for all the children in the world.

damage

This is not about one patient. It is about many. I have permission from the person I gave a copy to: one of many.

what do you say
to the person
with the terrible childhood
with addiction and chaos
and suicide attempts and hospitals
and that was the parents
that they ran away from

and then numbed themselves
in addiction for years
multidrug and chaos
and now stable
working their 12 steps

and grieving
their lost years
and their behavior
unforgiven, it takes time
to build trust after
thirty years of damage

and grieving
the next generation
following the same
path and feeling helpless
to stop them
and guilt for their
contribution

it is not a matter
of a pill
of a diagnosis

the simplicity of stopping
of getting clean
joy and pride
yes

and then the hard work
of grieving
begins

 

____________________________________________________________________________________________

I took the photograph at the Renwick Gallery.

bravery

There is more than one list of seven virtues. Courage, or bravery, goes back to Aristotle and Plato as one of the four cardinal virtues.

What is bravery to you? An extreme sport? A warrior?

My sister endured cancer treatment for 7 years, over 30 rounds of chemotherapy. She said, “People say I am brave, but they don’t understand. I don’t have a choice. It’s do the therapy or die.” It’s still brave, though, isn’t it.

The person who comes to my mind for bravery is a woman, a long time ago. She spoke Spanish and we had a translator. Her son had had rheumatic fever and they had gone to the pediatric cardiologist for the yearly visit. Her son had a damaged heart valve that was getting worse. He was somewhere between 9 and 12.

“The heart doctor says he needs surgery. He needs the valve replaced. But the heart doctor said he could die in surgery.” she said.

I read the notes and the heart ultrasound. “The heart valve is leaking more and more. If he doesn’t have the surgery it will damage his heart. He will be able to do less and less and then he will die. If he has the surgery, there is a small chance that he will die. But if he doesn’t, he will be able to grow and to run and to be active.”

She said, “I am so afraid.” But she returned to the pediatric cardiologist. And he got through the valve replacement surgery and did fine.

That is courage to me. The parents who take chances for their children: get into boats to escape war. Search for treatments. Fight for their home, their children, their loved ones. It is both men and women, mothers and fathers, grandmothers and grandfathers, and people who have no blood relation to a child that they reach out to help. Adoption, volunteering in schools, supporting a student, supporting an organization that helps children grow and thrive.

For the A to Z challenge….and last year.

 

 

 

 

Wall

This is for photrablogger’s Mundane Monday #94.

And bravo for this blog: https://safarfiertze.wordpress.com/2017/01/30/all-that-we-share/

and the Danes: https://youtu.be/jD8tjhVO1Tc  .

My paternal grandfather arrived as an immigrant from England. My father’s mother’s father was an immigrant from Scotland. My maternal uncle traces our family back to the Mayflower: immigrants.

Vital signs II

Pain is not a vital sign anymore, as I described in yesterday’s post. I wrote this poem in 2006, about pain  being the fifth vital sign. I disagreed.

Vital signs II

Pain
Is now a vital sign
On a scale of 1:10
What is your pain?
The nurses document
Every shift

Why isn’t joy
a vital sign?

In the hospital
we do see joy

and pain

I want feeling cared for
to be a vital sign

My initial thought
is that it isn’t
because we can’t treat it

But that isn’t true

I have been brainwashed

We can’t treat it
with drugs

We measure pain
and are told to treat it
helpful pamphlets
sponsored by the pharmaceutical companies
have articles
from experts

Pain is under treated
by primary care
in the hospital
and there are all
these helpful medicines

I find
in my practice
that much of the pain
I see
cannot be treated
with narcotics
and responds better
to my ear

To have someone
really listen
and be curious
and be present
when the person
speaks

If feeling cared for
were a vital sign
imagine

Some people
I think
have almost never felt cared for
in their lives

They might say
I feel cared for 2 on a scale of 10

And what could the nurses do?

No pills to fix the problem

But perhaps
if that question
were followed by another

Is there anything we can do
to make you feel more cared for?

I wonder
if asking the question
is all we need

first draft 5/20/06

I took the photograph Friday afternoon from the beach: two fronts were meeting. What is that like in the sky? Do they fight or welcome each other?