Apparently, my kidneys are manufacturing stones like cheap Chinese toys. Last night, I found myself back in the ER with another stabbing pain. This is now what I look for in home sale ads: “Charming Victorian house in diverse neighborhood. Walking distance to emergency room. Must see!”
This time, I thought that a CT scan did make sense, but that wasn’t going to happen for several hours, because all of the CT staff was out sick. So, doped up on morphine, I walked home in the sticky dawn. I then took advantage of my pain-free state to sleep for several hours, but now I’m awake and uncomfortable. Hence, this post.
I’m now in favor of some kind of “cap and trade” program for kidney stones. I’m also in favor of major changes to the health care system. Today’s lesson is that the pieces don’t move especially well together. ER docs, my doc on call, the urologist I’m supposed to see next week — my experience suggests that they won’t check each other’s notes thoroughly enough (if at all), and that there are lost efficiencies all over the place.
But don’t take my word for it: Here’s what some academic physicians had to say about the cost issue in a recent op-ed piece in the NY Times. Their many useful suggestions include reconsidering the “fee for service” model, which encourages overutilization of procedures. In a given year, for example, the number of CT scans done exceeds .2 per capita (62 million for 300 million people).
In a recent interview on NPR’s Fresh Air, Lisa Sanders, who writes the fascinating (to me and other worry warts) “Diagnosis” column for the Times, picked up on related point with her pithy insight that doctors are reimbursed for “doing” — not for “thinking.” One morning, she explained, she had some twelve patients, who represented the mine run of what internists encounter on a typical day: colds; bronchitis; flu symptoms; pain. Her final patient needed an ingrown toenail removed. Doing that brought Dr. Sanders more reimbursement from the insurance companies than everything else she’d done all morning, combined. Fee for service combined with heavy compensation for procedures, rather than diagnosis, may explain a good part of our current mess.
You may have heard that the evident need for some kind of health care reform hasn’t exactly resulted in universal acclaim for President Obama’s initiative. To an extent, the responsibility rests with the White House for failing to engage and to make clear exactly what’s being proposed, what would happen as a result, and so on.
Obama’s Town Hall Meetings have been a belated corrective to the more vitriolic incarnations of the format that have caught many people, including me, by surprise. Listen in and you’ll hear comments that are only sometimes about health care itself. In this story, one woman complains broadly and emotionally about the death of American exceptionalism. It seems to me that Kai Wright, senior writer for the Root who was interviewed for the story, is exactly right in saying that health care has provided a convenient flash point for broader anger and anxiety: “What is my place in a vastly changing culture and a vastly changing economy?” is the question he suggests underlies whatever is actually spoken.
Wright also blames right-wing flame-fanners — especially Glenn Beck — for provoking this anger. In the chain of distribution, Beck is the wholesaler, and people like John Stahl, President of the Berks County, PA Tea Party Patriots, are the distributors who work on the local level. Reading about Stahl’s criticisms of “Obamacare” at Arlen Specter’s noisy town hall meeting, I did the only sensible thing: I called the guy. (His phone number is on his organization’s website.)
Stahl, who’s about to turn 65, doesn’t plan to turn down Medicare. This would be an easy but unfair ground for calling him on hypocrisy; as he pointed out, Medicare is a contract on which people (presumably including “John Stahl”) have relied upon. But it’s broke, he says, and so is the whole system. He doesn’t exempt insurance companies from blame for what he acknowledges is a problem with our health care system but puts the lion’s share of blame on lawyers and med mal suits, illegal aliens (and legal ones, too!) using the system, and the insufficient number of doc being graduated from medical school.
A staunch libertarian (but one who critizes Obama and his staff for being “ideologues”), Stahl favors the free market solution (which I’m convinced won’t work in the case of health care insurance), opposes any kind of “counseling” of people about their legal options regarding end of life care (not the role of government, he says), and even put on a retro, Steve Forbes wig to call for the “flat tax, ” an idea that no one will ever be able to drive a stake through. The flat tax should fix the problem, he says, along with an unspecified dose of tort and immigration “reform.”
Stahl’s positions aren’t radical, and he stressed the need for civility in debate. But his idea of civility is broad enough to include even Claire McCaskill’s notorious Town Hall Meeting, which he defended. See what you think:
At the risk of engaging in amateur social psychology, Stahl seems to me very much to fit within Wright’s questioning classes. Laid off from his job in his mid-sixties, a conservative Christian seeing his world changing at a vertiginous pace, Wright has seized on an issue in which he’d seem to have little personal stake, using it as a prism through which his deeper concerns can be reflected. Obama is “not a good person.” He’s “not to be trusted,” based on his “background.” He and his ideologues are using the public option as a kind of Trojan horse, to get to their ultimate goal of complete government takeover of health care.
Is this code for a kind of racism? That’s much too simple, because Obama’s race may itself be a surrogate, for some, for what’s making them uncomfortable with change, more broadly. The world is caving in on John Stahl, and it’s not fair.