I had a a screening colonoscopy recently, which went very well.  The process for check in, the procedure, and the departure went smoothly.  It ought to.  This center does thousands a year.

The bill for everything was about $4000.  We know that screening colonoscopies catch early cancers and can be treated at the same time.  It is a great test.  It helped me 10 years ago.  Early colon cancer, as far as we know, is completely treatable, and this is one of the common cancers.  We cannot say that for sure about breast cancer, because it is entirely possible that many of the early cancers might stay that way.  But certainly screening mammography has some value.

Here we are, with an expensive test that clearly can save lives.  You can think of many others.  I had insurance.  If I didn’t, well…. I guess I take my chances and hope.  Many Americans do.

How do we as a country provide better medical care to our citizens?  It is clear that our care is suboptimal.  Nobody counts errors in care, which I tried to know more than a decade ago.  Nobody knows what percentage of people who need screening colonoscopies–those over 50 and those with a family history–get them.  And I am not even mentioning the other cancers and the other biochemical screening that we should do.

Of course, I don’t have time here to mention how we provide after illness care without bankrupting the country.  I just think we should do better than we do.  My detractors will probably say we have the best care in the world.  Perhaps, at some places, we do.  I would like to see good data.  But nobody can convince me we have the optimal care for people given costs and illness burden.  We do not.

And we will continue not to.  I saw what happened during the insurance reform debate.  It was called health care reform by the media, and it had nothing to do with care.  I bet my career on improving care and lost.  This was about insurance reform and little else.  We polarized the country, and those who have not treated as many dying patients as I have (including family members) had the gall and the audacity to call end of life planning, something only 30% of us have, “death panels”.  We polarized the country, in large part because those who had theirs cared not a whit for those who did not have care.  Many decried government’s role in health care, even as they were receiving Medicare or were in the military.  This is a fact.

What is the best answer?  I have my thoughts.  I want my detractors to come up with an answer, and I want it now.  I want it to be put to the House of Representatives and the Senate, and I want it enacted now.  If America can afford a trillion dollars for one war that was not necessary and another that is no longer necessary and cannot be won, then America can afford a trillion dollars for improving what we have now.  We can call it an “emergency authorization,” as Mr. Bush did, and keep it off the budget, so our finances don’t look so bad.  It worked for Mr. Bush, so it should work now.

I’ve offered my solutions to deal with waste and to improve the care we give.  I have been slammed for it.  So to my detractors, I ask, time to stop slamming me.  I have offered my solutions.  You offer yours.  No rhetorical questions, please.  Just tell me, how do we screen people for colon cancer in this country?  How do we screen for other issues?  How do we care for those who do not have 7 or 8 figure net worths and do not have the good fortune to have medical insurance?  How do we prevent things better, and how do we have efficient treatment for the most common medical conditions?  How do we allow people to die when it is time, and how do we deliver good care to those who bodies are failing but whose brains are fine?  How do we deliver good care to those whose brains have failed but whose bodies are fine?  How do we quit when we should, and how do we know we have done this appropriately?

I have offered my solutions to these problems for the past quarter century, without success.  I am now dealing with my own medical issues.  I want solutions, I want them clearly defined, I do not want personal attacks, which are cowardly, I just simply want the country to run better.  That to me is patriotism.  If the Republicans do it and take credit, good.  They should deserve it.  If the Democrats do, then also good.

We would do well to heed the comment by one who cut waste in government, and was called by one of the leading House Republicans as a patriot–Harry S Truman. Mr. Truman once said, “There is no limit to what a man can accomplish if he doesn’t care who gets the credit.”

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